A new study published in The Lancet, one of the world’s oldest and most highly regarded peer-reviewed medical journals, suggests that smokers given higher-nicotine vaping products consume fewer dangerous carcinogens through continued smoking compared with their peers given lower-strength vapes.
The study—funded by the National Institutes of Health (NIH) and the Food and Drug Administration (FDA)—looked at how smokers’ use of electronic nicotine delivery systems (ENDS) could help them cut back on cigarettes.
The participants, aged from 21 to 65, had smoked more than nine cigarettes per day for at least the past year and were not currently using ENDS. They then received either a cartomizer-based, pen-style ENDS paired with 0, 8, or 36 mg/mL liquid nicotine, or—for the control group—a cigarette-shaped plastic tube that did not deliver any nicotine or aerosol. Over the course of 24 weeks, all groups were instructed to reduce their cigarette consumption first by 50 percent, and then by 75 percent.
At 24 weeks, the participants had their levels of NNAL—a biomarker that shows exposure to carcinogens specific to tobacco—measured. Among the findings, participants given the placebo product without nicotine or aerosol saw an 8 percent NNAL decrease, while those given an e-cigarette with 0 mg/mL—delivering aerosol without nicotine—saw a 20 percent decrease. Those with 8 mg/mL saw nearly a 32 percent drop, whereas those with the 36 mg/mL nicotine ENDS showed a 46 percent reduction.
“It was really only the dose that we know delivers nicotine in a comparable level to cigarettes that really had a reliable reduction in cigarette smoking,” Jonathan Foulds, one of the co-authors and a Penn State professor who researches smoking cessation, told Filter.
The paper includes a caveat about other variables: User behavior, device design and battery power might all play a role. But it still disputes the notion that lowering the amount of nicotine in vaping products would have a desirable outcome—that is, allowing adult smokers to transition from lethal combustible cigarettes to safer alternatives. In fact, the conclusions point in the other direction. If only low-nicotine vapes are permitted to be on the market, and higher-nicotine—and more satisfying—cigarettes remain, switching won’t be easy.
“If you give an e-cigarette a lot of disadvantages, like lowering the nicotine level so it can’t compete with a cigarette, then it simply won’t compete.”
The results could have major implications for upcoming policy discussions, especially as the Biden administration considers lowering the nicotine levels in combustible cigarettes and several countries, meanwhile, pursue nicotine caps in e-cigarettes.
At the moment, Canada is entertaining instituting a nicotine cap similar to the European Union at 20 mg/mL. Tobacco harm reduction advocates have warned that such a policy is flawed, as it would make it harder for smokers to ditch cigarettes and substitute them with easy-to-use vapes. (The US has also flirted with a similar strategy.)
Many experts argue, in other words, that vapes are direct substitutes for cigarettes, and that a major factor in people’s likelihood of switching is how much a given vaping product mirrors the nicotine intake—and the familiar feeling—from a cigarette. Should an adult or even a teen choose to consume nicotine, they reason, the less dangerous option should be incentivized.
“This study is consistent with the idea that reducing the amount of nicotine in e-cigarettes may not have the desired effects, like that it’s less addictive,” Foulds told Filter. “It may have the opposite effect. The [lower-nicotine] e-cigarette is less addictive, but therefore less satisfying and less able to reduce the use of the more addictive product, the cigarette.”
“If you give an e-cigarette a lot of disadvantages, like lowering the nicotine level so it can’t compete with a cigarette,” he continued, “then it simply won’t compete.”
Foulds clarified that the participants did have other incentives and requirements. They didn’t have to pay for vaping products, for example, and they had to keep rigorous track of their consumption. But they did not want to quit smoking. They simply professed some interest in wanting to limit the number of cigarettes they smoked.
“They’re not that unlike the way many real consumers approach their attempts to use e-cigarettes,” Foulds said.