Learning from tobacco: bans on commercial availability are not unthinkable

In ‘Rethinking alcohol, tobacco and other drug control’, Robin Room (2003) has drawn on his considerable knowledge and experience with a range of psychoactive substances to develop a public health strategy for their control. He rightly places this within social and cultural contexts and points to the enormous social and health costs to both individuals and society. He dismisses the feasibility of banning these substances, which he attributes to our unwillingness to submit to the required level of authoritarian control, and argues for a policy of ‘selective discouragement’. Elements of such a policy include encouraging dilute forms of the substance, banning advertising and promotion, state control of production and distribution, eliminating vertical integration and strengthening local control. Tobacco is referred to throughout the paper as a particularly deadly drug that is nonetheless not amenable to bans. How well does tobacco fit the definition of a psychoactive drug as one that promotes pleasure and relieves pain? and how appropriate is the proposed policy for tobacco control? Tobacco companies would have us believe that smoking is all about pleasure, yet there is considerable evidence that much of the motivation for smoking is to relieve withdrawal—a ‘pain’ that issues from the use of tobacco itself. There is much speculation that psychiatric patients self-medicate with tobacco, using the nicotine to alter dopamine levels in the brain. Yet, other evidence suggests that smoking may actually induce depression. and certainly, there is no evidence that non-smokers attain greater happiness by taking up smoking. And what about tobacco control policies? Bans have been implemented in various countries at various times throughout history. One hundred years ago, legislation was proposed in Canada to ban the sale of cigarettes. Recent Ontario data show that more than one in five support a ban on the sale of cigarettes. Almost 30% of never-smokers support a ban and even 10% of smokers concur. Many Canadian and US cities now ban smoking in all indoor public places and, in some cases, outdoor spaces. Such controls on tobacco use in North America would have been unthinkable a generation ago. Smoking in homes, especially those with children, has declined dramatically in the past decade. Most smokers want to quit, and many have informally said that a ban on tobacco would help them quit. Opposition to strong tobacco control measures in the past has come largely from the tobacco industry, front groups and those with a vested financial interest, rather than from smokers themselves. Clearly, the legal status of tobacco is a historical accident, and it would never have become a legal product if introduced in the past few decades. Yet, there are precedents for such bans. The sale of several forms of smokeless tobacco is now banned in most EU countries, as well as in Australia, New Zealand, Israel, Hong Kong and Ireland. Bhutan has recently proposed a ban on the sale of cigarettes. We already ban the sale of tobacco products to minors in many countries. Most parents, smokers or not, don't want their children to smoke. Most young people who smoke want to quit. With strong public support for bans in public places growing daily, we need to ask: would it still require an authoritarian regime to enforce such policies? I suggest that the issue is not with the general public, or even particularly with smokers. Canada has already implemented many of the harm reduction measures that would reduce tobacco use. The failure to implement the most effective of these, substantial tax increases and restricted outlets, is a failure of political will associated with economic and political interests rather than one of public support. Of course, a ban on the sale of cigarettes will not happen soon, but let it not be due to a failure of imagination on our part. Along with policies of selective discouragement, let us include bans on commercial supply as one of a range of potential tobacco control strategies that we should seriously entertain.

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