In the US, they want to drastically cut the level of nicotine in cigarettes: some brands will have to cut it by 90%

The Biden administration wants to introduce a new rule that would require tobacco companies to reduce the level of nicotine in cigarettes sold in the US to a minimum or non-addictive level, reports FoxNews.

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These efforts are expected to be announced as part of the administration's biennial "unified agenda".
This proposal, which could take years to implement, would place the United States at the forefront of global anti-smoking efforts. Only one other country, New Zealand, has put forward such a plan, reports NewYorkTimes.

The experts explained that it could take at least a year for the Food and Drug Administration (FDA) to release the proposed rule.

At a June 21 press briefing, White House press secretary Karine Jean-Pierre said she would not comment on any leak and that "no policy decisions have been made at this time."

The initiative would be in line with White House policy; President Biden promised to halve cancer deaths in a quarter of a decade.

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The American Cancer Society shows that tobacco use remains the leading preventable cause of death in the US, accounting for about 1 in 5 deaths each year.

Nearly 2019 Americans died from cancer in 600, according to the Centers for Disease Control and Prevention (CDC).

In a 2018 notice, the FDA stated that reducing nicotine levels to minimal or non-addictive levels "may give addicted users the choice and the ability to quit smoking more easily, and may also help prevent experimenters (mostly youth) from starting regular use and becoming regular smokers.

The move was criticized by some, including the Post, calling it a cigarette ban.

Tobacco products are addictive because they contain nicotine, a chemical compound found in the tobacco plant. The FDA notes that while nicotine drives people to use these products, it is "thousands of chemicals found in tobacco and tobacco smoke that make tobacco use so deadly." Tobacco products coat the lungs in tar, release 7000 chemicals, and lead to cancer, heart disease, and lung disease.

In a statement posted on its website, Dr. Robert M. Califf, FDA Commissioner, said: “Reducing nicotine levels to minimally addictive or non-addictive levels will reduce the likelihood that future generations of young people will become addicted to cigarettes. and help smokers who are currently addicted to stop smoking.”

Nicotine is also available in e-cigarettes, chewing gum, patches and lozenges, but these products will not be affected by the new initiative.

“This single rule may have the biggest impact on public health in the history of healthcare,” said Mitch Zeller, recently retired director of the FDA Tobacco Center.

“This is the magnitude we're talking about here because tobacco use remains a leading cause of preventable disease and death,” he said.

About 1300 people die prematurely each day from smoking-related causes, according to the Centers for Disease Control and Prevention.

Not everything is so easy

However, the obstacles to such a plan are formidable and could take years to overcome. Some plans that have been made public call for a 95 percent reduction in the amount of nicotine in cigarettes. Experts say US smokers, approximately 30 million people, could find themselves in a nicotine withdrawal state that includes agitation, difficulty concentrating and irritability, and this will send them looking for alternatives like e-cigarettes. They deliver nicotine without most of the chemicals found in combustible cigarettes.

Experts say determined smokers may try to buy high-nicotine cigarettes purchased from illegal markets or overseas in Mexico and Canada.

The FDA will likely have to overcome resistance from the tobacco industry, which has already begun to provide reasons why the agency cannot turn the $80 billion market. Legal issues can take years to resolve, and the agency can give the industry five or more years to make changes.

Tobacco companies have already indicated that any plan to significantly cut nicotine would break the law. And some conservative lawmakers might see such policies as yet another example of an abuse of power, a weapon that could spill over into the midterms.

Other major tobacco initiatives, outlined in the landmark Tobacco Control Act of 2009, have been slow to take shape. The lawsuit set aside the requirement for tobacco companies to display pictorial warnings on cigarette packs. And the agency recently said it would take another year to make key decisions about which e-cigarettes could stay on the market.

A statement from tobacco company Altria, maker of Marlboro, gave a preview of the arguments opponents are expected to make against any rule that sharply reduces nicotine levels. “The focus should be less on taking products away from adult smokers and more on providing them with a reliable market for FDA-approved, reduced-harm, smoke-free products,” the company said in a June 21 statement. “This is the beginning of a long-term process that must be scientifically sound and take into account potentially serious unintended consequences.”

RAI Services, the parent company of RJ Reynolds, declined to comment on the announcement, but said, "We believe tobacco harm reduction is the best way to reduce the health impact of smoking."

Five years ago, Dr. Scott Gottlieb, then agency commissioner, unveiled a plan to reduce nicotine levels in cigarettes to minimal or non-addictive levels. The proposal took shape in 2017 but did not result in a formal rule under the Trump administration.

Retailers, wholesalers and tobacco companies objected to the proposal's 8000 comments. The Florida Wholesale Distribution Association trade group said this could lead to "new demand for black market goods and an increase in human trafficking, crime and other illegal activities."

In 2018, RAI Services reported that the FDA had no evidence that a plan to cut nicotine levels would improve public health. The agency "will need to give tobacco manufacturers decades to comply" and figure out how to grow low-nicotine tobacco, RAI said in a letter to the FDA.

Low nicotine cigarettes

Low-nicotine cigarettes are already available to consumers, albeit in limited quantities. This spring, New York-based biotech company 22nd Century Group began selling reduced-nicotine cigarettes that took 15 years and tens of millions of dollars to develop by genetically manipulating the tobacco plant. According to James Misch, the company's chief executive, the company's brand, VLN, contains 5% nicotine in regular cigarettes.

“It’s not some distant technology,” he said.

In order to earn the designation as a "reduced risk" tobacco product, VLN has been subjected to many tests and clinical trials by regulatory authorities.

The company is currently selling VLNs at Circle K convenience stores in Chicago as part of a pilot program. Mish called sales "modest" - retail prices are similar to premium brands like Marlboro Gold - but he said the new offering would likely speed up plans for a national rollout in the coming months.

Dr. Neil Benowitz, a professor of medicine at the University of California at San Francisco who studies tobacco use and smoking cessation, first proposed the idea of ​​removing nicotine from cigarettes in 1994.

He said one of the main concerns was whether smokers would inhale harder, hold their smoke longer, or smoke more cigarettes to compensate for lower nicotine levels.

Dorothy K. Hatsukami, professor of psychiatry at the University of Minnesota who studies the relationship between nicotine and smoking, says growing evidence suggests that rapidly and significantly reducing the nicotine content of cigarettes will provide greater public health benefits than the gradual approach that has been promoted some scientists.

A 2018 study led by Dr. Hatsukami that looked at the habits of 1250 smokers found that participants randomly assigned to ultra-low nicotine cigarettes smoked less and showed fewer signs of dependence than those given nicotine-level cigarettes. which gradually declined over a course of 20 weeks.

However, reducing nicotine in one fell swoop also had drawbacks: participants dropped out of the study more often than in the gradualist group, and they experienced more intense nicotine withdrawal. Some have secretly turned to their regular full nicotine brands.

“The bottom line is that we have known for decades that nicotine is what makes cigarettes so addictive, so if you reduce the amount of nicotine you make the smoking experience less satisfying and increase the likelihood that people will try to quit.” she said.

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Alex Lieber, Associate Professor of Oncology at Georgetown University School of Medicine who studies tobacco control policy, studied Poland's experience with the 2020 menthol cigarette ban.

According to Lieber, a study he and others wrote showed that the ban did not reduce overall cigarette sales, likely because tobacco companies lowered the price of cigarettes and also started selling flavor cards that smokers can put in a pack. cigarettes to bring back the flavor. Some experts say that any move to sell flavor cards in the US is likely to be illegal.

“They know how to sell and make money, and they will make more and more as long as they have room to maneuver,” he said. “I just don’t expect them to do anything less.”

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