Reducing tobacco's addictive qualities is a good first step

Wednesday, March 21, 2018

Tobacco use — mostly cigarette smoking — is the leading cause of preventable disease and death in the United States. It kills more than 480,000 Americans annually, and costs more than $300 billion a year, according to FDA Commissioner Scott Gottlieb, M.D.

It seems only logical for the U.S. Food and Drug Administration to take steps to reduce the addictive quality of tobacco, a path it has just begun.

Making cigarettes and other nicotine products less addictive could result in a median of 2.4 million fewer new smokers by 2025 and 33 million fewer by 2100, according to the FDA.

That would reduce the number of smokers from the current 15 percent of the U.S. population to 1.4 percent, according to an FDA estimate published online in the New England Journal of Medicine last week.

That translates to more than 8 million smokers’ lives being saved by 2100, the FDA said.

The agency is taking baby steps, for now, seeking comments on proposals to regulate premium cigars and flavorings in tobacco products.

“There are few things as commissioner that can save so many lives, which is why I’m so committed to our comprehensive plan on nicotine and tobacco,” Gottlieb said.

There are many details to be worked out, such as the best way to measure nicotine levels, and what is the maximum amount of nicotine that can be contained in tobacco so it can still be considered nonaddictive.

There are also questions about techniques for reducing nicotine levels, and whether certain groups are more sensitive to nicotine’s effects.

Altria, home to brands such as Marlboro, Copenhagen and Skoal, has been working on a reduced-nicotine product for almost 10 years and expects the FDA’s request to lower nicotine levels to take years more.

Some question whether lower nicotine levels would reduce smoking, or cause the truly addicted to simply consume more cigarettes, throwing the goal into question for adults.

There is little question, however, over the goal of reducing the number of young people who become addicted to tobacco at an early age.

“Kids will always engage in risky behavior,” said Mitch Zeller, director of the FDA's Center for Tobacco Products.

But in the future, children “would only be able to experiment with a cigarette that wouldn’t be capable of creating and sustaining addiction,” Zeller said. “Were that to happen, that’s where you get the demonstrable public health impact at a population level.”

America’s experience with prohibition, as well as it’s war on drugs is a lesson on the risk of unintended consequences.

While cigarettes and other dangerous tobacco products won’t be banned in the foreseeable future, limiting their addictive qualities is a good first step.

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