The impact of very low nicotine cigarettes on cannabis and alcohol use during a 12-week clinical trial.

INTRODUCTION: In January 2025, the US FDA announced a proposed rule for a reduced nicotine standard (RNS) in cigarettes. Evidence suggests that the use of very low nicotine content (VLNC) cigarettes decreases cigarette use and tobacco toxicant exposure; however, unintended consequences, such as a resulting increase in use of other reinforcing substances (e.g., cannabis, alcohol), are a concern. This secondary analysis aims to provide an ecologically valid assessment of the impact of RNS on alcohol and cannabis use. METHODS: During 2018-2022, participants were randomized to VLNC or normal nicotine content (NNC) cigarettes for 12 weeks. All participants had access to non-combusted nicotine products through an experimental tobacco marketplace. We examined the association between cigarette condition and alcohol or cannabis use, among participants reporting 1) use of each substance at baseline, to examine whether condition impacted frequency of use and 2) non-use at baseline, to examine differences in uptake during the study. RESULTS: Study condition did not affect frequency of alcohol or cannabis use among those reporting baseline use (mean differencealcohol = 0.90, 95% confidence interval [CI]: -5.33-7.03; mean differencecannabis = 0.87, 95% CI: -8.00-9.24), nor did it affect the frequency among those reporting baseline non-use (mean differencealcohol = 0.83, 95% CI: -0.14-1.80; mean differencecannabis = -1.92, 95% CI: -5.02-1.19) or likelihood of uptake (adjusted odds ratio [AOR]alcohol = 1.09, 95% CI: 0.85-1.38; AORcannabis = 1.20, 95% CI: 0.97-1.45). CONCLUSIONS: This study adds to the evidence that that unintended consequences of an RNS as it relates to significant increases in alcohol or cannabis use among people who smoke are unlikely.

Duke Scholars

Author F Joseph McClernon Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...