Thu Jan 18

Reducing nicotine in tobacco would help people quit – without prohibiting cigarettes

Written by: Richard Edwards, Professor of Public Health, University of Otago

Supporters of the new government’s plan to repeal Aotearoa New Zealand’s smokefree legislation ^[1] have claimed victory against “prohibition”^[2].

Introduced under Jacinda Ardern’s government, the smokefree law ^[3] came into effect in January 2023 and included a commitment to introduce mandated “denicotinisation” (cutting the nicotine to levels that are no longer addictive) of smoked tobacco products.

Studies estimated this measure would have greatly reduced ^[4] smoking and helped prevent avoidable death and suffering.

However, opponents, notably the tobacco industry and its allies, criticised the measure as “prohibition”.

In a submission to the select committee ^[5] on the smokefree legislation, Imperial Tobacco claimed

Mandating very low nicotine levels is equivalent to prohibiting the regular cigarettes currently consumed by millions of adult smokers.

In its submission, Japan Tobacco International wrote

The nicotine reduction policy is a de facto prohibition on conventional cigarettes and will have dire consequences.

But are the tobacco industry’s claims really true? And why has the current Health Minister gone from supporting denicotinisation to being set to repeal it?

Misunderstanding prohibition

When commentators label a public health measure as “prohibition”, they usually draw a comparison with alcohol prohibition in the United States ^[6] in the 1920s and 1930s. A statement that “prohibition never works” typically follows.

Yet, these arguments fail on at least three grounds.

First, they imply prohibition is never justified and fail to mention other highly successful “prohibitions”, such as the elimination of asbestos, leaded paint and petrol, or chlorofluorocarbons in aerosols. Or water quality standards prohibiting hazardous drinking water or car safety requirements prohibiting unsafe cars.

Second, they offer only a simplistic interpretation of the experience of the American prohibition era. Although not without its problems, it did substantially reduce alcohol consumption ^[8] and have positive impacts on population health.

Third, denicotinisation of cigarettes and tobacco is very different from alcohol prohibition in the US in the 1920s. Claiming “prohibition never works” based on that single experience a century ago is vacuous and wrong. Denicotinisation applies to a different product, in a different setting, and in a different time.

More fundamentally, denicotinisation of cigarettes and tobacco is not a prohibition.

Prohibition requires that something is prohibited. So what is that something under the smokefree law?

Not cigarettes, as tobacco products would still be available to people who wish to buy and use them, but they would no longer contain sufficient nicotine to be addictive. Nor is it banning nicotine; anyone walking down a street in any town or city centre in Aotearoa will see numerous specialist vape stores and other retailers selling nicotine-containing vapes.

Harm reduction, not prohibition

So if denicotinisation is not prohibition, what is it? And is it a good idea?

Denicotinisation is a form of harm reduction. Although denicotinised cigarettes would still create harmful toxins when smoked, they would cause less overall harm because they are no longer addictive and people would stop using them.

Research ^[9] found participants given denicotinised cigarettes smoked less and were more likely to quit smoking, because they found the cigarettes unrewarding and less appealing to smoke.

People who cannot stop using nicotine products completely would be encouraged to switch to less harmful products, such as vaping, which would still deliver nicotine.

Our own research ^[10] showed a strong majority of people who smoke in New Zealand regret starting, wanted to quit, and have tried to quit. However, almost nine out of ten felt addicted to smoking.

Removing the nicotine from cigarettes and tobacco would liberate people from that addiction. Almost half of our study respondents anticipated that if tobacco products were denicotinised they would reduce the number of cigarettes they smoked, would stop smoking, or switch to alternative products like e-cigarettes.

For ethical reasons, there are no trials giving young people denicotinised cigarettes. However, logic suggests adolescents and youth would be less inclined to try cigarettes with minimal nicotine content, and even if they did, they would be very unlikely to become addicted and continue to smoke long-term.

Denicotinisation is therefore not, as it is often portrayed, a constraint on freedom. It would enhance freedom. It would help liberate people who smoke from the grip of cigarettes and protect future generations from the risk of lifelong addiction and the terrible health effects that so often follow.

A question of life and death

Modelling studies ^[12] suggest denicotinisation would rapidly and equitably reduce smoking and smoking related disease, preventing 7570 deaths from 2020–2040 in Aotearoa, including 4260 Māori deaths.

While he was still in opposition, the current Health Minister Shane Reti acknowledged denicotinisation as a powerful measure that would do most of the “heavy lifting” to reduce smoking.

During the debates on the smokefree law, Reti strongly supported denicotinisation ^[13] and submitted a Supplementary Order Paper to the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act ^[14], arguing it should be the first measure implemented.

Reti has since abandoned this position to support the coalition government’s repeal ^[15].

Health professionals protest plans to repeal smokefree legislation with signs targetting Health Minister Shane Reti.

Health professionals protesting plans to repeal NZ’s smokefree law, with Health Minister Shane Reti coming under fire for changing his stance. Lynn Grieveson/Getty Images ^[16]

The government seems unaware of, or is ignoring, the research evidence and the very strong support for denicotinisation among the general population ^[17] and among youth and young adults ^[18].

Numerous surveys from around the world ^[19], including our studies in Aotearoa ^[20], have found most people who smoke (or who have recently quit) strongly support denicotinisation.

Almost the only groups that don’t support this measure are the tobacco industry and their apologists. Formerly secret internal tobacco company files reveal the reason for their opposition. A 1959 British American Tobacco document explained ^[21]

To lower nicotine too much might end up destroying the nicotine habit in a large number of consumers and prevent it ever being acquired by new smokers.

The New Zealand government should reverse its decision to repeal the smokefree legislation. Doing so will reassert themselves as ethical and principled leaders, whose evidence-based decisions will enhance individual New Zealanders’ freedom and health.