VLN Cigarettes Do Not Cause Compensatory Smoking

(Version 1.0 — Last updated: 6/22/22)

Introduction and Answer

When people first hear of lowering the nicotine content in cigarettes, the most often first reaction is that it would cause people to smoke “more”, called “compensatory smoking”, rather than to smoke less.

This first reaction that lower nicotine means more smoking is indeed intuitive, but is this intuition indeed correct?

Let’s answer this question right upfront now, and then go into a deep dive into the reasons for the answer, the misconceptions surrounding nicotine, broader issues, concluding with a discussion of published scientific evidence and links.

  • Question: Does lower nicotine in cigarettes cause you to smoke more?
  • Answer: No, and there is large and increasing body of scientific research to support this claim

Table of Contents

What is Nicotine in Smoking?

First, let’s define what nicotine is and the role it plays in smoking.

Nicotine is the substance in tobacco that causes you to become addicted to smoking. Since smoking is the number one preventable cause of death, it’s a important public health issue to reduce or stop smoking.

On June 21, 2022, the FDA quietly made it public their intention to require a maximum amount of nicotine in all tobacco below the addictive threshold, with the the goal of reducing smoking and thus the burden of disease for suffering and death.

This policy decision is based on a large corpus of scientific research showing that nicotine in the amount of 0.5 mg per gram of tobacco is the addictive threshold, as in the amount of nicotine below this threshold oes not appear to be addictive.

For comparison, conventional cigarettes may contain anywhere from 10 mg to 20 mg of nicotine per gram of tobacco, compared to a new type of Very Low Nicotine (VLN) cigarettes that contain below 0.5 mg nicotine per gram of tobacco, which is 95% less nicotine.

But how is the amount of nicotine measured?

The Difference Between Nicotine Yield vs. Content

Smokers and non-smokers alike know about the “Light” or “Slim” version of cigarettes. Examples include: Virginia Slims, Marlboro Lights Gold, Pall Mall Super Slims Silver 100s, Camel One, Winston XSence White Mini, among many others.

However, the reason they’re “Lights” or “Slims” is not because of the tobacco itself contains less nicotine, but rather because the type of paper or filters used to create the cigarettes leads to a lower reading of nicotine when measured by a machine, “which consists of taking a standard number of puffs of fixed duration and at fixed intervals until the cigarettes burn to the filter overwrap.” [Source: The Role of Compensation in Nicotine Reduction]

Smokers can do many things to increase their nicotine exposure, such drawing in a deeper breath or covering up the holes on their filters.

VLN Cigarettes are different from these Lights or Slims in that they actually contain different nicotine “content. More precisely.

  • Nicotine “Yield” is the amount of nicotine that’s measured by a machine when simulating smoking. It can be altered by different papers or holes in the filters of Lites and Slims. Smokers can adjust the amount of nicotine they ingest by altering their smoking behavior, such as by drawing in more deeply or covering the dilution holes on the filters. The tobacco is indistinguishable from normal tobacco containing nicotine content of 10x to 20x higher as measured by machines, so they’re able to get more nicotine by these
  • Nicotine “Content” in contrast, is a property of the tobacco itself and cannot be altered by the way a smoker inhales or whether they cover the holes on the cigarette filters. It’s a far better effective measurement of nicotine since it’s a property of the tobacco itself rather than the delivery mechanism such a cigarette paper or filter or the compensatory behavior. VLN tobacco contains less than 0.5mg of nicotine per cigarette, which is 95% less nicotine than normal cigarettes at 10mg to 20mg per cigarette.

What Lower Nicotine Really Means for Compensatory Smoking

So although it’s more intuitive that people would smoke more due to lower nicotine, it’s because people are talking implicitly about nicotine “yield“, where people can indeed change behavior to get enough nicotine, since the nicotine is there in the tobacco itself.

In contrast, if there’s lower nicotine “content“, as in the property of the cigarette itself, then this is actually impossible since there is not enough nicotine in the entire cigarette.

As a comparison, VLN contains nicotine of less than < 0.5 milligrams per cigarette. Compared to conventional cigarettes that contain 10 – 20 mg of nicotine per cigarette. To get the same amount of nicotine, a person would have to smoke 20 to 40, or even more cigarettes. Although this is “theoretically” possible, it’s effectively impossible mechanically and because smokers tend to satisfy their nicotine cravings before the full nicotine amount in conventional cigarettes.

Very Low Nicotine Cigarettes

Now that we have distinguished the difference between low nicotine “yield” and how it’s a far less accurate measure than low nicotine “content”, the question then becomes whether cigarettes with low nicotine content do indeed lead to “more” smoking.

The cumulative evidence in the Science says it does not. Provided here are a selected subset of published research. There are many more, and the reader is encouraged to search PubMed using a combination of keyphrases such as: “compensatory smoking”, “low nicotine” or “smoking cessation”.

When citing journal articles, the name of the paper is provided, with a full citation is located at the end of the page, enumerated with the full list of authors and journal citation including DOI.

Reference 1: Randomized Trial of Reduced-Nicotine Standards for Cigarettes
— Published in: The New England Journal of Medicine

To start, let’s consider the ideas in this video. this video summarizes the results in a publication in the prestigious New England Journal of Medicine.

Lower nicotine cigarettes cause less smoking, from: Randomized Trial of Reduced-Nicotine Standards for Cigarettes

Conclusion
In this 6-week study, reduced-nicotine cigarettes versus standard-nicotine cigarettes reduced nicotine exposure and dependence and the number of cigarettes smoked. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration Center for Tobacco Products; ClinicalTrials.gov number, NCT01681875.)

The research cigarettes used in the study come from the same plant biotechnology as VLN cigarettes pictured below.

VLN Kings and VLN Menthol Kings

Reference 2. The Role of Compensation in Nicotine Reduction
— Published in: Nicotine and Tobacco Research

Conclusions
The available research on switching from NNCs to VLNCs shows minimal evidence of compensatory smoking such that smokers do not smoke more cigarettes per day and are not exposed to higher levels of tobacco combustion toxicants. Furthermore, mathematical estimations based on the nicotine availability in VLNCs compared with NNC cigarettes with consideration of potential increases in bioavailability that could occur with intensive smoking suggest that substantial compensation would be impossible. It is much more likely that smokers who are unable to tolerate the extent of proposed nicotine reduction would switch to other sources of nicotine, rather than try to compensate by smoking more VLNC cigarettes more intensively.

Reference 3. The Impact of Exclusive Use of Very Low Nicotine Cigarettes on Compensatory Smoking: An Inpatient Crossover Clinical Trial
Published in Cancer Epidemiology, Biomarkers, and Prevention

Conclusions
Among current smokers who exclusively used VLNC cigarettes for 4 days, there was no significant compensatory smoking behavior.
Impact
These data, combined with the larger body of work, suggest that a mandated reduction in nicotine content is unlikely to result in an increase in smoking behavior to obtain more nicotine.

4. Mouth-Level Nicotine Intake Estimates from Discarded Filter Butts to Examine Compensatory Smoking in Low Nicotine Cigarettes
Published in Cancer Epidemiology, Biomarkers, and Prevention

Conclusions
Reductions in nicotine content did not result in compensatory changes in how intensively participants smoked research cigarettes.
Impact
Combined with data from clinical trials showing a reduction in cigarettes smoked per day, these data suggest that a reduction in nicotine content is unlikely to result in increased smoke exposure.

Discussion of Published Research Results

This selected set of publications have provided a body of scientific evidence that is expanding rapidly from the publications of research based on previous and ongoing clinical studies. More research will be added to this page as time goes on

Nicotine in a Broader Context

Mitch Zeller The past, present, and future of nicotine

The following video presentation by Mitch Zeller, former Director of the FDA’s Center for Tobacco Products goes into far more detail about how nicotine addiction in a wider context, including a discussion about many topics covered in this article such as the difference between effective nicotine “yield” as measured by a machine and usually involved with misinformation around compensatory smoking, and nicotine content as in the intrinsic nicotine properties of tobacco.

Because the dollar stakes are so high with global revenues in the tobacco industry at $850 Billion in 2021 and growing annually at 2.4% from 2022-2030 (Source: Grand View Research), the profit motive is so overwhelming and causes the issue of nicotine to involve a lot of intentional misinformation that seeps into the political realm.

Hopefully resources like this article and website can help clear up some intentional misinformation for the purpose of public health.

Mitch Zeller, former Director of the FDA’s Center for Tobacco Product presenting

Full References

Reference 1. Randomized Trial of Reduced-Nicotine Standards for Cigarettes

Eric C. Donny, Ph.D., Rachel L. Denlinger, B.S., Jennifer W. Tidey, Ph.D., Joseph S. Koopmeiners, Ph.D., Neal L. Benowitz, M.D., Ryan G. Vandrey, Ph.D., Mustafa al’Absi, Ph.D., Steven G. Carmella, B.A., Paul M. Cinciripini, Ph.D., Sarah S. Dermody, M.S., David J. Drobes, Ph.D., Stephen S. Hecht, Ph.D., Joni Jensen, M.P.H., Tonya Lane, M.Ed., Chap T. Le, Ph.D., F. Joseph McClernon, Ph.D., Ivan D. Montoya, M.D., M.P.H., Sharon E. Murphy, Ph.D., Jason D. Robinson, Ph.D., Maxine L. Stitzer, Ph.D., Andrew A. Strasser, Ph.D., Hilary Tindle, M.D., M.P.H., and Dorothy K. Hatsukami, Ph.D.

N Engl J Med 2015; 373:1340-1349
DOI: 10.1056/NEJMsa1502403

Reference 2. The Role of Compensation in Nicotine Reduction

Neal L Benowitz, MD, Eric C Donny, PhD, Kathryn C Edwards, PhD, Dorothy K Hatsukami, PhD, Tracy T Smith, PhD
Nicotine & Tobacco Research, Volume 21, Issue Supplement_1, December 2019, Pages S16–S18
DOI: 10.1093/ntr/ntz120

Reference 3. The Impact of Exclusive Use of Very Low Nicotine Cigarettes on Compensatory Smoking: An Inpatient Crossover Clinical Trial

Tracy T. Smith; Joseph S. Koopmeiners; Cassidy M. White; Rachel L. Denlinger-Apte; Lauren R. Pacek; Víctor R. De Jesús; Lanqing Wang; Clifford Watson; Benjamin C. Blount; Dorothy K. Hatsukami; Neal L. Benowitz; Eric C. Donny; Matthew J. Carpenter

Cancer Epidemiol Biomarkers Prev (2020) 29 (4): 880–886.
DOI: 10.1158/1055-9965.EPI-19-0963

Reference 4: Mouth-Level Nicotine Intake Estimates from Discarded Filter Butts to Examine Compensatory Smoking in Low Nicotine Cigarettes 

Tracy T. Smith; Joseph S. Koopmeiners; Dorothy K. Hatsukami; Katelyn M. Tessier; Neal L. Benowitz; Sharon E. Murphy; Andrew A. Strasser; Jennifer W. Tidey; Benjamin C. Blount; Liza Valentin; Roberto Bravo Cardenas; Clifford Watson; James L. Pirkle; Eric C. Donny

Cancer Epidemiol Biomarkers Prev (2020) 29 (3): 643–649.
DOI: 10.1158/1055-9965.EPI-19-0905