Large reductions in nicotine content could dramatically reduce reinforcement from and dependence on cigarettes. In this article, we summarise the potential benefits of reducing nicotine in combusted tobacco and address some of the common concerns. We focus specifically on New Zealand because it may be ideally situated to implement such a policy. The available data suggest that, in current smokers, very low nicotine content (VLNC) cigarettes decrease nicotine exposure, decrease cigarette dependence, reduce the number of cigarettes smoked per day and increase the likelihood of contemplating, making and succeeding at a quit attempt. New smokers would almost certainly be exposed to far less nicotine as a result of smoking VLNC cigarettes and, consequently, would probably be less likely to become chronic, dependent, smokers. Many of the concerns about reducing nicotine including compensatory smoking, an exacerbation of psychiatric symptoms, the perception that VLNC cigarettes are less harmful, and the potential for a black market are either not supported by the available data, likely mitigated by other factors including the availability of nicotine-containing e-cigarettes, or unlikely to offset the potential benefit to public health. Although not all concerns have been addressed or can be a priori, the magnitude of the potential benefits and the growing evidence of relatively few potential harms should make nicotine reduction one of the centrepieces for discussion of how to rapidly advance tobacco control. Policies that aim to render the most toxic tobacco products less addictive could help New Zealand attain their goal of becoming smokefree by 2025.
- End game
- Harm Reduction
- Public policy
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Disclaimer All authors have previously undertaken clinical trials that involved the use of reduced nicotine content cigarettes. Some of the cigarettes used in these trials were purchased from companies (Vector Group, 22nd Century). The companies concerned had no role in development of the study design, data collection, data analysis, data interpretation or writing of the trial publications. The content is solely the responsibility of the authors and does not necessarily represent the official views of the US Institutes of Health or the Food and Drug Administration or the New Zealand Ministry of Health.
Contributors ECD conceived the paper, wrote the initial draft, incorporated feedback from the coauthors and took responsibility for finalising the accepted manuscript. NW, DH and CB helped shape the ideas, provided substantive feedback on earlier drafts and approved of the final version.
Funding Contributions from all authors were supported by their respective institutions.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.