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Nicotine: The Addictive Chemical in Tobacco Products


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Nicotine is a highly addictive chemical compound present in the tobacco plant. Tobacco products, including cigarettes, cigars, smokeless tobacco, hookah tobacco, and most e-cigarettes, contain nicotine.

Some of the toxic chemicals in cigarettes are present in the tobacco plant itself

Nicotine Myths

Most people know that cigarettes and other tobacco products are addictive, but many people do not understand the role of nicotine in tobacco addiction, disease, and death. Nicotine is what addicts and keeps people using tobacco products, but it is not what makes tobacco use so deadly. Tobacco and tobacco smoke contain thousands of chemicals. It is this mix of chemicals—not nicotine—that causes serious disease and death in tobacco users, including fatal lung diseases, like chronic obstructive pulmonary disease (COPD) and cancer.1


Nicotine and Your Health

Addiction: Using any tobacco product containing nicotine can lead to nicotine addiction. This is because nicotine can change the way the brain works, causing cravings for more of it. Some tobacco products, like

Girl on a bus

cigarettes, are designed to deliver nicotine to the brain within seconds,2 making it easier to become dependent on nicotine and more difficult to quit. While nicotine naturally occurs in the tobacco plant itself, some tobacco products contain additives that may increase the absorption of nicotine.3

Adolescent Brain Development: Although many teens underestimate how easy it is to become addicted to nicotine, young people are the most at risk for nicotine addiction because their brains are still developing. In fact, the younger a person is when they start using tobacco, the more likely they are to become addicted.4 Nicotine exposure during adolescence can disrupt normal brain development and may have long-lasting effects, such as increased impulsivity and mood disorders.4 Because of nicotine’s powerfully addictive nature and profound effects on the developing brain, no tobacco products are safe for youth to use. 

Pregnancy and Fetal Health: If pregnant women use tobacco products, nicotine can cross the placenta and result in multiple adverse consequences. These outcomes may include, but are not limited to: premature labor; low birth weight; respiratory failure at birth; and even sudden infant death syndrome (SIDS).1, 5, 7, 8

Woman holding a baby

Nicotine Delivery on a Continuum of Risk

Products containing nicotine pose different levels of health risk to adult users, with combustible products -- like cigarettes, with their toxic mix of more than 7,000 chemicals2 and efficient delivery of nicotine to maximize addiction potential -- being the most harmful, nicotine replacement therapies (NRTs) being the least harmful, and noncombustible products falling somewhere in between.  


Lowering Nicotine Levels in Cigarettes: A Proposed Product Standard

As part of a new tobacco regulatory plan centered on nicotine and addiction, FDA is considering a product standard to lower nicotine in cigarettes to minimally addictive or nonaddictive levels.  The purpose of this action would be to help addicted adult smokers to quit while preventing future generations from becoming addicted to cigarettes in the first place. On March 15, 2018, FDA issued an advance notice of proposed rulemaking (ANPRM) seeking public comment on the proposed nicotine product standard.  Should a product standard be put in place by 2020, FDA-funded research suggests that nearly 8 million premature deaths caused by smoking would be avoided.9


Nicotine and Adult Harm Reduction

E-cigarettes: FDA is committed to protecting the public health of all Americans while regulating an addictive product that carries with it health risks. To this end, the agency is conducting ongoing research on potentially less harmful forms of nicotine delivery for adults, such as electronic nicotine delivery systems (ENDS), or e-cigarettes. Though more research on both individual and population health effects is needed, many studies suggest e-cigarettes may be less harmful than combustible cigarettes.

Vapes

In its 2018 report, “The Public Health Consequences of E-cigarettes,” the National Academies of Science Engineering, and Medicine (NASEM) found “there is substantial evidence that--except for nicotine--exposure to potentially toxic substances from e-cigarettes is significantly lower compared with combustible cigarettes.”10

The report went on to assert that some evidence suggests completely switching from cigarettes to e-cigarettes and other noncombustible products may present a significant harm-reduction opportunity to addicted adult smokers.10  While this statement backs up anecdotal reports, there is not yet enough evidence to support claims that e-cigarettes and other ENDS are effective tools for cessation. To date, no e-cigarette has been approved either as a cessation device or a modified risk tobacco product, and more research is needed to understand the potential risks and benefits these products may offer addicted adult smokers.

Nicotine Replacement Therapies: Nicotine replacement therapy (NRT) poses the lowest risk to health among all nicotine-containing products, and thus falls on the opposite end of the nicotine-delivery risk spectrum, whereas cigarettes are the most harmful. FDA-approved NRTs are designed to reduce symptoms of nicotine withdrawal and help adults quit smoking by delivering small amounts of nicotine to the brain without the toxic chemicals present in cigarette smoke. If used properly, NRTs are safe and effective cessation methods and can double an addicted smoker’s chances of successfully quitting cigarettes.11 NRTs are available both by prescription in the form of oral inhaler and nasal spray, and over-the-counter for adults age 18 and over as skin patches, lozenges, and gum.

The NRTs currently on the market are so safe that multiple types may be used together,12 and may even be started before a smoker actually quits.13  Both of these methods may increase the likelihood of cessation. But most NRTs have been on the market for over 20 years, and even with the use of these products, many smokers who try to quit are unsuccessful and require several attempts.

When FDA Commissioner Scott Gottlieb announced the agency’s comprehensive plan for nicotine and tobacco regulation in 2017, he made research of novel and effective therapeutic nicotine products for tobacco cessation a top priority. FDA’s Nicotine Steering Committee was formed and is tasked with evaluating safety and efficacy of therapeutic nicotine products and ensuring the agency’s policies enable the development of innovative products intended to help addicted adult smokers quit combustible tobacco use for good.

“We know that about 70 percent of adult smokers in the U.S. want to quit. In fact, nearly half try to quit each year. But few succeed. Use of FDA-approved NRT products is generally considered to double the likelihood of a successful quit attempt (with variations between products). Our ultimate goal is to help more smokers completely quit cigarettes.”  FDA Commissioner Scott Gottlieb, M.D. 


Additional Resources


1. U.S. Department of Health and Human Services (USDHHS). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
2. U.S. Department of Health and Human Services (USDHHS). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
3. U.S. Department of Health and Human Services (USDHHS). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General.Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010.
4. U.S. Department of Health and Human Services (USDHHS). A Report of the Surgeon General: Preventing Tobacco Use among Youth and Young Adults. We Can Make the Next Generation Tobacco-Free (Consumer Booklet). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012.
5. U.S. Department of Health and Human Services (USDHHS). E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016.
6. Blachman-Braun R, Del Mazo-Rodríguez RL, López-Sámano G, Buendía-Roldán I. Hookah, is it really harmless? Respiratory Medicine. 2014; 108(5):e661-e667.
7. U.S. Department of Health and Human Services (USDHHS). Women and Smoking. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2001.
8. U.S. Department of Health and Human Services (USDHHS). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Secondhand Smoke: What It Means to You (Consumer Booklet). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
9. Apelberg BJ, Feirman SP, Salazar E, et al. Potential Public Health Effects of Reducing Nicotine Levels in Cigarettes in the United States. The New England Journal of Medicine. 2018; (ISSN: 0028-4793).
10. National Academies of Sciences, Engineering, and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press. https://doi.org/10.17226/24952.
11. Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub5.
12. Sweeney CT, Fant RV, Fagerstrom KO, McGovern JF, Henningfield JE. Combination nicotine replacement therapy for smoking cessation: rationale, efficacy and tolerability. CNS Drugs. 2001;15(6): 453–467.
13. Carpenter MJ, Jardin BF, Burris JL, et al. Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: a review of the literature. Drugs. 2013;73(5): 407–426.



Audience: Health Professional, Public Health Community

Topics: Science/Research, chemicals, cigarettes, health education, prevention

Source: https://www.fda.gov/tobacco-products/products-guidance-regulations/nicotine-addictive-chemical-tobacco-products