At some point in the next few years, 30 million smokers in the United States could wake up to find that cigarettes sold at gas stations, convenience stores and smoke shops contain so little nicotine that they can't get their usual fix when lighting up.
Would the smokers be plunged into the throes of nicotine withdrawal and seek out their favorite brand on illegal markets, or would they use less harmful methods to get that rush?
The Food and Drug Administration said in June that it would reduce nicotine levels in cigarettes in order to reduce the health effects of an addiction that causes 480,000 deaths a year.
Next May is when the agency plans to introduce a fully developed proposal. Federally funded studies have shown that the most effective way to help smokers kick the habit is to reduce nicotine levels by 95 percent.
If the tobacco industry doesn't like the policy, it could take years for it to take effect. Any attempt to reduce nicotine in cigarettes to non-addictive levels would be a radical experiment, one that has never been implemented by any other country.
It took another two decades for the mechanics of nicotine dependence to be understood, but the science of nicotine addiction has come a long way.
Nicotine keeps smokers coming back for more despite the harmful chemicals in tobacco. Nicotine stimulates a surge of dopamine in the brain and indirectly produces a flood of dopamine, the chemical that promotes feelings of contentment and relaxation. Heavy smokers need a fresh injection a dozen or more times a day because the effects are short lived.
Many scientists have come to embrace a 95 percent reduction in nicotine levels as ideal for helping study subjects smoke less. He said that anything higher can encourage people to smoke more often.
The Tobacco Control Act gives the F.D.A. the power to regulate the manufacturing and marketing of tobacco.
The nicotine in tobacco can be hard to get enough of. The lungs can only handle so much of a burned substance, so smoking more causes adverse effects.
Even though tobacco control researchers cheered the F.D.A. announcement, they acknowledged that it would be difficult for inveterate smokers to stop smoking. A reflection of nicotine's addictive prowess and the limitations of nicotine replacement therapy, less than one in 10 adults who attempt to quit smoking succeeds.
The director of the National Institute on Drug Abuse expressed confidence in the studies that supported an immediate reduction in nicotine levels. She said that scientists and regulators needed to address the welter of unforeseen consequences that could prove disruptive to determined smokers and could fuel the creation of underground markets for full- nicotine cigarettes. She said that a randomized study can't predict outcomes completely. Life and biology aren't so precise.
The high number of study participants who cheat makes the current research on low-nicotine cigarettes questionable. Tobacco company executives warn that banning conventional cigarettes would cause smokers to go to Mexico and Canada to buy cigarettes. Vaping or nicotine gum can be used with low-nicotine cigarettes, which are just as harmful as traditional cigarettes, according to them.
Lynn T. Kozlowski, a tobacco researcher at the University at Buffalo who has contributed to four Surgeon General reports on smoking since 1981, said nicotine was a highly addictive drug and needed to be considered by the F.D.A.
A national experiment with a very low nicotine cigarette is something that scares me. He said that some of the paid participants smoked their own brands of cigarettes at the same time that researchers were giving them low-nicotine cigarettes.
In interviews, smokers who had heard about the F.D.A.'s announcement said they were conflicted by the prospect of being forced to abandon their addiction, even though they knew it would shorten their life span. A options trader who was taking a smoking break outside the Chicago Board of Trade feared he would end up smoking more if cigarettes contained less nicotine. Mr. Harrigan, who has been a pack-a-day smoker for 30 years, said that it will hurt people who are used to nicotine.
The agency has a conflicting stance on e-cigarettes, which deliver nicotine without the tar and many other toxins that are in the lungs when tobacco is lit. Though health experts agree that teenagers should be discouraged from trying e-cigarettes, there is mounting consensus that such products are useful for helping adults quit smoking.
Only six products have been approved by the F.D.A., and they have denied more than a million others. The agency ordered Juul off the shelves due to the risk of harm from chemicals in its e-liquids. The company has been given a further review.
Dr. Judith Prochaska, an addiction specialist who runs a smoking cessation clinic for patients with cancer and their families, said lighting up during a phone call, while sipping a cocktail or following a meal causes the mind to associate a cigarette with stimulation.
She said that the behaviors cue your brain that nicotine is going to come. The effect is conditioned here with a highly addictive drug.
The dependency gets deeper over time. Smoking can lead to the formation of millions of additional dopaminereceptors. Nicotine withdrawal can be difficult if a smoker goes cold turkey.
Nicotine patches, gum and e-liquids can help to satisfy some of the cravings, but they can't replace the experience of smoking a cigarette: the retreat outside with a co-conspirator, the crinkling of cellophane and foil as you open a new pack, the heady buzz
Bruce Holaday is a retired teacher from Mill Valley, Calif. Mr. Holaday says he has tried to quit 100 times using nicotine replacement products. He always returned to his addiction to Marlboro lights.
His last attempt in August, without nicotine replacement therapy, triggered a maelstrom of cravings that lasted a long time. He said that it was like a sudden earthquake of desire and need.
Mr. Holaday joined a support group at a health care facility. He said he learned to avoid stress by watching the news. He found that if he could face down the initial waves of craving, they would usually go away.
He passed the one year mark in June.
He gained weight but was not winded on hikes. He's confident he won't ever go back to smoking.
Mr Holaday paused and thought about the first time he smoked as a college student. He said that without the nicotine rush he would have quit smoking. Anything we can do to prevent a new generation from getting hooked is a positive thing.
Robert reported from Chicago.
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