Addiction Potential of Cigarettes With Reduced Nicotine Content in Populations With Psychiatric Disorders and Other Vulnerabilities to Tobacco Addiction | Psychiatry | JAMA Psychiatry | JAMA Network
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Original Investigation
October 2017

Addiction Potential of Cigarettes With Reduced Nicotine Content in Populations With Psychiatric Disorders and Other Vulnerabilities to Tobacco Addiction

Author Affiliations
  • 1University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
  • 2Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
  • 3Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 4Department of Applied Behavioral Science, University of Kansas, Lawrence
JAMA Psychiatry. 2017;74(10):1056-1064. doi:10.1001/jamapsychiatry.2017.2355
Key Points

Question  Would a national policy of reducing the nicotine content of cigarettes alter the addiction potential of smoking among adults with psychiatric disorders or other vulnerabilities to tobacco addiction?

Findings  In this multisite, double-blind, within-participant assessment of 169 adult smokers, the addiction potential of smoking was reduced by lowering the nicotine content of cigarettes to very low levels.

Meaning  A national tobacco regulatory policy that reduces the maximal nicotine content of cigarettes to low levels may help reduce smoking in populations that are highly vulnerable to tobacco addiction.

Abstract

Importance  A national policy is under consideration to reduce the nicotine content of cigarettes to lower nicotine addiction potential in the United States.

Objective  To examine how smokers with psychiatric disorders and other vulnerabilities to tobacco addiction respond to cigarettes with reduced nicotine content.

Design, Setting, and Participants  A multisite, double-blind, within-participant assessment of acute response to research cigarettes with nicotine content ranging from levels below a hypothesized addiction threshold to those representative of commercial cigarettes (0.4, 2.3, 5.2, and 15.8 mg/g of tobacco) at 3 academic sites included 169 daily smokers from the following 3 vulnerable populations: individuals with affective disorders (n = 56) or opioid dependence (n = 60) and socioeconomically disadvantaged women (n = 53). Data were collected from March 23, 2015, through April 25, 2016.

Interventions  After a brief smoking abstinence, participants were exposed to the cigarettes with varying nicotine doses across fourteen 2- to 4-hour outpatient sessions.

Main Outcomes and Measures  Addiction potential of the cigarettes was assessed using concurrent choice testing, the Cigarette Purchase Task (CPT), and validated measures of subjective effects, such as the Minnesota Nicotine Withdrawal Scale.

Results  Among the 169 daily smokers included in the analysis (120 women [71.0%] and 49 men [29.0%]; mean [SD] age, 35.6 [11.4] years), reducing the nicotine content of cigarettes decreased the relative reinforcing effects of smoking in all 3 populations. Across populations, the 0.4-mg/g dose was chosen significantly less than the 15.8-mg/g dose in concurrent choice testing (mean [SEM] 30% [0.04%] vs 70% [0.04%]; Cohen d = 0.40; P < .001) and generated lower demand in the CPT (α = .027 [95% CI, 0.023-0.031] vs α = .019 [95% CI, 0.016-0.022]; Cohen d = 1.17; P < .001). Preference for higher over lower nicotine content cigarettes could be reversed by increasing the response cost necessary to obtain the higher dose (mean [SEM], 61% [0.02%] vs 39% [0.02%]; Cohen d = 0.40; P < .001). All doses reduced Minnesota Nicotine Withdrawal Scale total scores (range of mean decreases, 0.10-0.50; Cohen d range, 0.21-1.05; P < .001 for all), although duration of withdrawal symptoms was greater at higher doses (η2 = 0.008; dose-by-time interaction, P = .002).

Conclusions and Relevance  Reducing the nicotine content of cigarettes may decrease their addiction potential in populations that are highly vulnerable to tobacco addiction. Smokers with psychiatric conditions and socioeconomic disadvantage are more addicted and less likely to quit and experience greater adverse health impacts. Policies to reduce these disparities are needed; reducing the nicotine content in cigarettes should be a policy focus.

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