Nicotine Science and Policy

Public perceptions of nicotine have long been marred by its association with harmful constituents of tobacco smoke, despite the substantial evidence showing that nicotine is not responsible for the many non-communicable diseases caused by tobacco smoking. Nicotine, safely administered, has long been accepted by governments and health authorities, including the WHO, as a valuable tool to aid smoking cessation in the form of nicotine replacement therapy. Joining us today is Michael Kariuki, a consultant pediatrician and epidemiologist from Kenya, to discuss the therapeutic applications of nicotine and the vital role of safer nicotine products in aiding smoking cessation.

Norway is following Sweden's lead in reducing smoking rates by embracing snus over cigarettes, as highlighted by GSTHR. Snus offers a safer nicotine consumption alternative, leading to a significant decline in smoking, especially among young adults. Despite its efficacy, snus's harm reduction benefits are not widely promoted by Norwegian health authorities. The country's progress in tobacco harm reduction showcases the potential for consumer-driven initiatives to combat smoking. Norway stands out for its strict tobacco control measures and significant shift towards snus as a substitute for cigarettes, even without official endorsement. This trend indicates the impact of harm reduction strategies and consumer choices in reducing tobacco-related harms.

While vaping offers a safer alternative to smoking with fewer health risks, it faces disproportionate restrictions compared to products like fast food, alcohol, and cigarettes. These discrepancies reveal biases influenced by politics and vested interests, hindering harm reduction efforts in public health. Advocates argue for fair regulation that ensures product safety without impeding consumer choice. By acknowledging vaping as a tool for harm reduction and promoting informed decision-making, policymakers can create a balanced approach that respects individual autonomy and fosters a healthier society.

To break a vaping addiction, strategies include tapering nicotine strength gradually, identifying triggers and seeking therapy, setting boundaries, using distractions like sweets, trying apps or text support interventions for quitting, and considering drug therapies like varenicline and cytisine. Progress can be hindered by triggers and a tendency to increase vaping frequency when reducing nicotine. Support from a buddy can aid in setting boundaries. It's crucial not to return to smoking cigarettes to avoid the unique risks they pose. Pharmacological therapies are available, but not yet licensed for vaping cessation in the UK, except for Nicorette’s QuickMist mouth spray.

The US FDA has officially authorized Zyn nicotine pouches, made by Phillip Morris, for sale in the US to help quit smoking. These pouches, offering 10 flavors, are placed between the gum and lips to release nicotine. Unlike tobacco, nicotine pouches have gained popularity without evidence of widespread teen use. While the FDA's approval does not signify safety, it acknowledges the harm reduction compared to other nicotine products. The agency emphasizes that no tobacco product is safe and discourages youth and non-users from starting. Additionally, the FDA has proposed a rule to limit nicotine levels in cigarettes, cigars, and rolling tobacco.

UVA Health's study on Nicotine Pouch Use Among US Military Personnel has sparked controversy due to exaggerated health claims. The research suggests an increase in pouch use, partly attributed to smoke-free military environments and performance benefits. The focus should be on transitioning from cigarettes, as dual use is prevalent in the army. The skewed demographics in the military lead to higher tobacco use rates. UVA Health's emphasis on pouches is criticized, as cigarettes pose a greater threat. The study's alarmist tone towards pouches overlooks the potential benefits and serves the agenda of anti-tobacco groups.

The FDA proposes reducing nicotine levels in tobacco products to combat addiction and save lives. If enacted, the US would be the first country to implement such a measure. Lower nicotine levels could help millions quit smoking, especially youth who often start smoking and face addiction. The proposal targets cigarettes, cigars, and pipe tobacco but excludes e-cigarettes and other noncombusted products. Despite potential lawsuits from the tobacco industry, the FDA aims to reduce tobacco-related illnesses and healthcare costs. The public can comment on the proposal, which could take years to be finalized and aims to prevent millions of smoking-related deaths and illnesses.

The UKVIA is alarmed by the exclusion of vaping industry and consumer representation in the Tobacco and Vapes Bill hearings, calling for real vapers' stories to be shared. Concerns arise that proposed measures may hinder vaping as a smoking cessation tool. To address this, UKVIA is advocating for industry participation and a retail licensing scheme. A REAL VAPER testimonial highlights successful smoking cessation through vaping. The association aims to influence government perception through the REAL VAPERS campaign, encouraging smokers to switch to a less harmful alternative. UKVIA emphasizes the importance of consumer testimonials in showcasing vaping's impact on quitting smoking.

Vaping has become popular as a substitute for smoking, with an increase in users in Scotland, including those under 16. While it is considered less harmful than smoking, vaping still poses health risks like addiction and lung damage. Hollyoaks star Paul Danan's recent death was attributed to excessive vaping, highlighting the potential dangers. The NHS warns of long-term health impacts, with concerns similar to those of traditional cigarettes. Belgium has banned e-cig sales due to health and environmental concerns, while Scotland and the UK plan to ban single-use vapes. The true extent of vaping's harm may not be fully realized for decades.

Federal officials proposed capping nicotine levels in cigarettes to reduce addiction, potentially helping millions quit smoking and preventing new smokers. Despite strong support and health benefits, the plan may face delays and legal challenges from tobacco companies. The FDA's slow progress is due to anticipated industry lawsuits. The regulation aims to cut smoking-related deaths and chronic diseases, complementing efforts to combat tobacco use. While the plan excludes some tobacco products, like e-cigarettes, concerns about illegal markets have been raised. The proposal, subject to public feedback, could take years to implement. The FDA's push to limit nicotine aligns with declining smoking rates and prior initiatives to reduce nicotine content in cigarettes.