Pharmacology and toxicology of nicotine, implications for public health

Weighing the benefits and risks of nicotine is crucial for developing effective public health policy. The primary harm of nicotine, which has resulted in millions of deaths worldwide over the past century, is its role in maintaining addiction to cigarette smoking. Non-combusted forms of nicotine are clearly much less harmful than smoking, with the level of harm influenced by the type of delivery device. The greatest potential benefit of widely accessible non-combusted nicotine products is to provide an alternative to cigarette smoking, including supporting future public policies to mandate the reduction of nicotine in cigarettes. The primary safety concerns with nicotine itself include addiction, especially among young never-smokers; adverse cardiovascular effects, particularly in people with pre-existing cardiovascular disease, and reproductive toxicity. Safety concerns based on biological plausibility from animal studies — but not yet established in people— are adverse effects on brain development and the promotion of cancer. Potential benefits of nicotine, in addition to promoting or supporting smoking cessation, include providing a source of pleasure, cognitive enhancement, mood regulation, and athletic performance. A major challenge in developing optimal healthcare policies for population health is addressing the concern of adolescent nicotine addiction, which can be exacerbated by tobacco industry marketing practices.