By Steven Reinberg
Health Day 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 the decline in nicotine is reducing smokers’ fears could amplify those who already could combat mood problems.
However, a new study shows that cigarettes contain nicotine at 5% of the normal dose can help anxious or depressed smokers quit smoking without worsening the mood or anxiety issues that led them to smoke in the first place.
“There do not appear to be any worrying 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, it appears that smokers feel less dependent on their cigarettes and are more able to quit if they are offered relatively brief help at follow-up appointments plus nicotine replacement therapy,” he said.
Smokers with mood and anxiety disorders showed no signs of “oversmoking” the very-low-nicotine cigarettes, nor was there any evidence that switching to them worsened their mental health, Foulds said.
The US Food and Drug Administration has suggested limiting the amount of nicotine in cigarettes to a minimum of dependency. Not only could this reduce addiction, but it could also reduce exposure to toxic substances and increase the likelihood of quitting smoking, Foulds said.
In 2019, the FDA approved two lower nicotine content cigarettes from 22nd Century Group, Inc. – Moonlight and Moonlight Menthol. Those brands are in market testing and not widely available, Foulds said.
“It would be appropriate to protect public health to speed up the implementation of such a regulation as soon as possible,” he said. “It has now been over 50 years since it became clear that cigarettes are fatal and addictive when used as directed. It is 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 a volunteer medical spokesman for the American Lung Association, shared this view.
“Reducing the amount of nicotine in cigarettes has been a public health tactic that we have been pursuing for the past two decades,” said Galiatsatos, who was involved in the study. “Nicotine is the reason people keep coming back to cigarettes because they know there are toxins in them, because they know they have these carcinogens in them, not because they want to create bad health situations for themselves.”
For the study, Foulds and his colleagues looked at 188 smokers who had mood or anxiety disorders and didn’t want to quit. They were randomly assigned to smoke cigarettes with the usual amount of nicotine or those with gradually reduced nicotine content for 18 weeks.
During that time, the researchers found no significant differences in mental health between the two groups. And those given cigarettes with reduced nicotine content were more likely to quit smoking than those whose smoke contained normal levels of nicotine – 18% versus 4%.
“It’s important to study people with mental illness because they make up about 25% of the population but smoke 40% of cigarettes in the US,” said Dr. Pamela Ling, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, who reviewed the results.
She found that people with mental illness die earlier than the general population, often from a smoking-related disease.
Ling said it’s time to make low-nicotine cigarettes the only smoke available.
“This study should allay concerns that cigarettes with reduced nicotine content may worsen symptoms in people with mental disorders,” Ling said. “It’s about time the FDA took action to reduce the nicotine in cigarettes to a minimum.
Ultimately, Galiatsatos said, politics, not health, will decide whether low-nicotine cigarettes will replace today’s cigarettes.
“If this was just a broccoli fight, we would have won,” he said. “It isn’t. It makes a lot of money for a lot of people. But from a clinical perspective, we need to seize these opportunities to implement appropriate clinical guidelines to convert these patients into non-smokers.”
The study was published online on November 2 in the journal PLUS ONE.
For more information on quitting smoking, see 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, American Lung Association Volunteer Medical Spokesperson 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 ONENovember 2, 2022, online