The missing ingredient Australia needs to permanently end its tobacco addiction

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From October 1, Australians who use e-cigarettes and other vaping products that contain nicotine will need a medical prescription to buy them in a local pharmacy or to order them abroad.

But there’s another evidence-based way to help more smokers quit, which Australia has yet to act on: reducing the nicotine in cigarettes to non-addicting levels. And electronic cigarettes could play an important role in this policy.

If you know someone who has tried to quit smoking before and failed, nicotine addiction is probably the reason they found it so difficult. Although nicotine on its own is not an important direct cause of the harmful health effects of smoking, it makes tobacco products very addicting. In 1963, tobacco industry lawyers wrote:

We are […] in the business of selling nicotine, an addictive drug.

So what are other countries doing to reduce nicotine addiction? What role could nicotine alternatives, including e-cigarettes, play, and how could the reduction of nicotine in cigarettes backfire if not well managed? And what potential does a new, very low nicotine standard for cigarettes have to end Australians’ addiction to smoking?



Read more: From October it will be next to impossible for most Australians to vape – in large part due to Canberra’s little-known ‘homework police’


How other countries are tackling a global killer

Most people know someone who has died or developed serious health problems from smoking.

Even today, smoking remains the leading preventable cause of premature death in Australia, causing the death of more than 20,000 Australians every year. It also costs the Australian economy $ 136.9 billion per year.

This is why many countries, including Australia, are setting targets to reduce smoking to very low levels. But new approaches are needed to achieve this goal.

Reducing nicotine levels in cigarettes to non-addictive levels has been first proposal by the United States Food and Drug Administration in 1994. Although it was not implemented at the time, this policy has attracted renewed interest.

New Zealand recently proposed a nicotine reduction strategy as an option for its Aotearoa 2025 Smoke-Free Action Plan.

When you smoke near your pets, they are twice as likely to get cancer: Quitline New Zealand.

The administration of US President Joe Biden is also considering the United States Food and Drug Administration proposal reducing nicotine levels to “give addicted users the choice and the ability to quit more easily.”

The World Health Organization supports a global nicotine reduction strategy and made recommendations for its implementation.

The good news is that it is possible to reduce the levels of nicotine in cigarettes, and these cigarettes have already been tested in clinical trials.

The results show people smoke fewer cigarettes when given cigarettes that have 95% or more reduced nicotine levels compared to regular cigarettes. They are also more likely to quit smoking. Indeed, those who smoke regularly find very low nicotine cigarettes less pleasant and less rewarding.

While it is unethical to conduct similar studies with young people who do not already smoke, reducing nicotine levels should also reduce the number of adolescents who become addicted to tobacco, with promising results from animal studies.

How could nicotine alternatives help?

Allowing only ultra-low nicotine cigarettes to be sold would require increased investment in smoking cessation services and support, such as nicotine replacement therapy (including patches and gum), prescription drugs and behavioral support for health professionals.

Vaping devices.
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A nicotine reduction policy for tobacco products has also been made more achievable by changes made by the Australian government to the way smokers can access electronic cigarettes containing nicotine from October 1, 2021.

Although not harmless, electronic cigarettes are likely to be significantly less harmful than smoked tobacco products. They may be an alternative source of nicotine for people addicted to nicotine, and have been shown to increase stop smoking compared to nicotine replacement therapy.



Read more: E-cigarettes: Misconceptions about their dangers could prevent people from quitting smoking


Ensuring access to low-risk forms of nicotine is at the heart of policies being considered by New Zealand and the United States.

But there are possible unintended consequences of a nicotine reduction policy. A lot of people hold misconceptions about nicotine and one of the risks is that people think that cigarettes with reduced nicotine content are less harmful than regular cigarettes. This could reduce motivation to quit smoking.

That is why we would also need a health education campaign encourage people to quit smoking and warn of the harms of continuing to smoke, regardless of nicotine content.

Another risk is the growth of the illicit tobacco market, which should be monitored by increased enforcement efforts.

Policymakers may also be concerned about the growing legal challenges of the tobacco industry. However, Australia’s successful defense tobacco plain packaging laws show that such industrial challenges can be overcome.

A smashed cigarette butt.

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Make it easier to quit smoking and prevent children from becoming addicted

Michael Russell, one of the founders of medical approaches to help people quit smoking, said if nicotine was taken out of cigarettes, people would be “a little more likely to smoke cigarettes than to blow bubbles. or to light sparklers “.

Modeling suggests that imposing very low nicotine levels for cigarettes would give New Zealand a “Realistic luck” achieve its goal of smoking less than 5% of the population. It was estimated that 24 million deaths in the US would have been avoided if the nicotine in cigarettes had been reduced decades ago.

If we make smoking less addictive, we could prevent a new generation from becoming addicted to tobacco and help those who currently smoke to quit. And that’s a good thing, given the high cost of cigarettes and their contribution to health inequalities in Australia.

Australia has led the world in tobacco control policy by introducing tobacco plain packaging laws. Playing a leading role in new tobacco control policies, such as reducing the addictiveness of tobacco products, could help us achieve a smoke-free Australia.

But does Australia have the essential ingredient – the political will – to complete the task?


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