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OBJECTIVE
To assess the feasibility
of reducing tobacco-caused disease by gradually removing nicotine from
cigarettes until they would not be effective causes of nicotine addiction.
DATA SOURCESIssues posed by such an
approach, and potential solutions, were identified from analysis of
literature published by the US Food and Drug Administration (FDA) in
its 1996 Tobacco Rule, comments of the tobacco industry and other
institutions and individuals on the rule, review of the reference lists
of relevant journal articles, other government publications, and
presentations made at scientific conferences.
DATA SYNTHESISThe role of nicotine
in causing and sustaining tobacco use was evaluated to project the
impact of a nicotine reduction strategy on initiation and maintenance
of, and relapse to, tobacco use. A range of potential concerns and
barriers was addressed, including the technical feasibility of reducing
cigarette nicotine content to non-addictive levels, the possibility
that compensatory smoking would reduce potential health benefits, and
whether such an approach would foster illicit ("black market")
tobacco sales. Education, treatment, and research needs to enable a
nicotine reduction strategy were also addressed. The Council on
Scientific Affairs came to the following conclusions: (a) gradually
eliminating nicotine from cigarettes is technically feasible; (b) a
nicotine reduction strategy holds great promise in preventing
adolescent tobacco addiction and assisting the millions of current
cigarette smokers in their efforts to quit using tobacco products; (c)
potential problems such as compensatory over-smoking of denicotinised
cigarettes and black market sales could be minimised by providing
alternate forms of nicotine delivery with less or little risk to
health, as part of expanded access to treatment; and (d) such a
strategy would need to be accompanied by relevant research and
increased efforts to educate consumers and health professionals about
tobacco and health.
CONCLUSIONSThe council recommends
the following: (a) that cessation of tobacco use should be the goal for
all tobacco users; (b) that the American Medical Association continue
to support FDA authority over tobacco products, and FDA classification
of nicotine as a drug and tobacco products as drug-delivery devices;
(c) that research be encouraged on cigarette modifications that may
result in less addicting cigarettes; (d) that the FDA require that the
addictiveness of cigarettes be reduced within 5-10 years; (e) expanded
surveillance to monitor trends in the use of tobacco products and other
nicotine-containing products; (f) expanded access to smoking cessation
treatment, and strengthening of the treatment infrastructure; and (g)
more accurate labelling of tobacco products, including a more
meaningful and understandable indication of nicotine content.
Relevant Articles
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L. JOOSSENS, A. HAYES;, J. E HENNINGFIELD, and J. SLADE Eliminating the nicotine in cigarettes Tob. Control, June 1, 1999; 8(2): 223 - 224. [Full Text]
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R. M DAVIS Tobacco Control: reflections on the first seven years Tob. Control, March 1, 1999; 8(1): 1 - 9. [Full Text]
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