A recent study published in The Lancet Regional Health examined the potential public health benefits of introducing low-nic cigarettes. The research aimed to determine how smokers would respond to very low nic content (VLNC) cigarettes in a real-world environment where regular or normal nic content (NNC) cigarettes and alternative nic delivery systems (ANDS) like e-cigarettes are readily available.
Titled “Reduced nic in cigarettes in a marketplace with alternative nic systems: randomized clinical trial,” the study involved six sites where smokers were randomly assigned to smoke either NNC or VLNC cigarettes. The participants, all adults over 21 who smoked between five and 40 cigarettes daily, could also purchase e-cigarettes and medical nic from an online experimental marketplace, and were observed for 12 weeks to assess their smoking behaviour and health outcomes.
The results suggested that participants in the VLNC group smoked significantly fewer cigarettes by the end of the study, averaging seven cigarettes per day compared to 13 in the NNC group. The study also found that VLNC users were three times more likely to attempt quitting, with 20% of VLNC participants abstaining from smoking for at least seven days, compared to 7% in the NNC group.
The paper also reported that while the availability of ANDS did not seem to significantly increase the likelihood of quitting, it did support VLNC users in reducing or quitting smoking. The fact that non-combustible tobacco use increased over time among VLNC users, suggested that these products can aid in the transition away from cigarettes/combustible tobacco.
The researchers concluded that introducing VLNC cigarettes in the market, coupled with the availability of ANDS, could significantly reduce cigarette consumption, promote quitting efforts, and lower exposure to tobacco-related toxins. These measures could serve as an essential public health strategy to reduce smoking prevalence and associated health risks.
The down side of lowering nic in cigarettes
Other studies have reported similar findings, however some experts argue that smokers tend to compensate for lower nic levels by smoking more cigarettes or inhaling more deeply, potentially increasing exposure to harmful tar and chemicals. Moreover, studies have concluded that reducing nic content in cigarettes does not lead to a sustained reduction in nic dependence or increased quit rates among smokers not initially interested in quitting.
The study “Effect of reducing the nic content of cigarettes on cigarette smoking behavior and tobacco smoke toxicant exposure: 2-year follow up,” aimed to determine the long-term effects of reducing nic content in cigarettes on smoking behaviour and nic intake. The research involved 135 smokers not interested in quitting, who were divided into two groups. One group smoked their usual brand, followed by progressively lower nic content cigarettes for seven months, then continued at the lowest nic level (0.5 mg/cigarette) for six months, and finally had no intervention for 12 months. While the control group smoked their usual brand throughout.
Key measurements included smoking behaviour, biomarkers of nic intake, and tobacco smoke toxicant exposure. The results indicated that after seven months of smoking very low nic content cigarettes (VLNC), nic intake was significantly reduced compared to baseline levels (plasma cotinine 149 ng/ml versus 250 ng/ml, P<0.005). However, there was no significant change in the number of cigarettes smoked per day or in expired carbon monoxide (CO) levels.
Moreover, during the 12-month follow-up, nic intake among the reduced nic content group returned to baseline levels, similar to the control group. Quit rates were low and not significantly different between the groups (7.5% for the VLNC group versus 2% for controls).
The results of allowing smokers to adjust nic levels according to their needs
Analysing this pattern from a different angle, a 2019 study led by Queen Mary University of London suggested that allowing smokers to control their nic intake while trying to quit can significantly aid in their efforts to stop smoking. This research involved 50 participants and represented the first study to tailor nic dosing based on individual smoker preferences during their quit attempt.
Dunja Przulj from Queen Mary’s Wolfson Institute of Preventive Medicine explained that while smokers typically control their nic intake through smoking, recommended dosages of nic replacement therapies (NRTs) for quitting may be too low for some individuals, potentially leading to relapse. The study indicated that medicinal nic products might be under-dosing smokers, which could contribute to the limited success seen with conventional treatments like nic patches and gum. Przulj emphasized that smokers should feel reassured in using higher nic doses if they find them helpful.
The study explored a novel approach to nic dosing. Historically, low doses of nic were used in NRTs due to concerns about toxicity and addictiveness. However, later evidence suggested that nic, when separated from tobacco products, has limited addictive potential and that higher doses are both safe and well-tolerated. Despite this, existing stop-smoking medications have not increased their nic levels accordingly.
Published in the journal Addiction, the study recruited participants from a tobacco dependence clinic in Argentina who underwent a combined approach of ‘pre-loading’ nic before their quit date and adjusting nic levels based on their feedback. They initially used one 21mg nic patch daily, starting four weeks before their quit date. The dosage was increased weekly by an additional 21mg patch, up to a maximum of 84mg/day, unless adverse effects were reported or the participant chose not to increase the dose. After the quit date, the dose was reduced weekly by 21mg until it reverted to the standard 21mg/day four weeks later. Throughout the pre-quit period, participants were encouraged to smoke as desired and were provided with additional oral NRTs.
This study’s findings suggest that smokers can tolerate significantly higher nic doses than currently recommended, potentially leading to more effective quit attempts by tailoring NRTs to individual needs.
Source:https://www.vapingpost.com/