Reducing the addictiveness of cigarettes

Objective-To assess the feasibility of reducing tobacco-caused disease by g radually removing nicotine from cigarettes until they would not be effectiv e causes of nicotine addiction. Data sources-Issues posed by such an approach, and potential solutions, wer e identified from analysis of literature published by the US Food and Drug Administration (FDA) in its 1996 Tobacco Rule, comments of the tobacco indu stry and other institutions and individuals on the rule, review of the refe rence lists of relevant journal articles, other government publications, an d presentations made at scientific conferences. Data synthesis-The role of nicotine in causing and sustaining tobacco use w as evaluated to project the impact of a nicotine reduction strategy on init iation and maintenance of, and relapse to, tobacco use. A range of potentia l concerns and barriers was addressed, including the technical feasibility of reducing cigarette nicotine content to non-addictive levels, the possibi lity that compensatory smoking would reduce potential health benefits, and whether such an approach would foster illicit ("black market") tobacco sale s. 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 prom ise in preventing adolescent tobacco addiction and assisting the millions o f 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 alternat e 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 acc ompanied by relevant research and increased efforts to educate consumers an d health professionals about tobacco and health. Conclusions-The council recommends the following: (a) that cessation of tob acco use should be the goal for all tobacco users; (b) that the American Me dical Association continue to support FDA authority over tobacco products, and FDA classification of nicotine as a drug and tobacco products as drug-d elivery devices; (c) that research be encouraged on cigarette modifications that may result in less addicting cigarettes; (d) that the FDA require tha t the addictiveness of cigarettes be reduced within 5-10 years; (e) expande d surveillance to monitor trends in the use of tobacco products and other n icotine-containing products; (f) expanded access to smoking cessation treat ment, and strengthening of the treatment infrastructure; and (g) more accur ate labelling of tobacco products, including a more meaningful and understa ndable indication of nicotine content.