Cigarette nicotine levels to make ‘monumental’ shift, and Pa. needs to prepare

It’s been a busy year, so many people likely missed some significant news from the Food and Drug Administration in June.

That month, the agency released a new proposal to reduce the maximum level of nicotine — a highly addictive substance — in cigarettes. Commercially sold cigarettes in the U.S. would contain approximately 95% less nicotine, a dramatic change. The new nicotine level would make cigarettes “minimally addictive” — meaning, nicotine levels would be so low that some smokers might no longer be hooked on cigarettes.

This shift, if it occurs, would be monumental. According to the FDA, lowering nicotine levels could prompt five million people to quit smoking within just the first year. It could also save millions of lives and prevent millions more young people from getting hooked in the future.

“Lowering nicotine levels could prompt five million people to quit smoking within just the first year.”

This policy could go into effect as early as May 2023. So what does this mean for Philadelphians?

While cigarette smoking has declined over the last decade, the latest smoking rates in the city remain higher than the national average. In 2019, roughly 23% of men and 17% of women living in Philadelphia smoked cigarettes, but those rates increased among people living in poverty.

Most smokers want to quit. For people who have been smoking for years, a dramatic reduction in nicotine will render their favorite brand less addictive and, in turn, less rewarding, which could make it easier to give up the habit. But for many smokers, that won’t be enough to get them to quit for good. For that to happen, more support is needed.

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The Centers for Disease Control and Prevention recommends that Pennsylvania dedicate $140 million to programs to help people stop smoking and prevent them from starting, but the state spends only $18 million in state and federal funding on these programs — earning Pennsylvania an F grade from the American Lung Association.

Pennsylvania needs to make these programs more of a priority, particularly for low-income people living in Philadelphia, a population with few resources to quit. It’s a great time to dedicate more state funding to these services, to help prepare Philadelphia smokers for the dramatic decrease in nicotine. Once this policy goes into effect, systems will need to be in place to meet growing demand for psychosocial support and services to help smokers quit.

For example, more funding would allow for expanding insurance coverage for evidence-based treatments and would bolster current resources such as behavioral counseling and smoking cessation medications. These expanded services would be coupled with existing programs such as the state quitline, or state-specific programs such as Text2quit, which sends smokers tailored text messages leading up to a date when they have chosen to quit. Another resource is Quitlogix, a state resource that connects people with personal coaches to help them quit.

Counseling and medication are among the most effective ways to stop smoking. Leading up to May 2023, the state will have to expand the availability of these supports, including investing in the infrastructure of public health organizations, departments, and nonprofits that are currently championing this work in Pennsylvania.

A good change is coming. Pennsylvania needs to prepare for it.

Teresa DeAtley is a postdoctoral fellow in the Perelman School of Medicine at the University of Pennsylvania.