Comprehensive Nicotine Regulation to End the Combustible Tobacco Epidemic
Cigarette smoking, the leading cause of preventable disease and death in the United States, is sustained by nicotine addiction. Most of the harm from smoking derives from products of combustion, with nicotine playing a minor role in causing direct harm. In 1994, the U.S. Food and Drug Administration (FDA) declared that nicotine in cigarettes was a drug—because use is intended to affect the structure and function of the body—and announced its intention to consider regulating cigarettes.
At that time, it was recognized that most smokers begin to smoke as children or adolescents. Young persons experiment with cigarettes in a social context and become addicted to nicotine over time. Most youth know that smoking is bad for health and may intend to smoke for only a few years. But they underestimate the risk for addiction, and many who experiment become addicted smokers as adults (1). After the FDA announcement in 1994, with a primary goal of preventing youth addiction to cigarette smoking, Jack Henningfield and I proposed that the nicotine content of tobacco be reduced to nonaddictive levels (2). In addition to preventing youth addiction, nicotine reduction would reduce the level of dependence of adult smokers who were already addicted, making it easier to quit. Alternatively, for those who were unable to stop nicotine use, other, cleaner sources, such as medications, could be made easily available to replace the nicotine from cigarettes. Clean nicotine can help manage withdrawal symptoms, provide smokers with an acceptable alternative to cigarettes, and make it clear that nicotine reduction in tobacco is not nicotine prohibition.
