VLN Cigarette

VLNCs

it has been suggested these pose all the risk, while offering none of the benefits

"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."

Very-Low Nicotine Cigarettes and Non-Daily Smokers https://clinicaltrials.gov/ct2/show/NCT02228824

"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.

"VLNCs did not cause untoward craving/withdrawal or compensatory smoking." Again making us think there is some other compound than nicotine involved.

" In this randomized clinical trial of 1250 smokers, immediate compared with gradual reduction to very low nicotine content cigarettes or with a control smoking group significantly reduced exposure (area under the concentration curve) to breath carbon monoxide (difference, 4.06 ppm and 3.38 ppm for immediate vs gradual reduction group and immediate reduction vs control group, respectively), acrolein (difference, 17% and 19%), and phenanthrene tetraol (difference, 12% and 14%); there were no significant differences between the gradual and control groups."

"Very Low Nicotine Content (VLNC) cigarettes might be useful as part of a tobacco control strategy, but relatively little is known about their acceptability as substitutes for regular cigarettes."

"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."

It appears that VLNCs work best given with nicotine lozenges, therefore why not just try nicotine lozenges, and cut out the burning plant materials?

" 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"

interestingly: "Very Low Nicotine Content cigarettes were associated with greater relief of withdrawal than the nicotine lozenge"

We have to wonder if the presence of something else in the smoke is the driver of addiction (MAOIs?)

"One study showed that, while nicotine levels in the bloodstreams of the VLNC group were indeed lower, the number of cigarettes smoked remained the same. Another showed that users compensate for lower nicotine levels either by using different puffing styles or by using other nicotine products, mainly e-cigarettes. In both studies, the toxins and carcinogens from combustion to which users are exposed remained the same, with the exception of those who substituted with noncombustible nicotine products."