Study: Smokers Switching to E-cigarettes Should Start with High-Nicotine Products

On March 5, according to Vapingpost, a bill initiated by Frank Pallone, chairman of the House Energy and Commerce Committee, proposes to set nicotine limits on tobacco products, a measure first suggested by former FDA Commissioner Scott Gottlieb in 2017.

"It is disappointing that the FDA seems willing to shelve this critical solution rather than commit to specific regulatory actions that could lead to significant public health benefits," Pallone wrote in a letter to FDA Commissioner Stephen Hahn. Pallone and co-sponsor Donna Shalala did not include specific nicotine limits in their bill, as they hope the FDA will set what it deems appropriate limits.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, stated that the government missed a golden opportunity to combat youth smoking by not establishing nicotine limits. Myers said, "Scott Gottlieb is gone, and it is clear that he was politically intervening in this matter. Political decision-makers have taken over."

Public health experts have long pointed out that setting nicotine limits on safer alternatives (such as vaping products) would adversely affect national smoking rates, prompting former smokers who switched to e-cigarettes to return to smoking. Data from the UK, where the EU TPD set limits, also confirmed these predictions.

Additionally, civil rights organizations, including the ACLU, have opposed the proposed bill, urging lawmakers to abandon the idea, stating that it would disproportionately pressure Black communities, among other concerns.

Moreover, health agencies across the EU are troubled by nicotine limits. In fact, experts in the UK have expressed concern, despite the fact that Public Health England has publicly recognized safer alternatives as smoking cessation tools, the number of people switching to e-cigarettes has dropped from 800,000 to 100,000 per year.

Furthermore, a 2018 study confirmed that reducing nicotine levels in e-cigarettes could lead smokers to use their devices more frequently, thereby increasing their exposure to toxins.

Researchers at London South Bank University noted that the findings suggest that smokers looking to switch to e-cigarettes should start with higher nicotine levels rather than lower ones to reduce compensatory behaviors and the amount of e-liquid used.

The study found that users of low-nicotine e-liquids not only became more dependent on nicotine but also vaped more frequently, with some even enhancing the functionality of their vaping devices.

The study concluded: "The use of lower nicotine concentration e-liquids may be associated with compensatory behaviors (e.g., higher puff frequency and duration), increased negative emotions, cravings to vape, and formaldehyde exposure."

Researchers added that despite this "compensatory" behavior, users of low-nicotine e-cigarettes still fail to achieve satisfactory nicotine levels. Therefore, lead author Dr. Lynne Dawkins concluded that former smokers should avoid starting with low nicotine levels, as this may make them more susceptible to relapse.