Big Question 7 - What is Nicotine?

Is nicotine addictive?

Yes, and this information is printed on the packaging of BAT's smokeless nicotinecontaining products.

While not the primary cause of smokingrelated disease, nicotine is addictive.

While nicotine is addictive, adult consumers can quit nicotine when motivated to do so. Any withdrawal symptoms upon cessation of smoking or nicotine use are typically mild and do not require medical attention.

What is nicotine’s risk profile?

As part of the UK’s National Health Service (NHS) ‘Vaping myths and facts’, the NHS states that “[a]lthough nicotine is addictive, it is relatively harmless to health.” The NHS acknowledge that “[i]t is the many other toxic chemicals contained in tobacco smoke that cause almost all the harm from smoking”, and “[n]icotine itself does not cause cancer, lung disease, heart disease or stroke and has been used safely for many years in medicines to help people stop smoking.”^[1]

The U.S. Food and Drug Administration (FDA) state that “Nicotine is what keeps people using tobacco products. However, it’s the thousands of chemicals contained in tobacco and tobacco smoke that make tobacco use so deadly. Some of these chemicals, known to cause lung damage, are also found in some e-cigarette aerosols. This toxic mix of chemicals—not nicotine—cause the serious health effects among those who use tobacco products, including fatal lung diseases, like chronic obstructive pulmonary disease (COPD) and cancer.”^[6]

What are the effects of nicotine?

Nicotine adult consumers have reported a variety of desired and rewarding effects, such as relaxation; increased alertness; cognitive improvements, and sustained attention to tasks.^[7] However, there are also known acute adverse effects caused by nicotine.^[8]

The effect that a certain amount of nicotine can have on a person depends on whether they are a regular consumer of nicotine, as well as standard variables such as body weight, age and health status. The immediate (acute) cardiovascular effects of nicotine include an increase in blood pressure and heart rate, as well as blood vessel constriction.

While these acute effects are transitory and do not pose health hazards by themselves for the vast majority of regular nicotine users, such physiological responses can lead to adverse effects in adult consumers with certain underlying health conditions. This is particularly so in people with pre-existing cardiovascular disease and diabetes.

Nicotine overdoses in recreational users are inherently self-limiting, as initial symptoms such as dizziness and nausea typically cause immediate cessation of use and the prompt resolution of such symptoms.

Does nicotine cause cancer?

A common misconception is that nicotine, as a substance, is the cause of smoking-related diseases. The primary cause of smokingrelated disease is not exposure to nicotine, but to the 150 toxicants among the over 7,500 distinct compounds created by the burning of tobacco.^[9,10,11] This lack of understanding is not surprising.

The World Health Organization (WHO) does not classify nicotine as carcinogenic^[12] and many other national health authorities^[1] recognise that nicotine, while addictive, does not directly cause cancer.

What are the long-term health effects of nicotine use?

Nicotine, when removed from cigarette smoking, is not a driver of smoking-related disease. Kim et al. concluded in a 2021 systematic review that there were no significant differences between nicotine and non-nicotine groups for the risk of arrhythmia, nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death.^[13]

Figure 1. Nicotine: Science and Guidance

Are nicotine effects different with different product formats or product categories?

No, the effect of nicotine is not different with different products. However, there are differences in the rate at which nicotine is absorbed into the body with different products.

For adult cigarette smokers, nicotine is absorbed into the body relatively quickly via inhalation and this can be measured using clinical Pharmacokinetic (PK) studies.

To facilitate adult smokers switching to lower risk profile products, a similar delivery profile of nicotine is useful for consumer acceptability. Studies have shown that other inhalation products (Heated Products and Vapour Products) can match the nicotine delivery of cigarettes, which is one of the reasons that tens of millions of adult smokers have switched to these types of products and found them acceptable and enjoyable alternatives to cigarettes.

Oral Tobacco Products, and Oral Nicotine Pouches deliver nicotine differently. In this case, the nicotine is delivered through the buccal mucosa (cheek walls, gums) and into the bloodstream typically over a much slower timeframe.

Clear guidance on who should not use nicotine

Nicotine is addictive and for adults only. The safest option is not to use tobacco products or nicotine. For those adult smokers who would otherwise continue to smoke, they should switch completely to a lower risk profile Smokeless Product.

Our Responsible Marketing Principles^[18] and Code^[19] are very clear and aligned with regulators and public health bodies that nicotine should not be used by the underaged and is not appropriate for use by pregnant or lactating females nor people with known health contraindications.

Nicotine: The future

Nicotine is integral to Tobacco Harm Reduction (THR). For adult smokers who would otherwise continue to smoke, having a choice of lower risk profile tobacco and nicotine products to completely switch to is important.

Think of it this way: while nicotine is addictive, with smoking, it is the carrier (smoke) that leads to the causes of smoke-related diseases, not the active molecule (nicotine). This is the opposite of, for example, alcohol, which has an inert carrier (typically water) while the active alcohol (ethanol) has been defined as a Group 1 carcinogen.^[20]

This ‘carrier versus active’ distinction is important when it comes to educating people about the true risk profile of nicotine and the causes of smoking-related disease. It is also fundamental when it comes to research around THR and the creation of lower risk profile products that can deliver nicotine in a relatively inert carrier with a lower risk profile compared to a cigarette smoke carrier.