Menthol’s Potential Effects on Nicotine Dependence: A White Paper

Publicly available internal tobacco industry documents were analyzed to answer the following questions regarding menthol’s role in nicotine dependence: 1) What are the addiction and exposure measures and what are their relationships to menthol cigarette use? 2) Do menthol smokers show different signs or levels of nicotine dependence compared to non-menthol smokers? 3) Does menthol affect cigarette consumption (cigarettes per day) and do menthol smokers smoke more or fewer cigarettes per day compared to non-menthol smokers? 4) What is menthols’ effect on nicotine metabolism (i.e. glucuronide formation) and do menthol smokers experience different nicotine exposure and/or altered nicotine metabolism as compared to non-menthol smokers? (i.e. serum cotinine levels) 5) Does menthol have an effect on nicotine delivery? 6) Does menthol alter the addictiveness of smoking through sensory stimulation? Tobacco industry documents reveal at least two important reasons for menthol’s use in cigarettes. A final collection of 309 documents was analyzed for this report, of which 72 were deemed relevant to one or more of the research questions and cited in this paper. Our analyses of these documents indicate 1) menthol is used in cigarettes to override the harsh taste of tobacco; 2) menthol has physiological effects, and it synergistically interacts with nicotine; 3) menthol makes low tar, low nicotine tobacco products that would otherwise be tasteless and unsatisfactory acceptable to smokers. Tobacco manufacturers manipulated menthol levels to produce tobacco products that would be easier to consume, especially for new and inexperienced smokers.