Thread by @Drug_Researcher

Nicotine-reduction is an idea kicked around for decades in the tobacco research field. Most fellow tobacco researchers have vehemently supported this plan. Like Captain Ahab, they tend to be so focused on their goal that they are blind to the downsides. Below I post a couple of recent studies I published that should cause concern about moving ahead with this unprecedented policy. I predict we would see a massive expansion in black market cigarettes as a result of this policy.

This is a recently double-blind RCT looking at different levels of nicotine, and their effect on smoking before and after a few weeks of exposure. We found very little unique effect of reduced nicotine on smoking. Exposure to experimental cigarettes reduced smoking, but this was true for full and reduced nicotine cigarette exposure. I think researchers have missed the confound that the experimental cigarettes used in these studies just don't taste good, and this might be responsible for some of the effects in the field suggesting a reduction in smoking.

onlinelibrary.wiley.com/doi/10.1002/je…

In this study, we looked at a potential black market if a nicotine reduction mandate was enacted. We found that plenty of smokers would rather use full nicotine illicit cigarettes than legal reduced-nicotine cigarettes. I think it's clear we'd get a massive increase in the black market.

pubmed.ncbi.nlm.nih.gov/37195268/

FDA has not taken a drastic expansion of a black market for cigarettes (which already exists to some extent to avoid state taxes) seriously. I've been told by FDA staff that they don't believe they are mandated to even consider such an outcome. This would be the first substance in human history in which a ban did not result in a black market. You don't think we'd see millions of unregulated cigarettes being shipped from China and elsewhere? Funneling money to organized crime, keeping cigarettes outside the domains of principled FDA regulation, allowing for additional toxins, and increasing the violence that is used to settle disputes in the black market. We have slowly turned the ship away from a criminal, prohibitionist approach to other problematic substances, but we will be going down this road with tobacco in the hopes that the outcomes will be different?

There is no other substance that is as lethal in the long term than tobacco cigarettes. Nothing is even close. I've worked for years on the problems of smoking, including smoking treatment research. And I've never taken any tobacco money. So my views are not due to a lack of concern, or some financial bias. I just see tobacco in the bigger picture, and apply the principles I see at play with all other drugs. I really think this proposed policy is about appearances. It looks great at the surface level, but we aren't thinking through the unintended consequences.