Policy support and potential black-market use in response to a reduced nicotine standard: responses following a 12-week open-label clinical trial

A reduced nicotine standard (RNS) could be one of the most significant tobacco control policies in history. The recent proposed rule issued by the U.S. Food and Drug Administration for an RNS is based on evidence showing that very low nicotine content (VLNC) cigarettes potentially decrease smoking rates, resulting in a substantial decline in smoking-related disease. 1 One potential concern of an RNS is the potential to contribute to a pervasive black market for normal nicotine content (NNC) cigarettes.2 Furthermore, support for an RNS is likely to be discussed as part of the rationale for (or against) its implementation. To address these concerns, the present study describes the intent to seek black-market cigarettes and policy support for an RNS among adults after non-blinded assignment to VLNC cigarettes in a 12-week clinical trial.