Very low nicotine cigarettes did not increase cannabis use

In January 2025, the US Food and Drug Administration announced a proposed rule for a reduced nicotine standard (RNS) in cigarettes. Evidence suggests that the use of very low nicotine content (VLNC) cigarettes decreases cigarette use and tobacco toxicant exposure; however, unintended consequences, such as a resulting increase in use of other reinforcing substances (eg, cannabis, alcohol), are a concern. This secondary analysis aims to provide an ecologically valid assessment of the impact of RNS on alcohol and cannabis use. During 2018-2022, participants were randomized to VLNC or normal nicotine content cigarettes for 12 weeks. All participants had access to non-combusted nicotine products through an experimental tobacco marketplace. We examined the association between cigarette condition and alcohol or cannabis use, among participants reporting (1) use of each substance at baseline, to examine whether condition impacted frequency of use and (2) non-use at baseline, to examine differences in uptake during the study. Study condition did not affect frequency of alcohol or cannabis use among those reporting baseline use (mean differencealcohol = 0.90, 95% CI, -5.33 to 7.03; mean differencecannabis = 0.87, 95% CI, -8.00 to 9.24), nor did it affect the frequency among those reporting baseline non-use (mean differencealcohol = 0.83, 95% CI, -0.14 to 1.80; mean differencecannabis = -1.92, 95% CI, -5.02 to 1.19) or likelihood of uptake (adjusted odds ratio [AOR]alcohol = 1.09, 95% CI, 0.85 to 1.38; AORcannabis = 1.20, 95% CI, 0.97 to 1.45). This study adds to the evidence that that unintended consequences of an RNS as it relates to significant increases in alcohol or cannabis use among people who smoke are unlikely. This secondary analysis provides an ecologically valid assessment of the impact of a reduced nicotine standard on alcohol and cannabis use. Results add to the evidence suggesting that increases in alcohol or cannabis use as a consequence of a reduced nicotine standard are unlikely, providing further evidence that implementing a reduced nicotine standard would have public health benefit.