The scientific discourse about nicotine is changing quickly. Previously seen through a narrow prism of addiction, new research from a range of fields — from neuroscience to clinical medicine — is painting a much more multifaceted picture. For proponents of tobacco harm reduction (THR), this expanding body of evidence confirms a familiar maxim: it is not the nicotine per se, but rather its delivery mechanism that largely dictates harm.
Sadly, this distinction is seldom reflected in public messaging and policy frameworks. And in some instances, it is even hidden — a risk that could hinder efforts to shift smokers away from cigarettes that burn.
More flawed vape research
..if research does not clearly distinguish between product categories, it risks perpetuating the myth that all nicotine use is equally harmful.
A recent observational analysis published in The American Journal of Physiology Heart and Circulatory Physiology shows just how easily nuance can go missing. The study found a link between nicotine use and increased blood pressure levels. But many leading experts, including Nicola Lindson, Jamie Brown and Peter Hajek, were quick to point out a serious error.
The study design was flawed, and the participants had only been asked about nicotine use in the most recent five days, which meant that they hadn’t provided information about long-term smoking history. This is a major limitation, considering that dozens of vapers are former smokers, and inflation of these histories makes it more challenging to disentangle the effects of vaping itself.
For one thing, lumping together smokers and vapers into the same analytical categories threatens to distort results. The harmful effects of smoking are already well known as major cardiovascular risk factors. That means that the stronger bad effects resulting from smoking will inform these groups and outweigh the relatively weak signalling coming from vaping when they are combined. In fact, experts said the results for exclusive vapers were not statistically significant and much less pronounced than in smokers.
Public health agencies and peer-reviewed research have consistently highlighted the risk gradient between smoking and vaping. But if research does not clearly distinguish between product categories, it risks perpetuating the myth that all nicotine use is equally harmful.
Nicotine and cognitive health
In addition to risk reduction, new research is delving into nicotine’s potential effects when used under controlled conditions.
Carefully administered low doses of nicotine have been found to improve factors like working memory and mood in people with mild cognitive impairment. A more general review published in Frontiers in Ageing Neuroscience emphasises nicotine’s effects on the brain’s cholinergic system, an important system for attention and learning. This body of work suggests a dose-dependent relationship, with modest levels potentially enhancing cognitive performance. Yet, higher doses induce diminishing or negative effects.
Neuroscience discussions, including in outlets popularised by Andrew Huberman, have also explored the effects of nicotine on acetylcholine receptors and dopamine pathways, which are permissive of focus and motivation. And while researchers emphasize that nicotine should not be recreationally used for cognitive enhancement, they do highlight that the effects of nicotine are not uniform. Its impact is highly context-dependent, shaped by dose and delivery.
This expanding complexity poses a challenge for regulators.
In clinical environments, nicotine can be prescribed in specific, controllable doses. In the real world, though, that ability to regulate how much you consume is influenced by what products exist. Traditional cigarettes leave little room for control and deliver a host of harmful byproducts with nicotine.
In contrast, many reduced-risk products allow tighter control over dosage and usage behaviours. Limiting access to those alternatives may thus make it harder, not easier, for individuals seeking to align their use with safer parameters. The dissonance between our understanding of science and the constraints we face in the real world is becoming increasingly clear.
More insights from medical research
Interestingly, similar advances in other areas of biomedical research demonstrate that compounds once thought straightforward or well understood can unlock unexpected therapeutic potential. According to a recent study published in Liver Research, nicotinic acid—a variant of vitamin B3—was shown to mitigate liver damage from ischemia-reperfusion injury (IRI) markedly. This potentially life-threatening complication can occur during surgical or transplant procedures. Nicotinic acid helped protect the liver in both animal studies and human liver cells. It worked as well as, or even better than, well-known antioxidants like N-acetylcysteine.
What makes it interesting is how it works. Instead of just acting as an antioxidant, nicotinic acid directly supports the health of mitochondria—the parts of cells that produce energy. It helps remove damaged mitochondria and supports the body’s creation of new, healthy ones. As a result, researchers observed reduced inflammation, decreased cell death, and lower levels of ferroptosis, an iron-mediated form of cell injury. Liver cells also maintained better energy balance, which helped keep their normal functions.
Meanwhile, new research into the wider effects of nicotine emphasises that in both science and policy, precision matters — as does context and proportion. The story has changed around nicotine. From cardiovascular studies to neuroscience and cellular biology, discoveries are upending old assumptions and exposing a more complicated reality.
The policy disconnect that needs correcting
For policymakers, the challenge is not to discount risk but to properly recognise it—and to design systems that accurately account for relative harm. For the harm reduction community, the narrative is unchanged: access to safer alternatives in a supportive environment with straightforward messaging and evidence-based information about compliance products is a critical driver for mitigating disease burden from smoking.
Science is ever-evolving, and regulations need to keep pace.
