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Toward a comprehensive long term nicotine policy
  1. N Gray1,
  2. J E Henningfield5,
  3. N L Benowitz2,
  4. G N Connolly3,
  5. C Dresler1,
  6. K Fagerstrom4,
  7. M J Jarvis6,
  8. P Boyle1
  1. 1International Agency for Research on Cancer, Lyon, France
  2. 2Department of Medicine, Psychiatry and Biopharmaceutical Sciences, University of California San Francisco, San Francisco, California, USA
  3. 3Harvard School of Public Health, Boston, Massachusetts, USA
  4. 4Helsingborg, Sweden
  5. 5Johns Hopkins University School of Medicine, Baltimore, and Pinney Associates, Inc, Bethesda, Maryland, USA
  6. 6University College London, London, UK
  1. Correspondence to:
 Dr Nigel Gray
 International Agency for Research on cancer, 150 Cours Albert Thomas, 69372 Lyon cedex 08, France; nigeluicc.org

Abstract

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.

  • 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
  • cigarette
  • clean nicotine
  • nicotine
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Footnotes

  • Competing interest statement: Boyle, Connolly, Gray, Jarvis. No competing interests. Dr Benowitz has consulted for several pharmaceutical companies that market smoking cessation medications. He has received research grant support in the past from GlaxoSmithKline Consumer Healthcare. Dr Benowitz has been a paid expert witness in litigation against tobacco companies. Karl Olav Fagerstrom: “I have consulted for most companies with an interest in smoking cessation medicines. I also owe a minority of shares in a company with an interest in developing nicotine replacement medications.” Carolyn Dresler was the Medical Director for Research and Development for GlaxoSmithKline Consumer Healthcare working on nicotine replacement therapy products for five years before joining the International Agency for Research on Cancer. Jack Henningfield provides consulting services regarding treatments for tobacco dependence to GlaxoSmithKline Consumer Health Care through Pinney Associates. JEH has a financial interest in a nicotine replacement product under development, and serves as an expert witness in litigation against the tobacco industry by the US Department of Justice and other plaintiffs.

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