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Tobacco addiction revisited

by Dzulkifli Abdul Razak
The Sun, May 24, 1997

EVER SINCE THE LIGGETT disclosure last March (see Healthtrack May 16), the tide is truly turning against tobacco-related businesses in an unprecedented way. Not only are more lawsuits being brought against tobacco giants by members of the public, governments are also joining in. One of the latest is a lawsuit initiated by the state of Mussouri a few weeks ago.

The main complaint in these lawsuits is generally the same - tobacco companies and others in the tobacco industry lied about the health risks and risks of addiction caused by smoking. The subject of addiction is central in the lawsuits, and often the industry finds itself in a precarious position when faced with questions related to tobacco addiction or dependence.

As expected, many tobacco companies treat this subject with some degree of obsession. When confronted with the fact that the substance nicotine in their cigarettes is addictive, the tobacco industry will put up a defence in an almost paranoid-like fashion. They prefer to dodge the question or disclaim it outright. They often try to avoid the subject in a light-hearted way. The most recent example is comparing nicotine to some kind of candy, unheard of in this part of the world, by a top ranking executive of one of the world's largest tobacco companies. He was quoted as saying that "tobacco is no more addictive than Gummy Bears candy."

This comparison is certainly not the first of its kind. A month after the Liggett confession, another top executive, when questioned by a Florida lawyer whose client had filed lawsuits against the industry, said that he did not believe "tobacco is any more addictive than coffee or carrots."

All this seems to indicate quite strongly that tobacco companies are not concerned about the public health problems that they are creating. They continue to disregard and misrepresent the material facts about the health risk of smoking and the addictive nature of nicotine. The fact is, should there be a need to make any comparison at all about the addictive nature of tobacco, there is nothing more appropriate than to compare it with drugs of abuse such as heroin, cocaine and amphetamine.

Perhaps, at this juncture, it is important to put the record straight so that the public is no longer fooled by absurd statements that the industry is fond of making. The best point to start off with is the Liggett documents, For example, it was reported that among the many documents revealed, a 1972 memorandum on the "crucial role of nicotine" seems to confirm that the tobacco industry knew all along of the addictive nature of tobacco but kept it secret.

In another words, when it comes to the hazards of smoking, the companies are not as naive as they want us to believe. In contrast, it is almost apparent that they are "conspiring to restrain and suppress research on the health effects of smoking," as mentioned in one of the allegations put forward by the Missouri State Attorny General, Jay Nixon.

Given the tract record of the industry in this matter, such allegations seems justified. Over the years, the tobacco industry has been accused of trying to manupulate the level of nicotine in their cigarettes as part of its marketing strategy. A case in point is when one company developed, or rather genetically manipulated, a tobacco plant said to contain twice the amount of nicotine found in other strains during the 80s. The plant, code-named Y-1, was grown in Brazil, presumably to avoid easy detection. This bizarre event was disclosed only in 1994 by then Food and Drugs Administration (FDA) Comissioner, Dr. David Kessler.

In other instances, the Liggett documents describe how it is possible to increase the "physiological" effects of nicotine in cigarettes, even if the level of nicotine is reduced to create the impression that the product is less dangerous.

That nicotine is a powerful addictive drug was already clearly stated in the United States Surgeon General's Report in 1988. Although this has been strengthened by further research from time to time, policy planners and decision makers largely remained unmoved- until the disclosure by the Liggett Group.

To date, independent scientific research has documented similarities between nicotine and a number of drugs including cocaine, amphetamine and heroin. By July 1995, the FDA concluded for the first time that nicotine is a drug that should be regulating tobacco products. This was upheld recently by the North Carolina court of law and others are takinf the same stand as well.

Furthermore, as recently as mid-1996, the scientific journal Nature published a finding that "adds new weight to the conclusion that nicotine is indeed addictive." The researchers showed that part of the brain involved in nicotine addiction is similar to that of cocaine, amphetamine and morphine in animal experiments. In fact, the latest issue of the same journal provided even more evidence towards this direction. Researchers are getting closer to identifying the mechanisms in the brain associated with tobacco addiction.

To understand the broader implication of this, it is worthwhile to quote an excerpt from an authoritative document from the World Health Organisation (WHO) entitled Tobacco Use: A Public Health Disaster.

"Nicotine has been clearly recognised as a drug of addiction and tobacco dependence has been classified as a mental and behavioural disorder according to the WHO International Classification of Diseases, ICD-10 (Classification F17.2). Experts in the field of substance abuse consider tobacco dependence to be strong or stronger than dependence on such substances as heroin and cocaine."

It is not surprising, therefore, if one of the researchers declares that: "Addiction is a disorder of the brain ni different from other forms of mental illness." In other words, nicotine or tobacco addiction is an outcome of long- term use, or rather abuse, of tobacco which develops in the first few years of cigarette smoking. For most people, it starts from adolescence or early adulthood. Once a person is addicted, cessation of tobacco use is usually difficult.

The same WHO documents states: "although 75% to 80% of smokers, where this has been measured, want to quit and about one-third have made at least three serious attempts, less than half of smokers succeed in stopping permanently before the age of 60.Nicotine dependence is clearly a major barrier to successful cessation."

Moreover, like all drugs of abuse, when nicotine use is abruptly stopped (typically when one runs out of his cigarette supply), withdrawal symptoms begin to emerge. These include restlessness, anxiety, heart palpitations and craving.

Recently, the Associated Press was quoted as saying that "a panel of experts with the WHO has proposed that it review tobacci for possible classification under the International Convention on Drug Control." The panel had recommended the proposal last October.

In view of the above arguments, the gravity of the matter cannot be over- emphasised. It is certainly not something to be taken in jest as some top officers of the tobacco industry have attempted to do. Candies and carrots cannot be allowed to be confused with nicotine. It is understandable therefore that many concerned citizens are outrages by such irresponsible statements.

The unfortunate analogy is especially "galling," according to New York Attorney General, Dennis Vacco because tobacco companies have targeted youngsters in their marketing strategy.

On hindsight, therefore, it is nost timely that we re-examine closely the position of the tobacco industry. The issue is that of addiction, regardless of whether it is tobacco or any other substance. It is no doubt a battle that must be fought long and hard in the face of a tight network of an ostentatious industry set to peddle addiction.

In this context, the coming 1997 World-No-Tobacco Day provides a golden opportunity for all of us to be "united for a tobacco-free world" - the only viable option left before society can be rid of the addiction once and for all.

The writer is a proffesor and director of the National Poison Centre, Universiti Sains Malaysia, 11800 Minden, Penang.

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