FEB/MAR 2007
Volume 13 - No. 1
SRNT Newsletter
February/March 2007, Volume 13, Number 1
Increased Cigarette Nicotine Delivery:
Health & Policy Implications
The Massachusetts Department of Health report that the machine measured nicotine yield of cigarettes increased an average of 10% from 1998 to 2004 raises issues of concern for health, medical practice, and policy1. Although machine-measured yields do not necessarily reflect actual nicotine exposure in smokers, if the data are accurate, they are another example of the manipulation of nicotine by the tobacco manufacturers described by Judge Kessler in the Department of Justice trial2, and they raise new questions concerning cigarette safety and regulatory needs. We offer the following observations to assist health professionals in advising patients and considering policy implications.
Increased nicotine yield of cigarettes could be beneficial if it changed the pattern of smoking to drive intake of toxic smoke constituents down, as suggested by the pioneering tobacco addiction researcher Michael Russell who wrote "People smoke for nicotine but die from the tar3." Unfortunately, numerous studies indicate that nicotine supplementation in this range (a few tenths of a milligram per cigarette or the equivalent of 1-3 cigarettes per day) would not likely substantially reduce smoke intake4.
Increased nicotine yield would be bad if it discouraged cessation or facilitated initiation, and there is an empirical foundation for the conclusion that increased nicotine delivery may contribute to these effects. Animal and human data for a broad range of drugs indicate that, if maintenance of addictive drug dosing becomes too difficult (by restrictions of access or increased cost), then extinction of the behavior will occur (in common vernacular "it is no longer worth the hassle5." To the extent that cigarette designs make addictive levels of nicotine delivery easier to achieve, such designs may ease the path to addiction for youth, and enable smokers to sustain their addiction as smoking restrictions and increased price drive their cigarettes per day down. To sustain addiction, cigarette smokers do adjust their smoking to compensate for lower nicotine yields or fewer opportunities to smoke, however, per cigarette compensation is not 100%. Increasing the availability of nicotine in cigarette tobacco means that cigarettes do not need to be smoked as intensively and/or fewer cigarettes can be smoked to achieve the same daily level of nicotine intake as when more cigarettes could be smoked. Therefore, the increased nicotine levels demonstrated in the Massachusetts report could undermine the health of America by delaying cessation and possibly facilitating development of addiction.
Acknowledgements:
All three authors have testified against the tobacco industry on tobacco design and ingredient delivery issues, including in the U.S. Department of Justice trial referenced in the letter, and all have provided consultative support to pharmaceutical developers of tobacco dependence treatment products. The Robert Wood Johnson Foundation Innovators Awards Program at The Johns Hopkins University School of Medicine and Pinney Associates provided administrative support for the development of this letter.
References
1. Massachusetts Department of Public Health. Change in Nicotine Yields 1998-2004, 2006. Accessed 5 September, 2006 at http://www.mass.gov/dph/mtcp/reports/nicotine_yields_1998_2004_report.pdf .
2. U.S. District Court for the District of Columbia. United States of America, Plaintiff, versus. Philip Morris, USA, Inc., et al., defendants. Civil Action No. 99-2496 (GK). Final Opinion. Accessed 5 September, 2006 at http://coop.dcd.uscourts.gov/99-2496-082006a.pdf .
3. Russell M.A. (1976). Low-tar medium nicotine cigarettes: A new approach to safer smoking. Brit Med J, 1, 1430-1433.
4: Benowitz N.L., Shoshana Z., & Jacob P. (1998). Suppression of nicotine intake during ad libitum cigarette smoking by high-dose transdermal nicotine. J Pharmacol Exper Ther, 287, 958-962.
5: Griffiths, R.R., Bigelow, G.E., & Henningfield, J.E. (1980). Similarities in animal and human drug-taking behavior. In: Mello, NK, ed. Advances in Substance Abuse, Conn.: JAI Press, Inc. 1-90.