Smoking Is Bad for You. Nicotine Isn’t—but Politicians Keep Trying To Ban It.

Easthampton just became the 25th Massachusetts municipality to adopt a “nicotine-free generation” policy. Anyone born after January 1, 2006, will never be old enough to legally buy nicotine products there. The ban doesn’t just apply to cigarettes. It also applies to noncombustible nicotine products that can help smokers reduce their risk.

Decades of anti-smoking campaigns have dramatically reduced cigarette use, especially among young people. That’s great news. But somehow along the way nicotine itself became associated with the worst harms of smoking, even though the chemical is not responsible for the cancers, the lung disease, or most of the cardiovascular disease caused by combustible tobacco. Worse, the pendulum has swung so far in the maximalist anti-nicotine direction that we risk criminalizing some of the most effective smoking-cessation alternatives.

Consider the reports that Marty Makary resigned as Food and Drug Administration (FDA) commissioner to protest the White House’s decision to authorize flavored nicotine vaping products. The products in question do not involve combustion—again, one of the core health problems of smoking—and may help adults move away from cigarettes. If Makary’s goal was to help Americans avoid the worst maladies of tobacco use, going after vaping is simply the wrong approach. Smoking is the problem. Vapes, not so much.

Public health institutions have spent so many decades fighting smoking that they have come to view nicotine itself as the enemy. In retrospect, it’s an easy mistake to make. If nicotine is what makes smoking appealing, then nicotine, critics reason, is the problem. Yet the relationship between nicotine and smoking-related disease is far more complicated than most people realize.

In 2015, Britain’s Royal Society for Public Health, not exactly the poster boy for a live-and-let-live approach to medicine, described nicotine as “no more harmful to health than caffeine.” That formulation may surprise many Americans, but it reflects an important reality. Nicotine is the addictive component of tobacco cigarettes, but it is not what causes lung cancer or emphysema. Those harms stem primarily from inhaling the products of combustion: tar, carbon monoxide, and thousands of toxic chemicals generated by burning tobacco.

Furthermore, a growing body of research suggests that nicotine may offer benefits that are rarely acknowledged in public discussion.

Nicotine as a Cognitive Tool

Millions of adults use nicotine for the same reason that millions consume caffeine every day: They believe it helps them think more clearly, concentrate more effectively, and cope more successfully with the demands of daily life.

Its pharmacology is surprisingly similar to caffeine. Both are stimulants. Nicotine increases alertness and concentration. It can improve attention and reaction time. Unlike caffeine, nicotine appears to have calming properties, increasing beta-endorphin release and helping many users manage stress and anxiety. The familiar phrase “I need a cigarette” may reflect not only habit but also nicotine’s ability to relieve tension.

Researchers have found that nicotine can enhance attention, working memory, and episodic memory in both smokers and nonsmokers. Studies have associated nicotine use with improved short-term verbal memory and faster learning rates among older adults. Other research suggests nicotine may help people diagnosed with schizophrenia compensate for cognitive deficits that interfere with daily functioning, perhaps helping explain the extraordinarily high smoking rates in that population.

Researchers have also explored nicotine’s potential role in relieving attention-deficit/hyperactivity disorder (ADHD). A growing body of research suggests nicotine can improve attention, inhibitory control, and aspects of executive functioning. A 1996 review published in Psychopharmacology concluded that the drug “may be useful in treating the symptoms of ADHD.” More recently, researchers reviewing the literature in 2017 reported that nicotine has been shown to improve attention and reduce inattentive symptoms in people diagnosed with the disorder. Nicotine is not an approved treatment for ADHD, and the evidence remains preliminary. Yet the existence of this research is difficult to reconcile with the common portrayal of nicotine as a substance devoid of any beneficial effects.

Taken together, these findings suggest that many nicotine users may not simply be satisfying a dependency. They may be obtaining effects they find useful.

This should not be surprising. Human beings have always sought substances that enhance performance, elevate mood, sharpen concentration, reduce fatigue, or alleviate stress. Billions of people consume coffee, tea, and other caffeinated beverages for precisely these reasons.

Scientists have also investigated nicotine’s potential role in conditions ranging from Parkinson’s disease and Alzheimer’s disease to ulcerative colitis and age-related cognitive decline. Not all of the findings are conclusive. Some lines of research have produced conflicting results. Others remain preliminary. No responsible observer would describe nicotine as a miracle drug. 

But imagine the reaction if a substance associated with improved attention, enhanced memory, possible neuroprotective effects, stress reduction, and improved cognitive functioning in certain patient populations were discovered today. Researchers would likely study it enthusiastically. Venture capital firms would fund startups developing innovative delivery systems. Journalists would write stories about its therapeutic potential.

Caffeine, by contrast, arrived wrapped in the traditions of coffeehouses, tea ceremonies, and morning routines. Nicotine arrived wrapped in the image of the cigarette. One became socially acceptable. The other became morally suspect.

That distinction has profoundly shaped public policy.

The Double Standard

We should still view nicotine critically, of course. Every psychoactive substance involves tradeoffs. Nicotine can be addictive and may raise heart rate and blood pressure. Some people experience unpleasant side effects. Adolescents in particular should not use nicotine products, because developing brains may be especially susceptible to nicotine’s effects.

Yet public health authorities themselves implicitly acknowledge nicotine’s relative safety every time they recommend nicotine replacement therapies. Millions of smokers have been encouraged to use nicotine gum, patches, lozenges, inhalers, and sprays for extended periods. Many continue to use them for months or years. If nicotine were truly the grave threat often portrayed in public discourse, these recommendations would be hard to justify.

Again, the caffeine comparison is instructive. Both are psychoactive stimulants. Both produce dependence in some users. Both can cause withdrawal symptoms. Both may raise heart rate and blood pressure. Yet no one proposes creating a “caffeine-free generation.”

No legislature is considering lifetime bans on coffee purchases for adults born after a particular date. Public health organizations do not issue urgent warnings about the dangers of flavored espresso drinks attracting teenagers.

Moreover, adults don’t need to demonstrate a therapeutic benefit before drinking coffee or having a cocktail. Nor should they have to prove that nicotine improves their memory or concentration before using it. The possible benefits of nicotine make today’s policies harder to justify, but individual autonomy does not depend on proving them.

The Rise of a Phobia

Call it nicotinophobia: an aversion to nicotine rooted less in evidence about the drug itself than in its historical association with smoking. This phobia treats nicotine not as a substance with risks and benefits that can be weighed rationally but as a contaminant whose presence alone justifies restriction.

In May, the World Health Organization urged governments to “protect young people from addiction to tobacco and nicotine products.” The U.S. Department of Health and Human Services warned last year about an “ongoing youth vaping epidemic” even while acknowledging continued declines in youth vaping. The American Lung Association maintains that no level of youth tobacco use is acceptable and urges people to “quit all nicotine and tobacco products for good.” The Campaign for Tobacco-Free Kids advocates broad restrictions on flavored nicotine products and has condemned the FDA’s authorization of flavored vaping products for adults.  

Perhaps the larger story behind these reports is that some policymakers are no longer focused primarily on reducing smoking-related disease. Increasingly, they appear interested in eliminating nicotine use itself. 

Massachusetts has become a laboratory for this approach. As The Examination recently reported, a growing number of Massachusetts municipalities have adopted “nicotine-free generation” policies that permanently prohibit the sale of nicotine products to people born after a specified date, even after those individuals reach adulthood. In June, Guy Bentley reported that public records reveal that state-funded health officials and activists recruited local supporters, including parents and teenagers, to testify in support of the bans.

Massachusetts state Sen. Jason Lewis (D–Middlesex) wants to impose this concept statewide. Last year he introduced a bill that would have prohibited the sale of nicotine products to anyone born after 2005. Under such a system, a 45-year-old born in 2006 could be barred from purchasing nicotine pouches, snus, or e-cigarettes while an older adult standing next to him could legally buy the same products.

Revealingly, these proposals typically exempt nicotine gum and nicotine patches. The distinction suggests that the target is not simply nicotine, but nicotine used for purposes other than smoking cessation.

Once nicotine itself becomes the focus of concern, harm reduction is no longer the sole organizing principle. Reducing nicotine use becomes an objective in its own right.

The Iron Law of Prohibition

When policymakers attempt to suppress products that consumers value, people rarely abandon those products altogether. They seek alternatives. Entrepreneurs adapt. Markets shift. Regulators respond. The cycle repeats.

Rather than eliminating demand, prohibition often spurs the development of alternative products that are more potent, less familiar, and less studied. Some drug policy scholars describe this pattern as the “iron law of prohibition“: the harder the enforcement, the harder the drug. 

Nicotine policy may be on the same path. As regulators tighten restrictions on nicotine products, manufacturers have introduced synthetic nicotine analogs that fall outside traditional regulatory frameworks. Some researchers worry that compounds such as 6-methyl nicotine may prove more potent than nicotine itself. Policies driven by hostility toward nicotine may encourage people to use substances whose risks are less well-understood.

Public health authorities may have become victims of their own success. Their campaign against smoking was so effective that many people no longer distinguish between smoking and nicotine. And now the authorities may be making a second mistake: confusing the existence of risk with the absence of benefit. If nicotine turns out to be genuinely useful for many adults, we should learn to disentangle it from smoking and think of it as an everyday stimulant, not a public menace.