Nicotine and Tobacco

Drugs and Our Society

Part 14

Nicotine and Tobacco1. One of the most pervasive / destructive drugs known

- entrenched in our culture

- integral role in our history

- “War of Independence”

a. Efforts to regulate

- latter part of 1800s

b. Anti-tobacco legislation

- characterized by two themes

Nicotine / Tobacco, cont. - fire hazards - morality of smoking

c. Beginning of 1900s - became less important - economic benefits associated - tobacco taxes source of revenue

d. Today: $45 billion industry - significant revenue source (state / federal)

Nicotine / Tobacco, cont.2. 1995: FDA proposal to regulate

- unsuccessful due to politics

a. Current emphasis

- control sale to minors

- control promotion of cigarettes

b. Rate of smoking declined: adult smoker

- 50% less from 20 years ago

Nicotine / Tobacco, cont.c. Perception of tobacco

- increasingly negative

- once viewed: “dirty habit” / “dirty practice”

- now a “life-threatening addiction”

3. Nicotine: addictive ingredient

- C. Everett Koop (former Surgeon General)

- first official to warn of dangers

- claimed: nicotine dependence powerful as

heroin / cocaine dependence

Nicotine / Tobacco, cont.a. Tobacco more available - can be considered more addictive

b. 90% of all smokers = become addicted - alcohol also available - most drinkers do not become alcoholics

3. American Psychiatric Association- recognized dependency as a disorder- depression common- suicide: 100% higher than non-smokers

Nicotine / Tobacco, cont.a. Comes from green tobacco plant

- genus: Nicotiana

- 60 species

- only nicotiana rustica / tabacum smoked

b. Tobacco from these plants are used in:

- cigars / cigarettes

- pipes

- snuff

- chewing tobacco

Nicotine / Tobacco, cont.1. History of tobacco use

- stone carving / Southern Mexico / 600 – 900 AD

- smoke blown through pipe

a. Columbus travels

- dried tobacco leaves as gifts (late 1400s)

- returned with tobacco seeds / planted

- became popular in Europe

b. Believed to be medical treatment

History, cont. - skin disease / injuries / internal disorders - cure diseases of eyes / nose / mouth - smoke could breath life into another

person

c. 1828: nicotine isolated - poisonous / addictive - medical value declined

d. Next 30 years: - religious leaders / physicians /educators

questioned the medical value

History, cont.e. Attacked for causing problems in society

- mental illness / delirium tremens / impotence

- and sexual perversions

f. Despite warnings:

- tobacco use for pleasure flourished

2. Jamestown: early settlement in the colonies

- early 1600s / brutal winters / food shortages

- settlers prepared to abandon

History, cont.

a. John Rolfe

- convinced to plant tobacco

- crop flourished / Jamestown prospered

b. Tobacco farming spread

- established as valuable commodity

- used as form of currency

c. Financed by French government

- funded Revolutionary War

History, cont.3. Late 1800s: cigarettes rolled by hand

- 1883: invented rolling machine

- started being massed produced

a. 1891: Richard Joshua Reynolds (RJR)

- saccharine in tobacco

- sweeter / longer shelf life

b. Also introduced Prince Albert (1907)

- sterilized in licorice casing

History, cont. - delightful / harmless tobacco

d. Introduced other brands:

- Camel

- Turkish / domestic leaves

- less expensive / highly popular

e. Competition:

- American Tobacco Co / Lucky Strike

- Liggett and Meyers / Chesterfield

History, cont.4. Opposition escalated

- first critic: Dr. Benjamin Rush (1798)

- condemned for adverse health effects

a. Women’s Christian Temperance Union

- with others

- supported controlling use / sale

b. Several states banned sale to children

- chewing / smoking

History, cont.c. Wisconsin / Nebraska

- possession illegal

- both adults / children

5. Despite efforts: popularity continued

- WWI: YMCA / US Army distributed to soldiers

- after war: use escalated

a. Morality / medical concerns took backseat

- public desire first

History, cont. - taxes contributed to revenue

b. WWII - manufacturer’s donated to soldiers - patriotic gesture

6. Costs of Smoking- one factor to reduce demand- increase cost

a. 1992: average tax = .62 cents

Costs, cont. - states continue to raise

- proceeds to government programs

- smoking prevention / treatment / schools

- Washington state, 2nd highest ($3.025)

b. Lawsuit settlement

- billions given to states

- programs for anti-tobacco use

- health care cost for tobacco related illness

- “bartered” away

Costs, cont.c. Sold half of award = get money now

- offset state budget deficits

d. Used in other programs

- not going to anti-smoking

- nor treatment for illness

7. Extent of tobacco use

- 1975 – 2000: 62.5% high school seniors smoked

- 11.3% half pack or more daily

Extent, cont.a. Office on Smoking / Health

- Center for Disease Control / Prevention

b. 2003: more than 65% high school seniors

- Caucasian = higher than Hispanic

- African-Americans least likely

c. Peaked in 1964

- Surgeon General’s Report

- dangers of smoking

Extent, cont.d. 1964 – today:

- more than 43 million quit

- continues to decline among adults

e. Data confusing:

- total number of smokers = increased

- percentage has decreased

- cigarettes smoked per capita: not decreased

f. People who smoke tend to smoke heavily

Extent, cont.g. Filters more popular than plain tip

- 2% in 1952

- 60% in 1963

- 90% today

h. Tar / nicotine sharply reduced

- cause people to smoke more

- seek same amount nicotine

- inhale more deeply / hold in lungs longer

- just smoke more cigarettes

Demographics of Smoking1. More adult males smoke

- females gaining

a. Manufacturer’s market to women

- link to independence / equality

- “Virginia Slims”

b. College students

- 28% recent increase

- all ethnic groups

Demographics, cont. - average starting age: 19 - 18%: 5 or more attempts to stop

c. Teens: more likely if sibling smokes - high school or less: more likely than college

- blue-collar: more likely than white-collar

2. Women / smoking- differences diminishing

a. 22% women smoke / 26% men (4%)

Demographics, cont. - 1965: 52% men / 34% women (18%)

b. Level of education (correlation)

- through 11th grade: 3 times more likely

- than women with 16 years / more

c. Since 1980: over 3 million women died

- prematurely from related diseases

d. Reduces life by 14 years

Demographics, cont.e. 25% of all cancer deaths

3. Tobacco Use by Young People- begin during childhood / adolescence- 89%: initiated by age 19

a. Average 2 / 3 years to become regular smoker - earlier in life

- more likely regular smoker

b. Study of childhood smokers:

Young People, cont. - 4%: 3rd / 4th grade students - 42%: 8th / 9th grade students - most experimental - 8th / 9th grades: 9% current smokers - mean age to start: 12.5 years

c. Teenage rates gone up - as advertising expenditures go up - 3 times more responsive than adults

d. 89% start as teenagers

Young People, cont.e. 14.9% age 12 – 17 current smokers (21/2

mil) - currently smoke: more likely to use drugs

Nicotine Tolerance / Dependence1. Build up tolerance quickly / matter of weeks

a. Continue to use: it is addictive - usually associate with narcotics - ignore nicotine addictiveness

b. Effects: highly reinforcing

Tolerance / Dependence, cont. - reaches brain in seconds

c. Not last long in body

- to compensate: light up another

- characteristic: other forms of addiction

d. Develop tolerance

- need more nicotine

- strong desire: continued use

- if not: undergo withdrawals

Tolerance / Dependence, cont.

2. Rituals – become ingrained

- light up after eating

- talking on phone

- driving vehicle

- after sex

a. Symptoms of withdrawal

- not fatal

- varies

- uncomfortable

Tolerance / Dependenceb. Proportional to intake

- more nicotine / greater withdrawal

(1) Most acute: 24 to 48 hours after ending

- craving: last weeks / months / years

(2) Symptoms:

- lower heart rate / blood pressure / heart

palpitations / difficulty maintaining attention / aggressiveness / insomnia /

tremors / hunger / headaches / fatigue

Pharmacology1. Nicotine

- 6000 chemical substances in tobacco smoke

- insecticide

- carcinogenic

a. Stimulant

- similar to amphetamines / cocaine

(1) Injected intravenously

- 5 to 10 times more reinforcing than cocaine

Pharmacology, cont.(2) Absorbed immediately by lungs

- brain: 10 seconds

- feel effects every inhale

(3) Quickly distributed in body

- traverses blood / brain

- placenta pregnant women = fetus

- breast milk

b. Liver metabolizes

Pharmacology, cont. - almost all before kidney excretion - stays: 8 to 12 hours

1. Passive smoke- involuntary / environmental / second-hand- detrimental effects: not limited to smokers

a. Indoor pollution - home / workplace

b. Blamed for 3,800 lung cancer deaths yearly

Passive Smoke, cont. - 8,000 to 26,000 asthma cases in children - extent of harm: degree of exposure - emotional discomfort around smokers c. Classified: mainstream / sidestream

(1) Mainstream - smoke exhaled - 58% nitrogen/13% carbon dioxide/12 % oxygen/8% particles (nicotine, tar, waxes dyes)/3.5% carbon mono./0.5% hydrogen

Passive, cont. (2) Sidestream

- comes from burning end of product

- not pass through filter

- hotter temperature

- more nicotine / carbon monoxide

c. Laws against smoking in public places

- precipitated by effects of sidestream smoke

2.Effects on non-smokers

Effects, cont.- besides irritating nose / eyes

- passive causes significant health problems

a. Linked to: lung / urinary tract problems

- also liver / pancreatic cancers

- increase in breast cancer

b. Lung cancer: higher living with smoker

- smoke at work increases risk (bar / restaurant)

- 3 times more likely

Effects, cont.c. EPA (1993): secondhand smoke a carcinogen

- 1998 smoking prohibited California bars/taverns

- NYC passed ban on smoking in public places

d. Effects on children

- more likely: respiratory infections

- colds / bronchitis / pneumonia

(1) 17% lung cancer deaths

- high levels of exposure

Effects, cont. (2) Women who smoke during pregnancy

- children exhibit impulsiveness / risk-taking /

rebelliousness

3. Rights of smokers vs. nonsmokers

- difficult to balance

a. Anti-smoking legislation

- federal (1998): minimum age of 18 to buy

- under age 27 must show ID

Rights, cont.

(1) Occurred because:

- local laws passed

- 1,000 local ordinances

(2) Tobacco petitioned state legislators

- 75% support measures to limit

- sales / possession

(3) Laws vary:

- Greensboro, NC = restricted smoking

Rights, cont. - San Francisco = no smoking in public /

private workplaces

- Massachusetts = police / fire fighters

- Vermont = raised taxes .26 pack

- Washington = .50 cents

- Congress = 1 of 4 warnings (rotate)

- Depts. Of Labor / Defense = smoking ban

(4) Airlines (1990)

- no smoking = domestic flights

Rights, cont. - flights shorter than 6 hours

b. Companies / corporations - passed non-smoking policies

c. Local governments - will not hire smokers - upheld

d. Tobacco settlement - $206 billion / over 25 year period