Cigarettes with ultralow nicotine levels are now being called the game-changer in the fight against smoking. If you are having trouble in quitting smoking, then, it is for you, that soon the Biden White House is expected to formally propose a plan that will order cigarette nicotine levels to be reduced, reports The Washington Post. For now though, it has been a failure, as these cigarettes, also known as VLN cigarettes that stands for very low nicotine are only available in 5,100 stores in 26 states. This is a very small fraction of the overall market for cigarettes. The company that makes it, 22nd Century, is struggling not because of the low supply, but also from the advocates who have long believed slashing nicotine levels altogether.

The Advent and ideation

Nicotine is a chemical that is produced naturally from tobacco that makes the cigarette and also keeps people hooked. While it is believed that it makes people alert, and get the "hit" to keep them going, it exposes the users to harmful substances, carcinogens, and increases the risk of heart disease, lung cancer, and other illness.

Ultralow-nicotine cigarettes, like the VLN brand, contain about 95% less nicotine than the regular cigarettes. The idea is quite simple: without the addictive grip of nicotine, smokers will find it easier to quit. Research too has shown some promise. For instance, the studies funded by the National Institute on Drug Abuse revealed that very low nicotine cigarettes reduced addiction potential significantly without having users to increase their smoking frequency. However, the problem is, why would anyone choose for a low-nicotine that does not make them feel the same way, when the high-nicotine cigarette is right next to it, making them feel the same way, with the same alertness, sold at the same price.

“It’s very hard to imagine someone actively choosing to continue to use a low-nicotine product for the same price when a high-nicotine product is right next to it,” said Eric Donny, a Wake Forest University School of Medicine nicotine researcher.

No wonder, the experiment with low nicotine product by Philip Morris' Next cigarettes in the 1980s and Vector Tobacco's Quest brand in the early 2000s, flopped.

FDA's Role in the Push

The Food and Drug Administration (FDA) has supported the development of such products, even allowing VLN cigarettes to be marketed as lower-risk options. However, these products remain a niche market, available in only a fraction of U.S. stores.

Recently, the Biden administration has considered a bold step—mandating a dramatic reduction in nicotine levels for all cigarettes sold in the United States. Supporters believe this move could save millions of lives, while critics, including tobacco companies, warn of potential unintended consequences.

What Could Be The Challenges?

Resistance from Big Tobacco Companies: They could argue that slashing nicotine levels could backfire. Their claim is, smokers will turn to black markets or smoke more to satisfy their cravings, which may lead to greater exposure to harmful substances.

Consumer Reluctance: History is proof to the instances of smokers being hesitant to embrace the low-nicotine products.

Political Hurdle: It may face political roadblocks, as under the Trump administration, plans to cut nicotine were shelved.

Could Low-Nicotine Cigarettes Be The Solution?

Advocates believe that ultralow-nicotine cigarettes could be a game-changer, comparing them to decaf coffee or non-alcoholic beer—products that reduce harm while offering a similar experience.

Some experts warn that a black market for traditional cigarettes could undermine these efforts. They also stress the need for safer alternatives, such as vaping products, to support smokers transitioning away from traditional cigarettes.

Jeana Keough, former star of The Real Housewives of Orange County, is struggling with her recovery from tongue cancer treatment. Her daughter Kara Bosworth recently revealed that her mother is still relying on a feeding tube for most of her nutrition, which leaves her “frustrated”.

Kara said that the 71-year-old had made little progress in eating by mouth despite completing radiation treatment. She also said that her mother is going through fatigue, coughing fits and difficulties with swallowing after her cancer treatment.

“Mom’s struggling. She’s still not getting nutrition orally except maybe a few bites and then she gets frustrated with the effort and the lack of taste,” Kara told Page Six. She also said the feeding tube remains her mother's “primary source of nutrition”.

Jeana Keough's Recovery After Tongue Cancer Treatment

Keough was diagnosed with squamous cell carcinoma of the tongue after a painful sore persisted for nearly a year.

She initially believed a tooth was rubbing against her tongue and visited her dentist several times to take care of it. She underwent a biopsy which eventually confirmed cancer.

After surgery to remove the cancer, doctors recommended a second operation to remove lymph nodes. During that procedure, they discovered that the cancer had spread, turning a one-time surgery into a more extensive invasive treatment.

Keough subsequently underwent surgery, chemotherapy, radiation and immunotherapy. These treatments can place considerable strain on the body. Additionally, treatment involving tongue and throat can make eating, drinking and speaking challenging.

Radiation can inflame the lining of the mouth and throat, causing pain and swallowing difficulties. Keough also experienced radiation burns on the outside of her neck. Her daughter previously described the pain as severe, even when applying medicated cream to the damaged skin.

In August, Kara said the family had been told that the weeks after radiation ended could be the most physically difficult because the effects of chemotherapy and radiation tend to compound.

Also read: New AI Tool Uses Facial Photos To Predict Cancer Patients’ Survival Risk

Feeding Difficulties And Fatigue

Keough's difficulty with eating has left her completely dependent on tube feeding to meet her nutritional needs. Her daughter said she becomes frustrated after a few bites because eating requires a lot of effort and food no longer tastes the same.

Kara also shared that her mother is sleeping a lot and experiencing coughing fits that cause her to vomit.

“I think she just wishes she didn’t do any treatment. [It’s been] very hard. She still is sleeping a lot and having a lot of coughing fits that cause her to vomit,” Kara told Page Six.

The family has also reported that Keough is undergoing speech and swallowing therapy. “She’s doing twice-weekly speech and swallow therapy, but we still have a long way to go,” Kara said.

Also read: Breast Cancer Awareness Month: Advancing A Risk-Informed and Equitable Approach to Breast Cancer Screening in India

What Does Recovery From Tongue Cancer Involve?

In advanced head-and-neck cancer, removing the tumour is only one part of successful treatment. When surgery involves structures that are essential for speaking and swallowing, doctors also have to think about what the patient’s life will look like after cancer treatment.

Reconstructive microsurgery can help restore the tissue lost during surgery, while structured rehabilitation helps patients work towards regaining important functions. The aim is mainly to treat the cancer while also helping the patient return to the life and work.

Recovery can be time-consuming after tongue cancer treatment. Depending on the extent of surgery and the treatment, patients may experience pain, changes in taste, difficulty swallowing, speech problems and fatigue.

Inflammation due to radiation can continue even after the final session, while chemotherapy can add to the overall burden on the body.

Speech and swallowing therapy may help patients regain normal function, while feeding tubes can provide nutrition and hydration when eating and drinking are still challenging.

Daily vaping in the United States has surged by 230% between 2013–14 and 2022–23. Additionally nearly half of young adults who vaped daily used high-nicotine e-cigarettes, according to two studies published in the journal Tobacco Control.

The findings have sparked concerns about the increase in nicotine dependence among young people. The studies analysed data from the US Population Assessment of Tobacco and Health (PATH) Study, which tracks tobacco and nicotine use across the country.

Daily Vaping Increased By 230%

The first study examined the patterns of vaping for a decade, from 2013–14 to 2022–23. Researchers found that the total number of vaping days across the population increased by 183%, while vaping in the past 30 days rose by 45%. Daily vaping increased by 230% over the same period.

Vaping days among people younger than 21 who had vaped in the previous 30 days increased by 337%. Among those aged 12–17, the increase was 278%. By 2022–23, people under the legal age of 21 accounted for 16% of all vaping days.

The researchers noted that the sharpest increases in vaping frequency occurred after 2016–18, coinciding with the rise of JUUL and nicotine salt e-liquids, which make nicotine easier to inhale.

“While vaping days increased across all age groups, pronounced increases between 2013–14 and 2022–23 were observed among youth and younger adults, likely influenced by industry marketing that has predominantly targeted young people, as well as increases in the size of the youth population,” the researchers wrote.

They also warned about dual use, in which people smoke cigarettes and vape without fully switching away from smoking, as well as the possibility of ex-smokers returning to nicotine use.

Also read: Selena Gomez Says Vaping Changed Her Voice: How E-Cigarettes Affect Vocal Cords

Nearly Half Of Young Adult Daily Vapers Used High-Nicotine Products

The second study published in the same journal examined use of nicotine e-cigarettes between 2017 and 2022. It found that among daily vapers aged 18–24, the number of people using e-cigarettes containing at least 4% nicotine jumped dramatically from 3.1% in 2017 to 49.2% in 2022.

By comparison, 32.8% of daily vapers aged 25–34 used products with at least 4% nicotine in 2022. The figure was 17.6% among those aged 35–54 and 4.5% among adults aged 55 and older. To sum up, young adults who vaped were 12 times more likely than those aged 55 and older to use high-nicotine products.

The study also linked higher nicotine concentrations with greater chance of dependence. People who used high-nicotine e-cigarettes in 2019 had 31% lower odds of being abstinent from vaping four years later.

“The Food and Drug Administration's (FDA) authorization of these products was based in part on the expectation that the benefits to adults who smoke would outweigh the risks of creating new nicotine dependence among young people. Our findings suggest that this balance needs to be reassessed,” the researchers said.

Senior author John Pierce added, “Previous research has questioned the effectiveness of e-cigarettes in helping smokers quit. In this study, we have documented that high-nicotine products have created a new generation of people who are dependent on nicotine.”

Also read: 5.4 Million Over-16s Now Vape in Britain: Why E-Cigarettes May Not Be Safer

5.4 Million Vape Users In The UK Are 16 Years Old And Above

In Great Britain, around 5.4 million people aged 16 years and over (9.9%) used an e-cigarette daily or occasionally in 2025, according to the ONS Opinions and Lifestyle Survey. For the second consecutive year, e-cigarette use was higher than cigarette smoking. In 2025, there were around:

• 5.4 million current e-cigarette users
• 4.8 million current smokers

The proportion of adults using e-cigarettes has also increased over the longer term, rising from 6.4% in 2020 to 9.9% in 2025.

“Inhaling these substances directly into the lungs introduces not just nicotine, but also numerous potentially carcinogenic and lung-damaging compounds. This is not harm reduction—it’s harm diversification.”, said Dr. Arun Chowdary Kotaru, Head and Senior Consultant of Pulmonology & Sleep Medicine.

He added, "The teenage brain is still developing until around the age of 25. Nicotine interferes with areas responsible for learning, impulse control, and mood regulation. Early exposure can also set the stage for a lifelong struggle with addiction, increasing vulnerability to other substance abuse later in life."

Propranolol is a beta-blocker that is used to address certain heart conditions and physical symptoms of anxiety. It has been gaining attention on social media for calming nerves before stressful life events like job interviews, presentations and other similar situations.

However, experts warn that its surging popularity may make it difficult to pay attention to the limited evidence supporting its use for anxiety.

The medication works by blocking the effects of adrenaline on beta receptors, slowing the heart rate and reducing physical symptoms like trembling, sweating and palpitations. It does not directly treat the emotional symptoms of anxiety.

Propranolol Has Becoming Popular As A 'Quick Fix'

In England, the NHS dispensed around 8.4 million propranolol prescription items in the 12 months leading up to June 2026, a 4.7% increase from the previous year. These figures cover all uses of the drug, not just anxiety.

Significant increases in prescriptions among younger women and teenage girls over a decade was also seen. Social media has helped promote propranolol as a quick fix for nerves, but its popularity does not reflect the strength of its clinical evidence.

Also read: Seasonal Depression & Anhedonia: How Winter Can Affect Pleasure And Motivation

What Does The Evidence Say?

Dr Daniel Gordon, private GP and managing director at DGA Health told Daily Mail that propranolol may help people whose anxiety mainly causes physical symptoms.

"In my experience, the people who find propranolol helpful are usually those whose anxiety shows up mostly in the body, with palpitations, shaking and a pounding chest," Dr Gordon said.

He also said that addressing those symptoms can treat physical symptoms, helping people feel more in control. But feeling calmer in the body is not the same as treating anxiety, and for many people talking therapies, and sometimes other medicines, prove to be helpful.

Additionally, the evidence available on Propranolol is insufficient contrary to its online popularity. A systematic review of eight small randomised trials, covering around 200 people, concluded that the evidence was insufficient to support routine use of propranolol in any anxiety disorder.

Some people do report relief of physical symptoms, but propranolol us not recommended for anxiety as there are no modern, reliable clinical trials.

Dr Gordon added, "This is exactly why proper assessment matters. Propranolol should generally not be used by people with asthma, certain heart rhythm problems such as heart block, a very slow heart rate or low blood pressure, and it can mask the warning signs of low blood sugar in people with diabetes."

Also read: The Silent Struggle Of Raising A Child With Mental Health Challenges: How Parents Can Cope With Stigma

Risks Of Taking Propranolol Without Prescription

Common side effects of propranolol include dizziness, tiredness, cold hands and feet, and sleep disturbances. Because propranolol can decrease heart rate and blood pressure, it may be unsuitable for people with low blood pressure. It can also be risky for people with asthma and heart conditions.

Buying prescription medication online is not inherently unsafe, but a brief questionnaire does not necessarily mean that a person's medical history and individual risks have been adequately assessed.

Gordon stressed that a medical doctor needs to review a patient's medical history before prescribing the drug as it can interact with other medications and may be unsuitable for some patients.

Alternatives For Managing Anxiety

Propranolol may help some people manage physical symptoms in some situations, but it is not a substitute for treating clinical anxiety.

Psychological therapies, including cognitive behavioural therapy (CBT), can help people manage anxious thoughts. Medication may also be appropriate depending on the person's symptoms.

People whose anxiety affects their work, relationships or daily activities should speak to a healthcare professional rather than taking propranolol.