It’s not uncommon when our program is tabling at community events for people to stop by and leaf through the cessation materials we have on offer. Occasionally it’s someone wanting to encourage a friend or family member to quit smoking. Usually it’s a middle-aged smoker who has tried to give up cigarettes many times without lasting success, still looking for a formula or method that will work. Most have sought help from their doctor, used nicotine replacement patches or gum, tried Chantix, called the Quitline for support; some have even been hypnotized. For these people and many like them, the power of nicotine addiction has been impossible to overcome.
This is where the concept of harm reduction comes in. Fifteen years of research has shown that when nicotine levels are reduced by 95% cigarettes are minimally or non- addictive, while the smoker still gets a sense of satisfaction. The result is that tobacco dependence is decreased, users smoke less, and cravings and withdrawal symptoms are reduced. This encourages smokers to make more quit attempts and makes it more likely that efforts to quit will be successful.
Based on this body of research, two years ago the FDA authorized 22nd Century Group (a Buffalo-based company) to market its proprietary low-nicotine cigarettes as modified-risk tobacco products. The brand is called VLN, available in regular or menthol, and will be marketed in 18 states by the end of the year. Conventional cigarettes contain 10-14 milligrams of nicotine; VNL contains 0.2-0.7 milligrams. A pack contains about the same amount of nicotine as one Marlboro.
Skeptics assert that smokers will just smoke more or take deeper drags, but in its scientific review the FDA found strong evidence that this is not the case. In fact, users of low-nicotine cigarettes tend to smoke fewer per day and don’t inhale more intensely. In addition, youth or other first-time users are unlikely to develop nicotine dependence.
A harm reduction option may have the greatest potential impact on populations where smoking rates are high and cessation may feel hopeless. These include adults with substance abuse disorder, mental health conditions, or socioeconomic disadvantages. At our tabling events, a number of people have told us that they have given up alcohol and other drugs, sometimes even cocaine or heroin, but still smoke. “I worry about my health,” they all say, “but I just can’t ever seem to stop no matter how much I try.” Research shows that for people in these vulnerable groups using low-nicotine cigarettes not only helps reduce smoking but does not increase other substance use or cause mood changes, two prospects that make some smokers so anxious they won’t even try to quit.
It’s important to note that low-nicotine cigarettes, as combustible tobacco products, are not safer in terms of cancer risks or lung health. The same toxins that make conventional cigarettes so dangerous exist in the low-nicotine version too. In this case, harm reduction refers to the potential they hold for helping smokers free their bodies and minds from nicotine addiction, especially when other methods have failed, and to prevent it in the first place.
The FDA believes that low-nicotine cigarettes could be a game-changer for public health and in June announced plans to develop a product standard that would set a maximum nicotine level for all cigarettes and some other tobacco products. In other words, all cigarette brands would become low-nicotine. The agency projects that by the year 2100 a low-nicotine standard would result in 33 million people not becoming regular smokers and an adult smoking rate of 1.4% (nationally it’s about 12% right now.)
It’s safe to say that we are years, or maybe decades, away from a low-nicotine standard becoming reality because the tobacco companies will fight it tooth and nail. But starting in a few months smokers will have the option of switching to VLN. For some, it may turn out to be a lifesaver.
The Healthcare Consortium is a local charitable organization with a mission of improving access to healthcare and supporting the health and well-being of the residents in our rural community. The agency is located at 325 Columbia St. in Hudson. For more information: visit www.columbiahealthnet.org or call 518-822-8820.
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