What is nicotine?
Nicotine is an alkaloid that occurs naturally in the tobacco plant and other plants in the Solanaceae family, at much lower levels. Nicotine can be extracted from tobacco for use in nicotine replacement therapy (NRT) products, the liquids used for e-cigarettes, nicotine pouches, and other nicotine products. Synthetic nicotine can also be produced, and its manufacturing costs have significantly decreased over time. Today, an increasing number of products on the market (e-liquids and nicotine pouches) contain synthetic nicotine. All our smoke-free products currently in the market contain tobacco-derived nicotine.
What is the history of nicotine use?
People have been consuming nicotine (through tobacco) for thousands of years, with the prevalence varying by culture, time, geography, and gender. The earliest evidence of nicotine (tobacco) consumption comes from the early inhabitants of North America’s desert west approximately 12,300 years ago.1 European sailors and settlers brought tobacco to Europe in the early 1500s.2 In the late 1800s, the cigarette-rolling machine was invented and commercial cigarettes became widespread.
Why is nicotine so often conflated with smoking?
Since smoking has been the most prevalent form of nicotine uptake for millennia, nicotine, smoking, cigarettes, and tobacco use can be difficult to separate in people’s minds. However, the effects of nicotine vary by product (depending on the delivery mechanism and what else is delivered besides the nicotine).
External independent surveys indicate prevalent misunderstandings regarding the impacts of nicotine among smokers and healthcare providers. National data from the U.K. and the U.S. indicate that misconceptions about nicotine are widespread among adults who smoke, with a significant segment of the population erroneously thinking that nicotine is the primary cause of smoking-related diseases. Misperceptions about nicotine also persist among healthcare professionals, with many incorrectly attributing smoking-related diseases to nicotine itself.3
The unfortunate outcome of these misperceptions for adults who smoke is that they tend to perceive nicotine to be as harmful to health as cigarette smoking and therefore may be dissuaded from switching to less harmful alternatives that contain nicotine.4
Furthermore, the misperceptions in healthcare professionals around the health effects of nicotine may prevent them from being able to differentiate the effects of smoking from nicotine itself.
How harmful is nicotine?
Nicotine effects are product-dependent (i.e., factors such as the amount of nicotine, route of administration, rate of delivery, and individual usage behavior will influence this) and vary based on the individual characteristics of the person consuming it.
Some populations should avoid nicotine-containing products, such as underage people and women who are pregnant or breastfeeding, as some studies have found that nicotine may have adverse effects on fetal development such as low birth weight.
Nicotine is not classified as a carcinogen by health bodies like the International Agency for Research on Cancer and the U.S. FDA.5 Although there is research ongoing into nicotine’s potential role in cancer promotion independent of cigarette smoke, there is currently insufficient evidence that nicotine contributes to or promotes the development of cancer in humans.
While nicotine is addictive and not risk-free, nicotine is not the primary cause of smoking-related diseases and considered low risk in healthy adults, particularly when it is compared with smoking.6 It is the extended exposure to the toxic by-products of combustion produced in high levels when a cigarette is lit that is the primary cause of smoking-related diseases such as cancer, respiratory illnesses, and cardiovascular conditions.6
What are the effects of nicotine?
Many people who consume nicotine indicate that they do so for the perceived benefits, which include enjoyment, stress management, and relaxation. Additionally, there is some evidence that nicotine can impact cognitive processes like improving attention, memory, and fine motor function.7
As an agonist of nicotinic acetylcholine receptors, nicotine also elicits a variety of transient cardiovascular effects such as increased heart rate and blood pressure.8 People with certain pre-existing conditions (e.g., heart disease, high blood pressure, diabetes, or epilepsy) should avoid nicotine consumption.
Sustained nicotine use can induce changes in the brain’s reward and stress systems. It is well understood that nicotine has reinforcing effects and as such can lead to addiction to nicotine-containing products, but the use of nicotine products will not lead to intoxication or functional impairment. The likelihood that nicotine use will lead to addiction depends on multiple factors around the product (including mode of use, amount, and rate and patterns of delivery), the environment around the product (like availability, price, and regulations), as well as the biopsychosocial differences between the users. While it can be difficult for some, anyone can quit tobacco and nicotine altogether with sufficient motivation.
How can nicotine contribute to making cigarettes obsolete?
Availability of less-harmful smoke-free products that do not require combustion can help smokers switch fully to these alternatives, thus driving cigarette obsolescence. Nicotine is an important ingredient of smoke-free products to enable people who smoke to successfully switch away from cigarette smoking. Nicotine is indeed a key factor influencing the acceptability of smoke-free alternatives among adult smokers, alongside elements such as taste, sensory experience, and ritual. Achieving the goal of phasing out cigarettes requires discussion informed by facts and science on the health effects of smoke-free products and nicotine itself.
Could nicotine have a therapeutic application?
The scientific community continues to explore ways in which nicotine and other alkaloids present in the tobacco plant can be isolated and potentially used as therapeutic compounds.9 For instance, scientists are studying nicotine as a possible active ingredient in pharmaceutical applications for treating schizophrenia, depression, anxiety, and other disorders.10
Scientists are also examining the potential effects of nicotine on conditions such as Tourette’s, Alzheimer’s, Parkinson’s, attention deficit hyperactivity disorder (ADHD), and other diseases.11 Cellular, animal, and human studies have yielded some promising results, yet the evidence is not conclusive, and nicotine’s addictiveness could be a limiting adverse effect for its development as a therapeutic compound.12
The U.S. National Institutes of Health funded a multi-center study designed to explore whether nicotine patches (used traditionally as NRT, to aid cessation) improve memory and functioning in patients with mild cognitive impairment. Top line results highlight that participants receiving nicotine showed small trends toward better performance than the placebo group in memory, attention, and daily functioning by the end of the study. However, these trends were not statistically significant. Overall, in this study, nicotine did not meaningfully slow the trajectory of cognitive decline in individuals with mild cognitive impairment. Nicotine treatment was generally well tolerated. Importantly, there was no evidence of cardiovascular complications, withdrawal, or dependence symptoms during the course of the two-year study. 13
Advancing the understanding of nicotine independent from smoking
As new nicotine-containing products continue to emerge, research will be essential to fully understand these products and the effects of nicotine itself. A clearer understanding of nicotine’s health effects, independent of smoking, is critically needed to inform evidence-based policy, regulation, and public health decisions.
We know many things about nicotine, but much remains to be discovered. People have many questions about nicotine, including its long-term effects. Advancing this knowledge requires collaboration between academic institutions, public health authorities, and regulatory bodies to fully understand the short- and long-term effects of nicotine use across different delivery systems.
We are committed to contributing to this understanding by conducting and publishing dedicated research focused on the effects of nicotine and nicotine-containing products. In 2025, we have begun exploring potential associations between nicotine consumption and cognitive effects such as focus and potential attention.
1Duke 2022; DOI: 10.1038/s41562-021-01202-9.
2Goodman 1994; DOI: 10.4324/9780203993651.
3 Christen 2025, DOI: https://doi.org/10.18332/tid/204839 ; King 2023 https://doi.org/10.1371/journal.pone.0292856
4Snell LM, Colby SM, DeAtley T, Cassidy R, and Tidey JW. Associations Between Nicotine Knowledge and Smoking Cessation Behaviors Among US Adults Who Smoke. doi: 10.1093/ntr/ntab246 2022.
5https://www.govinfo.gov/content/pkg/FR-2012-04-03/pdf/2012-7727.pdf and https://monographs.iarc.who.int/list-of-classifications.
6Khouja et al 2024, https://doi.org/10.1371/journal.pgen.1011157
7Heishman et al 2010. doi: 10.1007/s00213-010-1848-1
8Benowitz & Fraiman 2017. DOI: 10.1038/nrcardio.2017.36
9www.health.harvard.edu/newsletter_article/Nicotine_It_may_have_a_good_side.
10 Smith RC, Warner-Cohen J, Matute M, et al. Effects of nicotine nasal spray on cognitive function in schizophrenia. Neuropsychopharmacology 2006: 31:637-43. Barr RS, Culhave MA, Jubelt LE, et al. The effects of transdermal nicotine on cognition in nonsmokers with schizophrenia and nonpsychiatric controls. Neuropsychopharmacology 2008: 33:480-90. Featherstone RE, Siegel SJ. The Role of Nicotine in Schizophrenia. Int Rev Neurobiol. 2015;124:23-78. doi: 10.1016/bs.irn.2015.07.002. https://clinicaltrials.gov/study/NCT04433767
11 Terry AV Jr, Jones K, Bertrand D. Nicotinic acetylcholine receptors in neurological and psychiatric diseases. Pharmacol Res. 2023 May;191:106764. doi: 10.1016/j.phrs.2023.106764. Epub 2023 Apr 10. PMID: 37044234.
12 Newhouse PA, Sunderland T, Tariot PN, Blumhardt CL, Weingartner H, Mellow A, Murphy DL. Intravenous nicotine in Alzheimer’s disease: a pilot study. Psychopharmacology (Berl). 1988;95(2):171-5. doi: 10.1007/BF00174504. Jones G, Sahakian B, Levy R, Warburton DM, Gray J. Effects of acute subcutaneous nicotine on attention, information processing and short-term memory in Alzheimer’s disease. Psychopharmacology 1992: 108: 485-94. Wilson AL, Langley LK, Monley J, Bauer T, Rottunda S, McFalls E, Kovera C, McCarten JR. Nicotine patches in Alzheimer’s disease: pilot study on learning, memory, and safety. Pharmacol Biochem Behav. 1995 Jun Jul;51(2-3):509-14. doi: 10.1016/0091-3057(95)00043-v. White HK, Levin ED. Four-week nicotine skin patch treatment effects on cognitive performance in Alzheimer’s disease. Psychopharmacology 1999: 143: 158-65.
13 https://mindstudy.org/. Long-Term Nicotine Treatment of Mild Cognitive Impairment
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