A peer review of modelling behind the Government’s plans to remove nicotine from cigarettes has found significant flaws in the fundamental assumptions it used, says ASH Smokefree 2025.
The Ouakrim et al. (2022) modelling was funded by the Ministry of Health and used by Cabinet to estimate the likely impact of the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill. This legislation, currently being considered by the Health Select Committee, aims to create a smokefree generation, reduce the availability of smoked tobacco and – in a world first – remove nicotine from cigarettes.
ASH director Ben Youdan says the modelling by New Zealand and Australian academics incorrectly and optimistically assumes the mandatory removal of nicotine from cigarettes would reduce smoking by 85% over five years compared to current smoking cessation support and measures.
“We consider that there are significant flaws in the assumptions that inform the modelling, making it unreliable and inappropriate to guide policy. The preprint of the paper itself carries a disclaimer that it has not been peer-reviewed and, therefore, ‘should not be used to guide clinical practice’.
“ASH fully supports bold leadership to reduce smoking and we support passage of the Bill. It concerns us that reliance on a non-peer-reviewed model underpins policy that over promises and will underdeliver.” Ben Youdan says.
“ASH has spent the past 40 years working to stop people dying from cigarette smoking. But we know how hard it is for people dependent on nicotine to quit smoking. The Smokefree 2025 goal assumes that even when the goal is reached, a small proportion of adults – less than 5% – will continue to smoke. We don’t want to see these 150,000 people, the great majority living in the poorest circumstances, punished for their addiction. They need support, not de-facto banning.”
The Ouakrim modelling has been reviewed by ASH chair Emeritus Professor Robert Beaglehole and director Ben Youdan, alongside international tobacco policy experts Clive Bates from the United Kingdom, Adjunct Law Professor David Sweanor from Canada, Chair of End Smoking NZ and Consultant Medical Oncologist Dr George Laking (Te Whakatōhea) and epidemiologist Emeritus Professor Ruth Bonita.
“Its fundamental assumption is based on a misinterpretation of a 2009/10 New Zealand trial (by Associate Professor Natalie Walker and colleagues from the University of Auckland) of smokers trying to quit who were given free very low nicotine cigarettes. The trial found the seven-day abstinence quit rate at six months increased to 33% compared to 28% in the ‘usual care’ control group. The Ouakrim modellers also gathered international expert opinion to guide their estimated quit rate. They then assumed an approximate 30% quit rate in the first year due to the introduction of denicotinised cigarettes nationwide, even though the trial only found an incremental 5% reduction.
“This assumed quit rate was then applied cumulatively for five years to all people who smoke, including those with no interest in quitting, leading to the estimate of an 85% reduction in smoking over five years. The international evidence supports the use of very low nicotine cigarettes to help some people manage cravings, but certainly doesn’t suggest they are anywhere near the silver bullet to end smoking” Ben Youdan, Director of ASH says.
“It is impossible for the Government to assess the impact of these measures without including an assessment of the likely reaction of both people who smoke faced with mandatory withdrawal and of tobacco suppliers. This could involve buying nicotine cigarettes overseas online, hoarding cigarettes, buying illicit cigarettes brought into New Zealand in large-scale smuggling operations, switching to home-grown tobacco, or adding liquid nicotine to denicotinised tobacco.
“This modelling risks vastly overpromising the impact of a denicotinisation, not just because the underlying assumptions are weak, but because it does not even attempt to represent the dynamics that would emerge after nicotine is removed from cigarettes.
“In light of this review, ASH is calling on the Government to:
• Seek further independent scrutiny of the assumptions used in the modelling on which the legislation is based,
• Take steps to reduce the likely unintended consequences of the legislation on equity goals and illicit trade,
• Substantially increase efforts to encourage and support people who smoke to quit or move to less harmful products, and;
• Allow flexibility in the legislation for the most dependent smokers to access nicotine cigarettes in a controlled manner consistent with a harm reduction approach to addictions.
“If the recent progress towards the Smokefree 2025 goal is sustained over the next two years and enhanced with more health system support for less harmful alternatives such as vaping, we will make considerable progress regardless of this legislation” Ben Youdan says.
ASH’s review can be found here:
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