The FDA’s Menthol Ban and Big Tobacco’s Synthetic Workaround

As a final rule, nationally banning menthol as a characterizing flavor in cigarettes is expected to pass, Duke researchers find synthetic products mimicking menthol’s cooling effects in cigarettes.

by Rachael Joyner, DNP, FNP-BC, APRN

Earlier this month, the U.S. Food and Drug Administration (FDA) sent a proposed rule banning menthol cigarettes and flavored cigars to the White House Office of Management and Budget for final review. This proposed national ban on menthol has the potential to save the lives of millions and improve health equity.

Over 170 cities and counties in the U.S. have already banned the sale of menthol cigarettes. California and Massachusetts both have statewide bans.

However, a new study from researchers at Duke Health found that synthetics compounds that mimic the cooling effects of menthol are being added to cigarettes sold as “non-menthol” in states where a statewide menthol ban is already in effect.

Some of the cigarette brands with WS-3, the synthetic cooling agent identified in the study, were found to have an even stronger cooling effect then their menthol counterparts.

Menthol is a flavoring derived from peppermint that is added to cigarettes to make the smoke less harsh and more tolerable. There is evidence showing that menthol makes it easier to initiate the use of cigarettes and more difficult to quit smoking. This is partially because menthol enhances the effects of nicotine on the brain, increasing the addictiveness of cigarettes.

“Our organization has been raising a fuss. Menthol is a flavor, and it is a flavor preferred by African Americans,” said Delmonte Jefferson, Executive Director at the Center for Black Health and Equity.

Between 1980 and 2018, menthol cigarettes resulted in 3 million years of potential life lost, according to estimates from Centers for Disease Control and Prevention (CDC).

Groups such as The Center for Black Health and Equity (CBHE) have been advocating for a menthol ban for over a decade, since the FDA banned other flavors in 2009.

Delmonte Jefferson, Executive Director, Center for Black Health and Equity

“Our organization has been raising a fuss. Menthol is a flavor, and it is a flavor preferred by African Americans,” said Delmonte Jefferson, Executive Director at the CBHE.

The tobacco industry has aggressively marketed to certain groups, such as youth, women, and non-Hispanic Blacks and African Americans—these groups are more likely to smoke menthol cigarettes. Today, about 43% of all smokers use menthol cigarettes, including 80% of all African-American smokers and 50% of smokers under the age of 25.

Delmonte isn’t surprised by the synthetic compounds mimicking menthol popping up in “non-menthol” cigarettes. “The tobacco industry is a decade ahead of us in public health. They know that menthol will be banned eventually, and they are already asking themselves, ‘What will be the next best thing for us?’”

Though the FDA’s menthol ban rule may go into effect as soon as the end of the year, it could take 4 to 5 years before we actually see it truly take effect, Delmonte explains, due to the tobacco industry lawsuits that typically follow such a ruling.

“Meanwhile, we are continuing to fight at the local level, working to ban the sale of menthol. This requires building a local coalition.”

As for healthcare providers and tobacco treatment specialists hoping to address this issue, Delmonte offers this advice: “You have to be able to resonate with the folks who want to quit. You have to be able to relate to their experience and the reasons they started smoking.”

He explains that helping people quit tobacco products through treatment is only part of the solution. Addressing others factors, specifically social and economic, is key. “We have to address the social injustices and economic empowerment issues that are interrelated.”

To learn more about how to approach patients using menthol tobacco products and address health disparities related to tobacco use, sign up for one of our upcoming comprehensive Tobacco Treatment Specialist or CE Short Courses.

About the Author

Rachael Joyner, DNP, FNP-BC, APRN, Duke-UNC TTS Training Program

Rachael Joyner, DNP, FNP-BC, APRN, is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certificate in Tobacco Treatment Practice and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.