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Toward a comprehensive long term nicotine policy

¹ International Agency for Research on Cancer, Lyon, France
² Department of Medicine, Psychiatry and Biopharmaceutical Sciences, University of California San Francisco, San Francisco, California, USA
³ Harvard School of Public Health, Boston, Massachusetts, USA
⁴ Helsingborg, Sweden
⁵ Johns Hopkins University School of Medicine, Baltimore, and Pinney Associates, Inc, Bethesda, Maryland, USA
⁶ University College London, London, UK

Correspondence to:
Dr Nigel Gray
International Agency for Research on cancer, 150 Cours Albert Thomas, 69372 Lyon cedex 08, France; nigel{at}uicc.org

Global tobacco deaths are high and rising. Tobacco use is primarily driven by nicotine addiction. Overall tobacco control policy is relatively well agreed upon but a long term nicotine policy has been less well considered and requires further debate. Reaching consensus is important because a nicotine policy is integral to the target of reducing tobacco caused disease, and the contentious issues need to be resolved before the necessary political changes can be sought. A long term and comprehensive nicotine policy is proposed here. It envisages both reducing the attractiveness and addictiveness of existing tobacco based nicotine delivery systems as well as providing alternative sources of acceptable clean nicotine as competition for tobacco. Clean nicotine is defined as nicotine free enough of tobacco toxicants to pass regulatory approval. A three phase policy is proposed. The initial phase requires regulatory capture of cigarette and smoke constituents liberalising the market for clean nicotine; regulating all nicotine sources from the same agency; and research into nicotine absorption and the role of tobacco additives in this process. The second phase anticipates clean nicotine overtaking tobacco as the primary source of the drug (facilitated by use of regulatory and taxation measures); simplification of tobacco products by limitation of additives which make tobacco attractive and easier to smoke (but tobacco would still be able to provide a satisfying dose of nicotine). The third phase includes a progressive reduction in the nicotine content of cigarettes, with clean nicotine freely available to take the place of tobacco as society’s main nicotine source.

Abbreviations: FCTC, Framework Convention on Tobacco Control; FTND, Fagerstrom test for nicotine dependence; NDSS, nicotine dependence syndrome scale; NRT, nicotine replacement therapy; PREP, potential reduced exposure product; SACTob, Scientific Advisory Committee on Tobacco Product Regulation; TCM, tobacco control community

Keywords: cigarette; clean nicotine; nicotine

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