Nicotine science

External independent surveys indicate prevalent misunderstandings regarding the impacts of nicotine among smokers and healthcare providers. National data from the U.K. and the U.S. indicate that misconceptions about nicotine are widespread among adults who smoke, with a significant segment of the population erroneously thinking that nicotine is the cause of smoking-related cancers. Misperceptions about nicotine also persist among healthcare professionals, with many incorrectly attributing smoking-related diseases to nicotine itself.^3,4,5

The unfortunate outcome of these misperceptions for adults who smoke is that they tend to perceive nicotine to be as harmful to health as cigarette smoking and therefore may be dissuaded from switching to nicotine-containing products that do not combust. ⁶

Furthermore, the misperceptions in healthcare professionals around the health effects of nicotine may prevent them from being able to differentiate the health effects of smoking from nicotine itself.

Many people who smoke cigarettes indicate that they do so for the perceived benefits, which include enjoyment, stress management, and relaxation. Additionally, some studies report that nicotine can enhance cognitive processes like improving attention, memory, and fine motor function. 

As an agonist of nicotinic acetylcholine receptors, nicotine elicits a variety of transient cardiovascular effects such as increased heart rate and blood pressure. 

Sustained nicotine use can induce changes in the brain’s reward and stress systems, leading to withdrawal symptoms, although the effects are transitory and reversible once people quit and successfully abstain from using tobacco and nicotine products. 

It is well understood that nicotine is addictive and not risk-free. However, while it can be difficult for some, anyone can quit tobacco and nicotine altogether with sufficient motivation. 

Some studies have found that nicotine may have adverse effects on fetal development such as low birth weight. 

For all these reasons, some populations should avoid nicotine-containing products, such as minors, and women who are pregnant or breastfeeding, as well as people with pre-existing conditions including heart disease, high blood pressure, diabetes, or epilepsy. 

Achieving the goal of phasing out cigarettes will require a debate informed by facts and science on the health effects of smoke-free products and nicotine itself. As of today, much of our understanding of the importance and risks of nicotine is confounded with smoking. Therefore, as more and more new products emerge that separate nicotine from some or all of the aspects of the smoking ritual, much more research is needed to fully understand these new products as well as the role of nicotine itself. 

Some populations should avoid nicotine-containing products, such as underage people and women who are pregnant or breastfeeding, as some studies have found that nicotine may have adverse effects on fetal development such as low birth weight. People with pre-existing diseases or conditions (e.g., heart disease, high blood pressure, diabetes, or epilepsy) should also avoid nicotine consumption.

Although cancer is a complex and multifactorial process, research shows that nicotine is not classified as a carcinogen by health bodies like the International Agency for Research on Cancer and the U.S. FDA.^7,8 While there is research ongoing into nicotine’s role in cancer promotion separate from cigarette smoke, today, there is insufficient evidence that nicotine contributes to or promotes the development of cancer.

While nicotine is addictive and not risk-free, nicotine is not the primary cause of smoking-related diseases. It is the extended exposure to the toxic by-products of combustion produced in high levels when a cigarette is lit that results in smoking-related diseases such as cancer, respiratory illnesses, and cardiovascular conditions.

As an agonist of nicotinic acetylcholine receptors, nicotine also elicits a variety of transient cardiovascular effects such as increased heart rate and blood pressure.

Sustained nicotine use can induce changes in the brain’s reward and stress systems, although the effects are transitory and reversible once people quit and successfully abstain from using tobacco and nicotine products.

It is well understood that nicotine has reinforcing effects and as such can lead to addiction, but nicotine is not intoxicating or functionally impairing. The likelihood that nicotine use will lead to addiction depends on multiple factors around the product (including mode of use, amount, and rate and patterns of delivery), the environment around the product (like availability, price, and regulations), as well as the biopsychosocial differences between the users. While it can be difficult for some, anyone can quit tobacco and nicotine altogether with sufficient motivation.

Scientists are also examining the potential effects of nicotine on treating conditions such as Tourette’s, Alzheimer’s, Parkinson’s, attention deficit hyperactivity disorder (ADHD), and other diseases.¹² Cellular, animal, and human studies have yielded some promising results, yet the evidence is not conclusive, and nicotine’s addictiveness could be a limiting adverse effect for its development as a therapeutic compound.¹³

The U.S. National Institutes of Health funded a multi-center study designed to explore whether nicotine patches (used traditionally as NRT, to aid cessation) improve memory and functioning in patients with mild cognitive impairment, compared to placebo in 380 subjects exposed for two years, the results of which should become available in 2026.¹⁴