Is it biologically plausible that menthol enhances the addictiveness of cigarette smoking?

The evidence is sufficient to conclude that it is biologically plausible that menthol makes cigarette
smoking more addictive. The evidence reviewed suggests several mechanisms by which menthol could contribute to the initiation and persistence of cigarette smoking.

• Nicotine is required for the acquisition and maintenance of addiction to cigarette smoking. But as described previously, menthol can modulate nicotine effects and may act directly on nicotinic
cholinergic receptors to alter nicotine response.

• While nicotine is required for nicotine addiction, the addictiveness of cigarettes is also influenced by sensory factors. Menthol provides an unmistakable

• Sensory experiences can contribute to conditioned aspects of smoking behavior. Once drug selfadministration has been established, taste and other sensory factors can function as stimuli that can substantially enhance the strength and persistence of drug self‐administration.

• Stimuli associated with drug intake and/or withdrawal can come to evoke craving that promotes resumption of self‐administration of the drug after a period of abstinence. Thus, menthol from food or toothpaste could serve as a sensory cue to prompt relapse to smoking. These mechanisms have been demonstrated in a variety of animal and human studies with a variety of addictive drugs.

• Another potentially relevant issue is the relationship between menthol and genetic differences in perception of taste. As noted above, various studies raise the possibility that menthol might interact with genetically determined taste sensitivity to facilitate smoking. Thus, there may be a genetically susceptible population for whom menthol cigarettes facilitate smoking.