Briefing: Nicotine for Policymakers

I have added a new briefing to my set of Evidence Briefings aimed at policymakers working on nicotine and tobacco policy. Updated following comments on 24 May 2025.

Please see Evidence Briefing 5: Nicotine for Policymakers, a narrative discussion with 100+ supporting citations. It is also available as an MS Word download.

The first page has a summary of insights:

• Nicotine is the primary psychoactive agent in tobacco and alternative nicotine delivery systems (ANDS – vapes, pouches, heated and smokeless tobacco). It is a stimulant that produces subjective feelings of pleasure, reduces stress and anxiety and improves aspects of cognitive function. Its use can make people feel better and feel as though they function better. Nicotine does not cause drug effects like intoxication, oblivion, hallucinations, or violence. It may also have therapeutic benefits, showing promise for some inflammatory diseases, ADHD, and Parkinson’s Disease, among others.
• The subjectively perceived positive aspects of nicotine use largely explain why people use nicotine. However, these rewards can consolidate into a physical dependence with withdrawal and craving, reinforcing nicotine use. Nicotine may provide immediate relief from stress, but its overall impact may increase stress levels physiologically and psychologically due to the cycle of use, relief, and withdrawal.
• Nicotine use is disproportionately prevalent in poorer, marginalised or otherwise disadvantaged sub-populations. Nicotine probably interacts with elevated levels of stress in these groups.
• There is no simple answer to the question, Is nicotine addictive? It depends on the characteristics of the user, the route of administration, and the definition of “addiction”, which is an imprecise and stigmatising term. Addiction usually refers to compulsive behaviour that persists in the face of significant harm caused to the user. Cigarette smoking meets this definition, but ANDS use may not. It is better to think of physical dependence or addiction as an emergent constellation of behaviours with consequences for the individual rather than an intrinsic property of a molecule, device or liquid.
• Nicotine is not a major direct cause of smoking-related disease. Dozens of other hazardous and potentially hazardous chemicals form through combustion and constitute the particles and toxic gases of inhaled tobacco smoke. These are overwhelmingly the causes of smoking-related diseases.
• Nicotine in isolation is much less harmful than smoking but not entirely harmless. It does not cause cancer, heart disease or lung illnesses but may increase risks in people with preexisting cardiovascular conditions and can promote tumour growth in animals. Smoking causes poor pregnancy outcomes, but nicotine is unlikely to be the primary cause. Nicotine may contribute to adverse outcomes in pregnancy, and nicotine-induced constriction of blood vessels may aggravate peripheral arterial disease.
• Nicotine is the primary reason people use tobacco or ANDS, and the use of these products should be understood as nicotine-seeking behaviour. Within broad limits, the user, not the product, determines the dose. Users generally regulate their intake to maintain desired levels of nicotine in the body. Regulatory schemes that try to control nicotine intake through restrictions on product design are unlikely to succeed, as users titrate their nicotine intake to preferred levels, resulting in “compensation” (using the product more intensively) or switching nicotine products if compensation is not possible.
• As with other psychoactive substances – alcohol, caffeine, cannabis, etc. – the demand for nicotine is unlikely to disappear even with punitive laws. Demand is driven primarily by the real or perceived benefits experienced by those using it and, for some people, the effort required to stop.
• The main deterrent to nicotine use, the multiple health and welfare harms arising from smoking, is significantly reduced in smoke-free alternative nicotine delivery systems. The secondary deterrent is the effect of policies designed to control smoking, such as high taxes. For substantially safer alternatives, this deterrent should also significantly diminish. It is possible, therefore, that overall societal nicotine use will increase, though the total harms associated with using nicotine will substantially decline.