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XIII meeting SRNT Europe, Antalya Turkey 8-11 Sept 2011
Murray Laugesen, MB ChB
FNZCPHM
Aim To assess
options for reducing nicotine content in combustible tobacco products
by 2020 to less addictive levels.
Justification
for lowering nicotine content of cigarettes
Smoking is highly
addictive
NZ health warning
85% of smokers want cigarettes to be less
addictive Thomson, Wilson NZMed J. 2010
Mouth smoke exposure (MLE) of nicotine is high
in NZ cigarettes –Mariner
2010. (2nd highest of 8 countries).
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Preliminary step: Testing and labeling for nicotine content
Fig.1 Nicotine
content: NZ cigarettes
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Per 0.7 g tobacco NZ PH Report 1997
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For all top-selling brands, nicotine content
exceeded 10 mg per cigarette. Some RYO brands contain nearly 20 mg nicotine
per 0.7 g cigarette. Initially MN, LN, and VLN brands would be made
to order.
Table 2. Proposed
tax of nicotine content by cigarette type
|
Per
cigarette
|
Nicotine content
Mg
|
Nicotine
ISO
yield
mg
|
Nicotine
tax
NZ$
|
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High HN
|
12
|
0.8
|
0.50
|
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Medium MN
|
8
|
0.6
|
0.38
|
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Low LN
|
4
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0.4
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0.25
|
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Very low VLN
|
2
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0.2
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0.00
|
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1.
Sinking lid on nicotine content, all brands together, either
gradually or rapidly
Either over 5-10
years, or, over one year, reducing to VLN levels.
§
Government mandates
lowered nicotine content.
§
Once only VLN are on
sale, smoking soon becomes
pointless.
Disadvantages
§
Border control needed
against HN.
§
Prohibition on smokers
obtaining satisfying doses of nicotine.
§
Some compensatory smoking
when using MN and LN cigarettes.
CPD = Cigarettes per day.
HN = High nicotine as in Table 2. Many usual
brands exceed 12 mg..
MN, LN
= medium, low nicotine
content.
VLN = Very low nicotine content, also called
de-nicotinised cigarettes)
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2. Nicotine content
taxation of cigarettes
Tax is levied per milligram of nicotine content per unburnt
cigarette. Rate proposed initially is 4 cents per mg. After nicotine tax, HN
sales will fall; VLNs cost no extra, and their sales will increase
most.
No tax on nicotine in medicines or electronic cigarettes as
this nicotine is not harmful.
Biological effects
of VLNs
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Cravings reduction: VLNs to HNs fraction*
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85%
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CPD#
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-5.2 CPD
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Motivation to smoke#
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-31%
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% of brain α4 β2 nicotine receptors populated**
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MN 78%
VLN 23%
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*Barrett 2010 #Donny
2007. **Brody 2009.
Table 1. Effect on smokers
not intending to quit who switch 100% to VLN cigarettes Benowitz 2007
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Biological effect
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% change
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Cigarettes smoked per day
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-53
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Nicotine inhaled per day
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-44
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Addiction score FTND
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-42
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Carcinogen NNAL (urine)
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-55
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CO exhaled
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-34
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Self efficacy in quitting
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+100
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Table 3.
Anticipated effect of proposed nicotine tax on nicotine yield
and cost of smoking, by number of HNs smoked.
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No. of HNs smoked per day
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Nicotine yield % change
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$ cost of
smoking,
% change#
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0
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-
75%
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0%
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2
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-
67%
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+12%
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5
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-
50%
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+32%
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20
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0%
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108%
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# Incorporates cascade effects of
trade share increases based on previous responses to tax, and GST,
2000-2010.
Nicotine
tax, though completely novel, and untried, has advantages over a sinking
lid, for like tobacco tax, by increasing price, it can decrease CPD,
increase revenue, while preserving nicotine choices. Additionally,
nicotine tax will switch many smokers from HN to VLN cigarettes, and
thus lower addiction scores, lower motivation to continue smoking,
and further reduce CPD.
Simulation studies are needed.
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1.
Can nicotine tax reduce smoking
more effectively than tobacco tax for a given price increase?
2. Does a nicotine tax increase quitting long term?
Continued..
Table 4. Estimated
price-only effects of nicotine tax on total cigarette sales
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HN Cigarettes
Smoked per day
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%
increase in price
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Change in sales overall*
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2
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12
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-16
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5
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32
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-43
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20
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108
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-144?
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* assuming all smokers
smoked this many HNs. Based on real price elasticity, NZ 2000-2010,
of -1.33 of tobacco tax effects aided by a comprehensive tobacco
control programme.
Funding: Nil. Conflict of
interest Nil.
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