Wednesday, February 9, 2011

Tobacco Prohibition and a Law of Physics

If tobacco prohibitionists get their way, will it really be a 'win' for public health?

It's pretty obvious that the "anti-smoking" movement, based on the principle that smoking is the "leading cause of preventable deaths" in the world, has changed course. No longer is it only about the health risks of smoking. Unable (and often unwilling) to get smoking products banned in the U.S., these groups now target smokeless tobacco products; making unsubstantiated claims that these products somehow lead to smoking and must be banned to protect public health. They completely ignore, hide and even discourage the substantial research and science that contradicts their claims.

And they don't stop there.

After "wins" of banning rarely sold "flavored" cigarettes and insisting that smokeless products, such as snus and chew,  display technically true (yet intentionally misleading) labels which declare that the much safer products are "not a safe alternative to smoking," they have set their sights on nearly harmless nicotine products such as tobacco lozenges and e-cigarettes. They are now somehow convinced that people accustomed to the pleasant taste and low health risks of these nicotine products will suddenly and inexplicably stop using their safer, pleasant-tasting product and switch to the harsh smoke, foul taste and increased health risks of cigarette smoking. Apparently any nicotine product, unless it is made by a pharmaceutical company and designed to get the user to wean off of nicotine, is now taboo. Anti-smoking for health reasons has now become anti-smokeless nicotine for no valid reason at all.

So, what if they get their way? What if tomorrow all tobacco and non-pharmaceutical nicotine products were removed from the market? Would this be the great victory for public health that the health groups claim it will be?

Well, let's look first at why people smoke. Most people will point to the obvious - that people are addicted to the nicotine. So why did they try smoking in the first place? Peer pressure? Parental example? Rebellion? Stress? Those could all be reasons to start. But while millions of people try smoking for various reasons, only a small percentage of them keep smoking. So, why don't they just stop like the others? If it was just that "nicotine is as addictive as heroin" as claimed, why do the vast majority of people who try smoking not become addicted? The most logical answer is that there is something about smoking, tobacco and nicotine that goes beyond the addictive nature of nicotine itself, a theory which is most simply supported by the fact that most nicotine-only products fail to actually keep smokers from smoking.

If it was just the need for nicotine, a piece of nicotine gum would be 100% effective as a tobacco replacement, yet the success rate actually hovers around 7%. Many smokers reportedly miss the mechanics themselves - the taste, the feel, the ritual and the social aspect of smoking. However e-cigarettes, which not only contain nicotine but also mimic the habits and ritual associated with smoking, reportedly still seem to be "missing something" for about 25% of users. Additionally, smokers who have been nicotine and cigarette-free for several years have been known to relapse under certain stressors or triggers - which strongly indicates that smoking is linked just as much to the smoker's mental health and less to simple chemical addiction and habit as thought.

Whether it's chemical or psychological, smokers seem to be predispositioned to smoking for various reasons. In spite of the negative health risks posed by smoking, tobacco and nicotine products seem to provide many benefits similar to various medications. Tobacco or smoking may be a stimulant for some and have a calming, stress-reducing effect on others. Some find it improves cognitive abilities or lessens attention deficit disorders. Others find it keeps them from other oral fixations such as over-eating or compulsive nail biting. The presence of nicotine and other monoamine oxidase inhibitors (MAOIs), which act as anti-depressants, in cigarette smoke suggests that those suffering from mild depression often find relief from tobacco use. Research also shows that an inordinate number of those with schizophrenia or other mental health issues are smokers and may be somehow "self-medicating."

My experience within the e-cigarette community has shown me just how different smokers (and their reasons for smoking) really are. It's reflected in the choices smokers make when actually given a choice with e-cigarettes. Suddenly they can choose the nicotine level, no nicotine, flavors, styles, sizes and the vapor production to best fit their needs. While some e-cigarette users pick up a basic e-cigarette and never have the desire to smoke again, others can't give up tobacco altogether, no matter how high the nicotine content. They seem to need something else found in tobacco other than the smoking habit or nicotine, such as the other tobacco alkaloids or MAOIs. Many in this category find that using a smokeless tobacco such as snus, along with e-cigarettes, can satisfactorily replace smoking. On the other hand, some e-cigarette users just need a higher nicotine content, while others need no nicotine at all - just the look, taste and feel of smoking.

So, smoking seems to be helping people with a great variety of mental health issues and addictive behaviors and the sense of satisfaction is determined by different factors for each individual. The drawback is that this "cure all" comes in such a deadly delivery system. The question is that in trying to keep people from harming themselves with the delivery system, by targeting even low-risk products - such as smokeless tobacco and e-cigarettes - simply because they contain nicotine, will the goal of improving public health really be achieved? What will the people who rely on smoking turn to instead? Will those with oral fixations turn to food and become obese and face other health risks? Will those looking for relief from depression or other mental health issues, smokers who may currently avoid recreational drugs such as marijuana, cocaine, heroin, prescription drugs and even alcohol, turn to even more dangerous behaviors and/or addictions? Will all of these smokers just quit tobacco and nicotine use and somehow be magically cured of all of the underlying issues that caused them to continue smoke in the first place? Is it really reasonable to expect them to stop something that works for them and simply substitute a pharmaceutical drug in its place? Are pharmaceutical drugs really free from risks and side effects themselves? Are those dependent upon tobacco-specific chemicals any more "weak" or "immoral" than those dependent upon pharmaceutical chemicals to get through their day?

The solution to the health issues related to smoking is not to remove access to nicotine and tobacco and hope all of the reasons why smokers smoked go away too. The solution is to develop and make accessible the safer products which can address the real needs of smokers, without passing moral judgment on the product or the user. Smokeless tobacco and e-cigarettes already address many of those issues with very low health risks. The majority of scientific research does not support the claims that their use will lead to smoking, so other than the irrational vilification of tobacco and nicotine and the moral judgment of the user, there is no valid reason to call for their removal.

The likelihood of cigarettes being banned for sale (and without a black market created) is slim to none. Therefore, those affected by the removal of safer tobacco and long-term nicotine products are not only current smokers, but those who for whatever reason may choose to try smoking and find themselves dependent in the future. So long as tobacco cigarettes remain available and so long as there are people who find the benefits outweigh the risks, removing safer options merely increases the health risks for those who may have otherwise sought them out. Smokers and “would-have-been” smokers deprived of all sources of tobacco or nicotine, including low risk products, will likely seek out an alternative for relief that may even more dangerous and detrimental than smoking itself.

Basic physics - for every action there is always an equal and opposite reaction. Considering the likely reaction of a ban on all tobacco and nicotine products, can prohibitionists really forsee that it will result in a "win" for public health?


  1. Outstanding rightup, Kristin!!! 'Can't think of a thing I'd add or change. Nicely done. :)

  2. Very well reasoned and makes an important point. Is there anything to gain by blocking people from low risk products that help them quit smoking?

    I have been sober for 35 years, I have quit cigarettes a few times (cold turkey) in the past. When stress builds high enough for me, I'd go back to smoking because it was a far better choice for me than the alternative.

    I am not smoking now, and it has been painless for me, because of the alternative of e- cigarettes. I really don't think I had it in me to try and quit cold turkey again - at least not at this time. But this subsitute really worked for me and I easily was able to stop smoking - again. I have tried at other time to use alternative ways to help aid quitting: nic gum, patches, medication, hypnosis, and acupunture and they were not effective for me. The only way in the past that worked was for me to muster all my energy towards quitting and truely suffer - for months - as I fought to stay away from cigarettes. I was successful, sometimes, but for me it was not the kind of endevor I undertook lightly. One time I gained 80 pounds and it took over a year to loose it - but it wasn't the first year because that year was the year I was still fighting to stay away from cigarettes.

    I was not mildly addicted to drugs an alcohol and it was tough to get past that but I can say that in my experience, smoking has been much harder to quit.

  3. Well Done!

    As a follow-up. you may want to do a survey of ex-smokers to see which product they prefer and why. The results would supply some empirical data to support your arguments here. (Everybody loves graphs!)

  4. I assume you mean by products preferred by "ex-smokers" current e-cigarette users? A lot of my conclusions come from observation of e-cigarette and snus user comments on, but a lot of it is supported by the CASAA E-cigarette User Survey, as well:

  5. Just discovered your blog. Exemplary work. Had to add you to our links.


  6. Thanks, Paul, that means a lot coming from you. I'm honored!

  7. The sponsors of the Washington State SB 5380 and HB 1246 should all be sent a copy of this article. These bills would ban the the use of all flavors except "tobacco" in every product except for cigarettes (menthol is still legal). The vast majority of e-cigarette users start out with tobacco flavors but soon switch to more pleasant flavors. As a result, the taste of real cigarettes becomes unpleasant. Imagine a product that stamps out the desire to inhale smoke!

    The bills would outlaw all sales of snus, which research has shown to reduce the smoking-related disease risks by up to 99%, and dissolvable tobacco products such as orbs. If every smoker switched to a lower risk smoke-free alternative, the number of "tobacco-related" deaths would fall from 440,000 per year to 6,000. Only a politician would outlaw the safest products while protecting the sale of the deadliest products and then claim to be doing it to save lives.

  8. Kristin, you've been paying attention. That is a great blog and hits the target dead center. There is such a variety of reasons why people have continued to smoke and no matter what political attempt is made, some people will continue to smoke. Make it illegal, they'll go black market, but they'll smoke. Not because of nicotine per see, but because they're people and people want to make their own decisions.

    For the rest of us that wanted to quit and tried the various, disgustingly ineffective, medically approved methods and failed, there was no "safe alternative to smoking" according to the prohibitionist so we continued to smoke.

    Then along came electronic cigarettes and discussions about other smokeless products. The internet gives you the ability to see what the antis have hidden for decades as well as the newer products available today. All avenues that potentially lead smokers out of the darkness that the zealots have placed us in.

    PVs and Swedish snus have freed me from inhaling RIP cigarettes that started impacting my health to a content position of being a former smoker. The products currently available give many new approaches for those that are interested in quiting smoking and they should be advertised, not criticized.

    Again, great job!!!