VLN Cigarette
VLNC (Very Low Nicotine Cigarettes) For those who are new to smoking, it is hoped that with the low nicotine content people won't become addicted to them and convert to habitual smoking. For people who already habitually smoke, it is hoped that the lower level of nicotine will help them break free from smoking or if they want/need more nicotine, convert to a safer alternative. The US FDA granted the first MRTP (Modified Risk Tobacco Product) to a VLNC on December 23, 2021.
- Terms:
- VLN = Very Low Nicotine
- VLNC = Very Low Nicotine Cigarettes
- CPD = Cigarettes Per Day
- RNC = Reduced Nicotine Cigarette (non-brand hypernym used in some papers)
Studies
- Messaging on mortality effects of VLNC cigarettes (i.e., cigarettes with 95% less nicotine are as deadly as current cigarettes) was associated with more accurate perceptions of the health risks of VLNC cigarettes than the control; however, misperceptions remained in one-third of participants.
- Differential dropout and noncompliance indicate some smokers had difficulty transitioning to cigarettes with reduced nicotine. These smokers will benefit from supplemental nicotine in medicinal or noncombustible tobacco products if a nicotine reduction standard is established. Other smokers successfully transitioned to very low nicotine content cigarettes exclusively and substantially reduced their exposure to nicotine.
2021: Reactions to reduced nicotine content cigarettes in a sample of young adult, low-frequency smokers
- Reducing nicotine content will likely lower the abuse liability of cigarettes for most young, low-frequency smokers. Additional work is needed to determine if compensatory smoking may lead to increased toxicant exposure, and if a subset of individuals choosing lower nicotine cigarettes may continue to smoke regardless of nicotine content.
- These results indicate that an immediate reduction in nicotine would result in beneficial effects in both young and older adults. Young adults show less positive subjective effects of smoking following switching to VLNC cigarettes relative to older adults.
- Consistent with assumed-but rarely tested-causes of smoking reinforcement, sensory perceptions from a cigarette predict its relative reinforcing efficacy.
- Several participants expected, prior to trying VLNC cigarettes, to compensate for the reduced nicotine levels by smoking more cigarettes but were surprised when they did not increase their smoking. A subset of participants reported experiencing minor withdrawal symptoms, such as irritability and fatigue. Several participants reported feeling less dependent after exclusively smoking VLNC cigarettes. Most participants said they would smoke VLNC cigarettes if they were the only cigarettes available to purchase. Some also said that smoking VLNC cigarettes could help people taper down or quit smoking.
- Here we report that cigarette manufacturers have had the ability to voluntarily implement such a standard for decades. We use a well-validated model to demonstrate that millions of smoking attributable deaths and life-years lost would have been averted if the industry had implemented such a standard.
- These 3 randomized clinical trials including 775 participants with affective disorders, opioid use disorder, or socioeconomic disadvantage found that reducing nicotine content significantly decreased total cigarettes smoked daily and nicotine dependence severity.
2020 Commentary: Is Nicotine Reduction in Cigarettes Enough?
- "Is this strong policy statement warranted by the findings in this study? We think not. The main finding—a modest within-trial reduction in cigarette consumption—does not support the objectives of the comprehensive plan for nicotine regulation at a national level. The ability of the VLNC intervention to promote smoking cessation was specifically tested at week 12 when participants were offered $100 to abstain from smoking for 24 hours, a modest goal given that most smokers who abstain for 24 hours relapse, and smokers do not get such offers in real life. The VLNC intervention did not result in smoking cessation. This raises serious questions about the conclusion that a VLNC cigarette policy alone would promote smoking cessation or reduce morbidity and mortality. The health benefits of VLNC cigarettes remain unclear. Reductions in the level of NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol), a biomarker for tobacco smoke carcinogens, were small, and 1 group (opioid users) experienced an increase in the level of NNAL."
- Ten pregnant smokers in Burlington, VT and Baltimore, MD participated in 2017–2018.
- Reducing the nicotine content of cigarettes may decrease their abuse liability in pregnant smokers without causing untoward craving/withdrawal or compensatory smoking. Studies of extended exposure to VLNCs in pregnant women are warranted.
- 17 people completed the study.
- Although replication with larger samples and longer access is needed, results indicate nicotine reduction to ≤2.3 mg/g in cigarettes would attenuate reinforcement. This choice procedure may efficiently inform future clinical trials to assess relative reinforcing effects of smoking reduced nicotine cigarettes.
- Recent population-level data highlight that 49%–80% of US adults incorrectly believe that nicotine is responsible for most of the cancer caused by smoking
- Nearly half (47%) of adult smokers believe that continued smoking of VLNC cigarettes is less likely to cause cancer than smoking their current cigarettes.This misperception is more common among smokers who are age 55+ (57%) and Black (57%).
2019: Effects of 6-Week Use of Very Low Nicotine Content Cigarettes in Smokers With Serious Mental Illness
- "These results suggest that a reduced-nicotine standard for cigarettes would reduce smoking among smokers with SMI. However, the lack of effect on total nicotine exposure indicates VLNC noncompliance, suggesting that smokers with SMI may respond to a reduced-nicotine standard by substituting alternative forms of nicotine."
- It can be assumed that even if reduced nicotine cigarettes are mandated, the black market will continue to supply nicotine containing tobacco, and cigarettes as long as there is demand.
- Small trial - 10 participants
- Reducing the nicotine content of cigarettes may decrease their abuse liability in pregnant smokers without causing untoward craving/withdrawal or compensatory smoking. Studies of extended exposure to VLNCs in pregnant women are warranted.
- Switching to VLNCCs caused substantial smoking reduction among ITS (non-daily intermittent smokers) but did not significantly increase abstinence. Response to a VLNCC intervention suggests that nicotine-seeking motivates ITS' smoking.
- In this study, compared with gradual nicotine reduction, immediate reduction was associated with lower toxicant exposure across time, smoking fewer CPD (cigarettes per day), greater reduction in dependence, and more cigarette-free days. However, the immediate reduction in nicotine caused greater withdrawal symptoms, greater use of nonstudy cigarettes, and higher drop-out rates.
- The results from this review suggest that smoking VLNC cigarettes may fail to reverse withdrawal-induced disruptions in performance following complete smoking abstinence or reduced nicotine exposure. Of the 19 studies reviewed herein, 15 reported significant differences in performance when smokers smoked VLNC versus NNC cigarettes. All results were in the direction of performance being worse when participants smoked VLNC relative to NNC cigarettes.
- It is important to underscore the evidence suggesting that combined NRT and VLNC cigarettes restore disrupted performance when smoking VLNC cigarettes alone does not. Thus, if a reduced nicotine content policy was adopted, supplemental use of NRT and likely other non-combustible forms of nicotine (e.g., e-cigarettes) would be a viable option for protecting against the type of performance disruptions revealed in this review, although a larger number of studies directly examining this matter would be helpful.
- LNC cigarettes share the behavioral and sensory components of smoking while delivering negligible levels of nicotine. Although smokers rated VLNCs as less satisfying than regular cigarettes, smokers said they would increase their consumption of VLNCs as the price of regular cigarettes increased, if VLNCs were available at a lower price. This suggests that VLNCs are partially substitutable for regular cigarettes. VLNCs can be part of an effective tobacco control strategy, by reducing nicotine dependence and improving health and financial outcomes for smokers.
- Smokers may misconstrue RNC cigarettes as less harmful than regular cigarettes. These beliefs, in conjunction with favorable subjective ratings, may increase product use.
- Biomarker analysis demonstrates a high degree of noncompliance with smoking VLNC cigarettes, indicating that smokers are supplementing these with conventional cigarettes.
- In this 6-week study, reduced-nicotine cigarettes versus standard-nicotine cigarettes reduced nicotine exposure and dependence and the number of cigarettes smoked.
- During the 12 months follow-up, cotinine levels in RNC smokers rose to baseline levels and to those of control smokers. Quit rates among RNC smokers were very low (7.5% vs 3 % in controls, N.S.).
- Article: Low-Nicotine Cigarettes Fail to Sway Smokers
- Study Finds Effectiveness of Cessation Aid Slips After 6 Months
- Combining very low nicotine content cigarettes with nicotine patch may improve the acute effects resulting from switching to either of these products alone.
- To determine the combined effect of very low nicotine content (VLNC) cigarettes and usual Quitline care [nicotine replacement therapy (NRT) and behavioural support] on smoking abstinence, in smokers motivated to quit.
- VLNC cigarettes plus NRT (nicotine patch, gum and/or lozenge) significantly increased quit rates at all measured time points (3 & 6 weeks and 3 & 6 months) over use of NRT only
- VLNC found to be slightly better than nicotine replacement alone
- "Unlike the 0.3 mg cigarettes, 0.05 mg cigarettes were not associated with compensatory smoking behaviors. Furthermore, the 0.05 mg cigarettes and nicotine lozenge were associated with reduced carcinogen exposure, nicotine dependence and product withdrawal scores. The 0.05 mg cigarette was associated with greater relief of withdrawal from usual brand cigarettes than the nicotine lozenge. The 0.05 mg cigarette led to a significantly higher rate of cessation than the 0.3 mg cigarette and a similar rate as nicotine lozenge."
- In summary, a toxicological analysis does not indicate that low-nicotine and nicotine-free Quest® cigarettes have less adverse toxicological effects in the laboratory than conventional cigarettes. This should draw the attention of the consumers and policy makers. A more comprehensive evaluation in smokers is expected for these new products.
Statements, Official Comments, Testimony
- However, we all agree that there is one important requirement common to each of the perspectives above: that is the availability of low-risk non-combustible alternative tobacco or nicotine products that are sufficiently satisfying alternatives to cigarettes that smokers who choose to continue to use nicotine would be willing to switch to them.
Discussion links BLOGs, Articles, Videos, etc
2021: A Mixed Record
2018: Video Low-Nicotine Cigarettes
Suggestions to add to this page
* “The data from this study are important because they suggest that smokers do not engage in compensatory smoking by smoking each cigarette more intensely when switching to low-nicotine cigarettes,”