Henningfield J E, Benowitz N L, Slade J, Houston T P, Davis R M, Deitchman S D
Tob Control. 1998 Autumn;7(3):281-93. doi: 10.1136/tc.7.3.281.
To assess the feasibility of reducing tobacco-caused disease by gradually removing nicotine from cigarettes until they would not be effective causes of nicotine addiction.
Issues posed by such an approach, and potential solutions, were identified from analysis of literature published by the US Food and Drug Administration (FDA) in its 1996 Tobacco Rule, comments of the tobacco industry and other institutions and individuals on the rule, review of the reference lists of relevant journal articles, other government publications, and presentations made at scientific conferences.
The role of nicotine in causing and sustaining tobacco use was evaluated to project the impact of a nicotine reduction strategy on initiation and maintenance of, and relapse to, tobacco use. A range of potential concerns and barriers was addressed, including the technical feasibility of reducing cigarette nicotine content to non-addictive levels, the possibility that compensatory smoking would reduce potential health benefits, and whether such an approach would foster illicit ("black market") tobacco sales. Education, treatment, and research needs to enable a nicotine reduction strategy were also addressed. The Council on Scientific Affairs came to the following conclusions: (a) gradually eliminating nicotine from cigarettes is technically feasible; (b) a nicotine reduction strategy holds great promise in preventing adolescent tobacco addiction and assisting the millions of current cigarette smokers in their efforts to quit using tobacco products; (c) potential problems such as compensatory over-smoking of denicotinised cigarettes and black market sales could be minimised by providing alternate forms of nicotine delivery with less or little risk to health, as part of expanded access to treatment; and (d) such a strategy would need to be accompanied by relevant research and increased efforts to educate consumers and health professionals about tobacco and health.
The council recommends the following: (a) that cessation of tobacco use should be the goal for all tobacco users; (b) that the American Medical Association continue to support FDA authority over tobacco products, and FDA classification of nicotine as a drug and tobacco products as drug-delivery devices; (c) that research be encouraged on cigarette modifications that may result in less addicting cigarettes; (d) that the FDA require that the addictiveness of cigarettes be reduced within 5-10 years; (e) expanded surveillance to monitor trends in the use of tobacco products and other nicotine-containing products; (f) expanded access to smoking cessation treatment, and strengthening of the treatment infrastructure; and (g) more accurate labelling of tobacco products, including a more meaningful and understandable indication of nicotine content.
评估通过逐步去除香烟中的尼古丁直至其不再成为尼古丁成瘾的有效诱因来减少烟草所致疾病的可行性。
通过分析美国食品药品监督管理局（FDA）1996年烟草法规发布的文献、烟草行业及其他机构和个人对该法规的评论、查阅相关期刊文章的参考文献列表、其他政府出版物以及在科学会议上的发言，确定了这种方法所带来的问题及潜在解决方案。
评估了尼古丁在引发和维持烟草使用中的作用，以预测尼古丁减少策略对烟草使用的起始、维持及复吸的影响。探讨了一系列潜在的问题和障碍，包括将香烟尼古丁含量降低至非成瘾水平的技术可行性、代偿性吸烟可能会降低潜在健康益处的可能性，以及这种方法是否会助长非法（“黑市”）烟草销售。还讨论了实施尼古丁减少策略所需的教育、治疗和研究需求。科学事务委员会得出以下结论：（a）逐步从香烟中消除尼古丁在技术上是可行的；（b）尼古丁减少策略在预防青少年烟草成瘾以及帮助数百万当前吸烟者努力戒烟方面具有巨大潜力；（c）通过提供危害较小或几乎无危害的替代尼古丁递送形式，作为扩大治疗可及性的一部分，可将诸如对去尼古丁香烟的代偿性过度吸烟和黑市销售等潜在问题降至最低；（d）这样的策略需要伴随相关研究，并加大力度向消费者和健康专业人员开展有关烟草与健康的教育。
委员会建议如下：（a）所有烟草使用者均应以戒烟为目标；（b）美国医学协会应继续支持FDA对烟草产品的监管权，以及FDA将尼古丁归类为药物并将烟草产品归类为药物递送装置；（c）鼓励开展有关可能降低香烟成瘾性的香烟改良研究；（d）FDA应要求在5至10年内降低香烟的成瘾性；（e）扩大监测以监控烟草产品和其他含尼古丁产品的使用趋势；（f）扩大戒烟治疗的可及性，并加强治疗基础设施；（g）对烟草产品进行更准确的标签标注，包括更有意义且易于理解的尼古丁含量说明。
