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 The cigarettes tested were not the "low-nicotine" or "light"
products that have been on the market for decades. Those brands used
tobacco with regular nicotine levels and a vent system that tries to
make it harder for a smoker to inhale the powerfully-addictive
substance.
After their introduction, studies showed that smokers quickly
learned how to manipulate them to inhale enough nicotine anyway.
"Smokers got around it by inhaling more deeply and more often.
That's been the accepted truism," said Dr. Norman Edelman, senior
scientific advisor for the American Lung Association, who was not
involved in the research. "Now here comes this very well done study
and it shows that if you simply reduce the nicotine in the tobacco,
that doesn't seem to happen. Smokers don't seem to increase their
consumption of cigarettes because they're getting less nicotine."
"These cigarettes don't have much nicotine in the tobacco itself, so
no matter what the user does, it's just not there to extract," chief
study author Eric Donny of the University of Pittsburgh told Reuters
Health.
"This is a very different approach, and this one might make smokers
less dependent on cigarettes and better able to quit," he said.
In their study, published in The New England Journal of Medicine,
Donny and his colleagues found that an 85 percent to 97 percent
reduction in nicotine produced a 23 percent reduction in the number
of cigarettes smoked.
And participants who spent six weeks smoking the cigarettes with the
lowest nicotine content were twice as likely to report trying to
quit smoking within 30 days after the end of the study.
The experiment was done on 840 smokers who told the investigators
when they signed up that they had no interest in quitting. They were
paid up to $835 for their participation. The researchers used
questionnaires to measure smoking dependence, nicotine withdrawal,
depression and craving.
The study, the largest ever done on reduced-nicotine cigarettes, was
designed to give the U.S. Food and Drug Administration a scientific
basis for cutting back on the addictive chemical in tobacco
products.
"We believe these data support exploration of a national
nicotine-reduction policy, and we recommend that additional
attention be paid to low-nicotine cigarettes as a potential clinical
smoking-cessation resource," Drs. Michael Fiore and Timothy Baker of
the University of Wisconsin School of Medicine and Public Health
write in a Journal commentary.
Edelman, however, said he doubts the new findings will be enough to
impose regulations.
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"Whether you can leap from this to a new policy is kind of
problematic," he said. "The study was only six weeks. In the smoking
cessation business, we don't even look at a six week study. Six
months or a year is the real test of whether an intervention is
effective or not."
All the volunteers were smoking at least five cigarettes per day.
They were told to smoke their regular brand or experimental
cigarettes - all provided free of charge - with one of six different
levels of nicotine. At the end of the six-week test study, they were
asked to abstain for at least 18 hours so their craving and
withdrawal symptoms could be measured.
Cigarettes typically have about 15.8 milligrams of nicotine per gram
of tobacco. When nicotine levels were reduced to as low as 5.2 mg,
the researchers saw no significant change in smoking behavior.
But when the nicotine levels dropped to 2.4 mg or lower, the number
of cigarettes smoked showed a modest decline. Smokers went from 21.3
cigarettes per week with 15.8 mg of nicotine to 16.5 cigarettes per
week with 2.4 mg of nicotine.
The same effect was seen when the nicotine level was dropped even
lower, to 0.4 mg, a level believed to be too low to be addicting.
People on the low-nicotine cigarettes also reported less craving and
less dependence.
Thirty days after the end of the study, about 35 percent of the
volunteers who had been smoking the low-nicotine cigarettes had
tried to quit versus 17 percent of those consuming regular-strength
cigarettes.
"Whether cigarettes have lots of nicotine or a little bit of
nicotine, they're still unsafe," Edelman said. "The best way of
protecting your health is to quit."
SOURCE: http://bit.ly/1rzGOHe New England Journal of Medicine,
online September 30, 2015.
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