Why legalise smoke-free products that contain nicotine?

If there is a way to consume the nicotine naturally present in tobacco while being exposed to significantly lower levels of harmful chemicals than in cigarette smoke, should Australian adult smokers who would otherwise continue to smoke, not have the choice of consuming these products rather than smoking cigarettes? This is the critically important question which Australian regulators need to consider in regulating access to smoke-free products.

What is nicotine?

Nicotine is the most well-known molecule in tobacco. It is found in plants, more specifically, the Solanaceae family, commonly known as nightshades. This family includes tomatoes, potatoes and eggplants/aubergines.11 Nicotine is also naturally present in the tobacco plant. To put it into perspective, a single cigarette contains ~ 12 mg of nicotine – around 18 thousand times more nicotine than in a potato, by mass. But only a fraction (<2 mg) of that nicotine is transferred into the smoke of a cigarette.1

Because nicotine is so well-known, it is tempting for people to wrongly associate all the dangers of smoking with nicotine. It is true that nicotine is addictive and that it is not risk-free, but it is not the primary cause of smoking-related diseases. Indeed, nicotine is the key ingredient of nicotine replacement therapies designed to help smokers quit tobacco and nicotine use altogether. These products are available without prescription, either over-the-counter in pharmacies or in some cases from other retailers.

The main culprit is smoke…

Smoking-related harm is caused by repeated exposure to toxicants emitted by a burning cigarette. Smoking cessation, by eliminating exposure to combustion toxicants, is the best way to reduce the harm and risk of smoking-related disease. As noted by McNeil1

“Since nicotine itself is not a highly hazardous drug, encouraging smokers to obtain nicotine from sources that do not involve tobacco combustion is a potential means to reduce the morbidity and mortality they sustain, without the need to overcome their addiction to nicotine.”

Although the nature and extent of any long-term health hazard from inhaling nicotine remains uncertain because there is no experience of such use other than from cigarettes, it is inherently unlikely that nicotine inhalation itself contributes significantly to the diseases caused by smoking. The main culprit is smoke and, if nicotine can be delivered effectively and acceptably to smokers without smoke, most, if not all, of the harm of smoking could probably be avoided.2 Nicotine is a key component of smoke-free products as it makes the alternatives acceptable to smokers who would otherwise continue smoking cigarettes.

Choices for smokers who choose not to quit

For the nearly 3 million Australians who continue to smoke, the risks of continued smoking are consequential and well-established. Although cessation is the best way to reduce the risk of smoking-related diseases, many smokers choose not to quit. Smoke-free products are intended for these smokers as it allows them to benefit from access to an alternative to cigarettes. Although not risk free, there is a growing evidence-base supporting the conclusion that these products are better alternatives to cigarettes. Additionally, while the science is still developing on the magnitude of the benefits resulting from reduced exposure to combustion toxicants, for adult smokers who switch completely to smoke-free products, these benefits may be substantial.3

Nicotine regulations in Australia need urgent review

In reviewing the available science on smoke free products, regulators must acknowledge that only cigarettes – one of the most harmful ways to consume nicotine – currently enjoy an exemption and that, in the absence of alternatives, many smokers will continue to smoke.  By contrast, the right mix of policy measures regulating nicotine can maximise the opportunities that smoke free innovation offers to smokers as well as to our public health system. Many countries around the world have already found ways to do this. Australia’s strong regulatory base in tobacco control makes it well-placed to develop and implement a regulatory framework that permits the sale of smoke-free products to existing smokers, while simultaneously preventing initiation, encouraging cessation and protecting consumers.

It is time for Australian regulators to review existing research on nicotine and smoke-free products and make an objective assessment as to how access to these products would affect smokers and public health. It’s time that we start talking about regulation rather than prohibition.

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1 A. McNeilReducing Harm from Nicotine Use. Fifty Years since Smoking and Health. Progress, Lessons and Priorities for a Smoke-free UK. Royal College of Physcians, London (2012)

2 Royal College of Physicians (2016) Nicotine without smoke, Tobacco harm reduction, A report by the Tobacco Advisory Group of the Royal College of Physicians, April 2016.

3 Slob W. et al., A method for comparing the impact of carcinogenicity of tobacco products: A case study on heated tobacco versus cigarettes, Risk Analysis (2020).