Reduced nicotine cigarettes may make it easier for smokers with mental health conditions to quit

Reducing exposure to nicotine and cigarette toxins would not worsen symptoms in people with unipolar mood or anxiety disorders and would make it easier for them to quit smoking, according to a randomized US study.

After numerous clinical trials, the first very low nicotine cigarettes were marketed in the United States in April 2022The benefit of reduced exposure to nicotine would be to make cigarettes less addictive and thus make it easier to quit smoking.

Because smokers with these disorders experience more severe withdrawal symptoms when quitting, the question of whether these individuals would be weakened if they were to switch to low-yield cigarettes has regularly been raised. To test this hypothesis, a team of researchers from the Universities of Pennsylvania and Harvard undertook a randomized, double-blind study.

A randomized, double-blind study with measurement of biological markers

The research compared two groups of smokers who did not want to quit and who had unipolar mood or anxiety disorders.[1]One received cigarettes with a standard nicotine content (11.6 mg), the other cigarettes whose nicotine content was reduced over the course of the research to reach a minimum threshold of 0.2 mg. 188 people were included in this experiment, which took place over 33 weeks. After smoking their own cigarettes for two weeks, smokers were asked to smoke only the cigarettes received during the study and avoid consuming any other form of nicotine products. Assessments using the Kessler Psychological Distress Scale were conducted at the beginning and end of the follow-up. Measurements of plasma levels of nicotine, carbon monoxide (CO) in exhaled air and various biomarkers were carried out at several times.

At week 18 of the research protocol, participants were offered a choice for the remaining twelve weeks: to return to their old cigarettes, continue smoking the cigarettes given in the protocol, or quit smoking. A typical attrition rate in this type of protocol was observed, but it was similar in both groups, and it brought the number of participants down to 143 at week 18, then to 121 at the end of the program.

Encouraging results on a sensitive population

Smokers who received reduced-nicotine cigarettes had lower plasma cotinine concentrations and lower exhaled CO levels at the end of the protocol, and reported feeling less addictive to cigarettes than those in the control group. The physical and, especially, mental health of these participants was not affected. Furthermore, more participants in this group had reduced their cigarette consumption or had successfully quit smoking than those in the control group.

The researchers conclude that low-nicotine cigarettes could reduce exposure to tobacco toxins and promote smoking cessation, without worsening symptoms in smokers with unipolar mood or anxiety disorders. The authors recommend that further research consider more severe mental health disorders and implement protocols with more abrupt nicotine reduction.

Already considered in the United States and New Zealand, the widespread use of low-nicotine cigarettes finds an additional argument here. This possible widespread adoption, however, may still take several years to become effective.

Keywords: reduced-nicotine cigarettes, cotinine, CO, anxiety, unipolar disorders, withdrawal

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[1] Foulds J, Veldheer S, Pashas G, Hrabovsky S, Hameed A, Allen SI, et al. (2022) The effects of reduced nicotine content cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: A double-blind randomized trial. PLoS ONE 17(11): e0275522.