SACTob Recommendation on Nicotine and the Regulation in Tobacco and Non-Tobacco Products

Over the past two decades a wealth of research findings have pointed to nicotine as the key pharmacological factor underlying tobacco use. The 1988 report of the US Surgeon General identified cigarette smoking as nicotine addiction (1); the Royal College of Physicians similarly concluded that nicotine is an addictive drug on par with heroin and cocaine, and that the primary purpose of smoking tobacco is to deliver a dose of nicotine rapidly to the brain (2). The Diagnostic and Statistical Manual of Mental Disorders [D.S.M-IV] classifies nicotine-related disorders into the sub-categories of dependence [305.10] and withdrawal [292.0] which may develop with the use of all forms of tobacco (3). The effects of tobacco and nicotine to produce dependence and withdrawal are also identified by the International Statistical Classification of Diseases and Related Health Problems [I.C.D-10] as a disease in the category [T 65.2] ‘Toxic effect of other and unspecified substances’ (4). While nicotine is acknowledged to be the primary reinforcer of smoking (5,6), and nicotine-free cigarettes have consistently failed in the marketplace (7), exposure to nicotine in itself is believed not to be responsible for more than a minor portion of tobacco related disease (8). Rather, harmful gases and particulates, which can be thought of as contaminants of the cigarette as a nicotine delivery device (9), cause the great majority of smoking related diseases and their specific role in the reinforcing effects of smoking is not well understood.