Could nicotine play a role in harm reduction?

Nicotine is not the primary cause of smoking-related diseases 

Nicotine is an alkaloid produced by many plants of the Solanaceae family. Within this family of plants, tobacco contains by far the highest levels of nicotine. It is present in cigarettes, e-cigarettes, other smoke-free alternatives as well as in nicotine replacement therapies. Nicotine is addictive and not risk free, but it is not the primary cause of smoking-related diseases.  

The Commissioner of the U.S. Food and Drug Administration (FDA) and Director of the FDA’s Center for Tobacco Products wrote in 2017: “Nicotine, though not benign, is not directly responsible for the tobacco-caused cancer, lung disease, and heart disease that kill hundreds of thousands of Americans each year.” 

Tobacco smoke contains more than 6,000 chemicals, nearly 100 of which have been classified by public health agencies as harmful or potentially harmful constituents. Chronic exposure to high levels of those toxic substances emitted in the smoke when tobacco is burned is causally linked to smoking-related diseases such as cardiovascular and respiratory diseases, and lung cancer. 

Our heated tobacco products heat tobacco without burning, at temperatures below the ignition temperature of tobacco. At these lower temperatures, nicotine and flavors are released from tobacco while generating on average about 90% to 95% lower levels of chemicals that are harmful or potentially harmful compared with cigarette smoke. 

Since the regulatory focus is shifting from the harms of cigarettes to health effects of nicotine, more research is needed on how nicotine affects the body and the brain, and how this varies according to route of administration. PMI is dedicated to substantiating the risk profile of our smoke-free products, and having a better understanding of nicotine and its role in tobacco harm reduction is part of that. 

For more information on this topic, see the presentation by Dr. Badrul Chowdhury, PMI’s Chief Life Sciences Officer, Smoke-Free Products, at our 2023 Investor Day and the PMI Integrated Report 2023.  

 

Nicotine has a variety of effects 

Nicotine binds to nicotinic acetylcholine receptors in the central and peripheral nervous system to elicit a variety of physiological responses, for example, a transient increased heart rate and blood pressure. These effects can be influenced by the route of administration, such as via the lungs, mouth, or skin. Each of these routes affects the rate and amount of nicotine taken up into the body.  

Many people who smoke cigarettes indicate that they do so for the perceived benefits, including enjoyment, stress management, and relaxation. Additionally, some studies report that nicotine can enhance cognitive processes such as improving attention, memory, and fine motor function. 

Sustained nicotine use can also induce changes in the brain’s reward and stress systems, leading to withdrawal symptoms, although the effects are transitory and reversible once people quit and successfully abstain from using tobacco and nicotine products. It is well understood that nicotine is addictive and not risk free. However, whilst it can be difficult for some, anyone can quit tobacco and nicotine altogether with sufficient motivation. Some studies have found that nicotine may have adverse effects on fetal development such as low birth weight. For these reasons, some populations should avoid nicotine-containing products altogether, including minors, women who are pregnant or breastfeeding, and people with pre-existing conditions, including heart disease, high blood pressure, diabetes, or epilepsy. 

The scientific community continues to explore ways in which nicotine and other alkaloids present in the tobacco plant can be isolated and potentially used as therapeutic compounds. For instance, scientists are studying nicotine as a possible active ingredient in pharmaceutical applications for treating schizophrenia, depression, and other anxiety disorders. Scientists are also examining the potential effects of nicotine on treating conditions such as Tourette’s, Alzheimer’s, Parkinson’s, attention deficit hyperactivity disorder (ADHD), and other diseases. Cellular, animal, and human studies have yielded some promising results, yet existing data are still not conclusive, and nicotine’s addictiveness could be a limiting adverse effect for its development as a therapeutic compound for human health. 

 

The role of nicotine in smoke-free products 

PMI has developed smoke-free products that deliver nicotine with significantly lower levels of the harmful chemicals found in tobacco smoke. The presence of nicotine in smoke-free products is an important factor among others, including ritual, sensory, and taste, to successfully move adults away from cigarettes through adoption of smoke-free products.  

These products have the potential to reduce the health harm of cigarette smoking. PMI continues to conduct scientific programs to demonstrate the reduced-risk profile of these products when used by adult smokers who would otherwise continue to smoke.  

 

Nicotine research supports regulators and policymakers 

At PMI, research and development is the catalyst for our business transformation. The rigor with which we conduct our research—and the openness with which we share our methodologies and findings—builds confidence in our science among the scientific community, regulators, and our consumers.  

Scientific research from any corporation may be met with skepticism. Sharing our science and listening to feedback are critical to both encouraging debate with experts and the broader public and building trust. We produce a regular briefing through our Scientific Update publication, which complements what we share throughout the year via articles in peer-reviewed journals, presentations at conferences, and the PMI Science website. From 2008 through 2023, we have published over 532 papers on smoke-free products and related science in peer-reviewed publications. As more and more new products emerge that separate nicotine from some or all of the aspects of the smoking ritual, much more research is needed to fully understand these new products as well as the role of nicotine itself.  

 

What next for nicotine? 

Many questions remain about nicotine, including its long-term effects, separate from the effects of smoking and the addiction potential of different types of products. Steps should be taken by academia and industry to fully understand the short- and long-term impacts of nicotine use. We plan to contribute to this understanding by conducting and publishing dedicated research focusing on understanding the effects of nicotine. As such, our website PMIScience will remain up-to-date with our latest findings.