Low-nicotine cigarettes won’t make smokers restless, according to research

by Steven Reinberg

Heilsudag reporter

FRIDAY Nov. 4, 2022 (HealthDay News) — The U.S. Food and Drug Administration has proposed limiting the amount of nicotine in cigarettes to minimally addictive levels, but there have been concerns that reducing nicotine could increase anxiety in smokers who may already struggle with mood problems.

However, a new study shows that while cigarettes with nicotine at 5% of the usual dose soul help anxious or depressed smokers quit, they do so without exacerbating the mood or anxiety problems that led them to smoke in the first place.

“There do not appear to be any worrisome, unintended consequences of having to switch to very low nicotine cigarettes,” said lead researcher Jonathan Foulds, professor of public health sciences and psychiatry at Penn State University School of Medicine.

“On the contrary, the result appears to be that smokers feel less dependent on their cigarettes and are able to quit smoking when they are offered relatively short follow-up support along with nicotine replacement therapy,” he said.

Smokers with mood and anxiety disorders showed no signs of “switching off” from very low-nicotine cigarettes, nor did switching to them make their mental health worse, Foulds said.

The US Food and Drug Administration has proposed limiting the amount of nicotine in cigarettes to the minimum addictive level. Doing so could not only reduce addiction but also reduce exposure to toxic substances and increase the likelihood of quitting, Foulds said.

In 2019, the FDA approved two lower nicotine cigarettes manufactured by 22nd Century Group, Inc. — Moonshine and moonshine menthol. Those brands are in market testing and not generally available, Foulds said.

“It would be reasonable for the protection of public health to proceed with the implementation of such a regulation as soon as possible,” he said. “It’s been over 50 years since it became clear that cigarettes are deadly and addictive when used as intended. It’s time to take action to minimize the addictive part of cigarettes.”

Dr. Panagis Galiatsatos, an assistant professor of medicine at Johns Hopkins University in Baltimore and an American Lung Association volunteer, agreed.

“Reducing the amount of nicotine in cigarettes has been a public health strategy that we’ve been pursuing for the last two decades,” said Galiatsatos, who was part of the study. “Nicotine is why people keep going back to cigarettes, knowing that toxins are in there, knowing that these carcinogens are in there, not because they want to create dire health conditions for themselves.

For the study, Foulds and his colleagues studied 188 smokers who had mood or anxiety disorders and did not want to quit. They were randomly assigned to smoke cigarettes with a standard amount of nicotine or those whose nicotine content was gradually reduced over 18 weeks.

At the time, researchers found no significant difference in mental health between the two groups. And those who received lower nicotine cigarettes were more likely to quit smoking than those who smoked the normal amount of nicotine – 18% against. 4%.

“It is important to study people with mental health problems, since they make up about 25% of the population but smoke 40% of cigarettes in the United States,” said Dr. Pamela Ling, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, who reviewed the findings.

She noted that people with mental health problems die earlier than the general population, often from diseases related to smoking.

Ling said it is time to make low-nicotine cigarettes the only smoking available.

“This study should allay concerns that reduced nicotine cigarettes could worsen symptoms in people with mental illness,” Ling said. “It is time for the FDA to take action to reduce the nicotine in cigarettes to the lowest levels. This study suggests that such action would help smokers quit, including those with mental health problems.”

Ultimately, Galiatsatos said politics, not health concerns, will determine whether nicotine cigarettes will replace cigarettes today.

“If it was just a fight over broccoli, we would have won,” he said. “It’s not. It makes a lot of money for a lot of individuals. But from a physician’s perspective, we need to take advantage of these opportunities to implement appropriate clinical guidelines to make these patients smoke-free.”

The study was published online in November. 2 in the diary PLUS ONE.

More information

For more information on quitting smoking, visit the US Centers for Disease Control and Prevention.

SOURCES: Jonathan Foulds, PhD, professor, public health sciences and psychiatry, Penn State University, Hershey; Panagis Galiatsatos, MD, volunteer physician advocate, American Lung Association, and assistant professor of medicine, Johns Hopkins University, Baltimore; Pamela Ling, MD, MPH, Director, Center for Tobacco Control Research and Education, University of California, San Francisco; PLUS ONE, Nov. 2, 2022, online

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