healthHealth and Medicine

FDA Plan To Dramatically Reduce Cigarette Nicotine Levels Could Save 8.5 Million Lives


Robin Andrews

Science & Policy Writer

This proposal could lead to revolutionary health benefits. phildaint/Shutterstock

With 1,300 deaths per day in the US alone from the effects of cigarette smoking, it’s like having a 9/11 terror attack every 2.2 days. So what’s a nation to do? Well, as announced by the Food and Drug Administration (FDA), a potential solution may be to dramatically reduce the amount of addiction-driving nicotine in cigarettes, thereby hitting the habit’s Achilles’ heel.

Referring to tackling tobacco use – particularly cigarette smoking – as one of the most important actions he could take to advance public health, FDA Commissioner Scott Gottlieb has announced that the proposal would reduce nicotine levels in combustible cigarettes to “minimally or non-addictive levels”.


This represents a rather revolutionary step. Although restrictions on how tobacco products are sold are in place in countries all over the world, Vox notes that America might become the first country in the world to force tobacco companies to dial down the addictive potential of the products themselves.

According to Dr Gottlieb, this represents a “pivotal step… that could ultimately bring us closer to our vision of a world where combustible cigarettes would no longer create or sustain addiction.”

An accompanying analysis in the New England Journal of Medicine outlines one such version of the proposal. Creating a complex model to assess the effects on public health of creating such minimally addictive cigarettes, a multidisciplinary team estimated that there would be roughly 8.5 million fewer tobacco-caused deaths by 2100.

At the same time, within a year of the implementation of this policy, 5 million additional smokers would quit their habit. Extend this to 2100, and 33 million people – particularly young adults, where the addition most frequently takes hold – would have been prevented from becoming regular smokers.


A concern some have raised is the prospect of smokers simply upping their consumption of cigarettes to get their nicotine fix, but the paper addressed that.

“The policy would mandate an absolute reduction in nicotine to levels so low that there would not be enough nicotine available in cigarette tobacco for smokers to sustain addiction,” something they note is backed up by multiple studies. Incidentally, it appears that both gradual and immediate reductions in nicotine levels work at cutting down smoking levels.

The paper also points out that smokers may try to maintain their nicotine dependence by seeking out “illicit cigarettes”, hinting at the creation of a black market. At this point, there’s not really enough evidence to say either way if such a market would emerge, but in any case, the public health benefit of the policy arguably overwhelms other less predictable concerns.

It’s fair to say that, despite eschewing stronger anti-smoking public health campaigns more than other nations, the number of cigarette smokers in the US has declined precipitously over the last century. As noted by the Washington Post, in 1965, 42.4 percent of American adults smoked; that has since fallen to 16.8 percent in 2014.


Smoking, however, remains a scourge. According to the Centers for Disease Control and Prevention (CDC), right now, more than 16 million Americans are living with an affliction caused by smoking. Each year, 480,000 American cigarette smokers die of related illnesses, and an additional 41,000 perish from second-hand smoke exposure.

Such a policy proposal, then – which remains a proposal, not anything enforceable at this stage – would have undeniable, game-changing health benefits for both smokers and non-smokers. Smoking also costs the US around $300 billion in health costs and faltering productivity each year, so it’d be a huge economic boon too.

Only time will tell if the new policy works, and it’ll certainly face strong resistance from the tobacco industry before it becomes legally enforceable.


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