Implementing a Nicotine Cap to Make America Healthy Again

The U.S. Department of Health and Human Services’ (HHS) "Make America Healthy Again" initiative cannot eradicate the root causes of the nation’s chronic disease epidemic without tackling cigarette smoking, which kills over 480,000 Americans and costs $600 billion annually. This commentary reinvigorates a pivotal 2017 FDA framework by urging the current administration to finalize the proposed rule establishing a maximum nicotine cap in all cigarettes and selected combusted tobacco. Evidence demonstrates that capping nicotine at non-addictive levels (∼95% reduction) rapidly decreases dependence and accelerates smoking cessation. The FDA projects that a nicotine cap will prevent 4.3 million smoking-related deaths by 2100 while saving $1.1 trillion annually in healthcare and productivity costs over forty years. To maximize these gains, we outline two supporting strategies. First, the administration must substantially fund the nation's under-resourced smoking cessation infrastructure to meet the inevitable surge in quitting. Second, provide adults who smoke evidence-based information on the full spectrum of quitting smoking options by communicating the tobacco/nicotine continuum of risk, that is, that combusted products (e.g., cigarettes) carry the greatest risk of disease, non-combusted products (e.g., e-cigarettes) are likely to pose less risk than cigarettes, and medicinal nicotine products (e.g., patches) are the safest option.