Why the FDA's Novel Plan for Nicotine Is a Step in the Right Direction

The plan to lower nicotine levels in cigarettes could potentially save more lives than if the opioid epidemic was ended today
The plan to lower nicotine levels in cigarettes could potentially save more lives than if the opioid epidemic was ended today

The new commissioner of the Food and Drug Administration (FDA) recently made a surprising and bold announcement that could potentially save more lives than if we ended the opioid epidemic today. FDA Commissioner Scott Gottlieb, a physician and cancer survivor, said that federal regulators will start a conversation about dramatically reducing the amount of nicotine in cigarettes, low enough to make them nonaddictive, while taking a go-slow approach to adopting new regulations on electronic cigarettes and other devices that are increasingly popular for consuming nicotine.

As Gottlieb put it, efforts to reduce smoking in the United States call for “Envisioning a world where cigarettes would no longer create or sustain addiction, and where adults who still need or want nicotine could get it from alternative and less harmful sources.”

This is a potentially historic announcement that offers a common-sense approach to moving the nation forward in our effort to reduce the number of illnesses and deaths caused by smoking. It is certainly an approach that has scientific merit.

I have spent decades working to reduce the harm of tobacco use. In 1992, I joined the Centers for Disease Control and Prevention as director of the Office on Smoking and Health. I can recall when the FDA's standard response to requests that it regulate nicotine in cigarettes was to assert that cigarettes are neither a food nor a drug, but “a device of pleasure” outside of their authority.

I can assure you that few smokers derive true pleasure from their addiction. My research team has found that most smokers regret that they ever started, and they desperately want to quit the habit.

The death toll of smoking: 15 times higher than for opioids

Though the opioid crisis is currently attracting the attention of the media and decision-makers across society, smoking remains the leading cause of preventable death and disease in the United States, causing more than 480,000 deaths a year. To put the scourge of conventional cigarettes in context, smoking kills 15 times more Americans per year than opioids.

Most Americans understand that smoking can cause cancer, but they may not be aware that it is also tied to a wide range of other health problems including heart disease, stroke and chronic obstructive pulmonary disease. In fact, a new study published in the journal Health Affairs found that infant mortality across the 13-state Appalachia region was 16 percent higher than the rest of the U.S. and overall life expectancy 2.4 years shorter, largely due to the higher rates of smoking in Appalachia.

As Gottlieb has noted, cigarettes are the only legal consumer product that, when used as intended, will kill half of all long-term users.

The new approach that Gottlieb proposes is a first step on a long journey that has great promise. If nicotine levels in cigarettes can be reduced significantly, it won't take long for smokers to realize that lighting up more frequently and dragging more deeply will never give them the same nicotine hit as in the past.