The Food and Drug Administration unveiled last week what may be one of the most important public-health initiatives of this century: an ambitious long-term strategy to finally end tobacco’s cycle of addiction and death, a scourge that has taken the lives of millions of Americans over centuries of cultivation and consumption. The FDA should move quickly to make this vision a reality - more quickly than it did under the Obama administration.
Though smoking rates are at historic lows, the habit still kills roughly half a million people every year. Meanwhile, some 2,500 youths light up for the first time every day, representing a new generation of smokers who, absent intervention, will refill the ranks of those destined to die prematurely due to their nicotine dependence.
Nicotine is astonishingly addictive, working its calming effects on users with incredible speed when combusted along with everything else in tobacco leaves - including a range of toxins. Public-health authorities have encouraged people for years to get their nicotine fix some other way, including by chewing gum or wearing a patch. More recently, e-cigarettes have become popular as an alternative nicotine delivery mechanism. But millions continue to smoke.
So the FDA is proposing to lower nicotine levels in combustible cigarettes to minimally addictive or non-addictive levels. Commissioner Scott Gottlieb explained that allowing nicotine levels to remain the same in gums, patches and e-cigarettes will encourage smokers to move toward “products capable of delivering nicotine without having to set tobacco on fire,” which is by far the riskiest way to obtain the drug. There is a risk that addicts would simply take deeper puffs or hold smoke in their lungs longer, seeking to maximize their nicotine hit. But these behaviors would be minimized if nicotine levels were not tapered down slowly but cut dramatically all at once, spurring smokers accustomed to a certain level of nicotine intake to switch immediately to non-tobacco alternatives.
The most profound gains, however, would take time to see. Nearly all habitual smokers get hooked in their teens. No public-health authority can stop all young people from experimenting with cigarettes. But by making cigarettes far less addictive, the FDA can minimize the number of lifelong smokers that teen experimentation produces.
The role of e-cigarettes in this initiative is still controversial. Anti-smoking activists are wary of the devices, which vaporize nicotine-laced liquid for inhalation, because they can still hook people on nicotine, their various flavorings seem to appeal to teens and it is not entirely clear how safe “vaping” is. Ideally, smokers who cannot quit would move to e-cigarettes, and teen use would be limited. The FDA has begun to regulate the e-cigarette industry, but the agency also announced last week a slight relaxation of its timeline on enforcing some rules.
The sooner the FDA makes good on its long-term vision - low-nicotine cigarettes along with a well-regulated e-cigarette industry - the better.
The FDA should move with determination now.