Smoking, tobacco & nicotine
Posted on January 11, 2012New Years resolutions often fail because of incomplete planning and understanding of the recovery/change process. Dr Inaba gives us a clear perspective, including the sequence of habit change.
Posted on July 28, 2011Smoking in public is facing ever-greater restrictions; individuals, and the tobacco industries are pushing back in court. Meanwhile varenicline (Chantix) has been found to have serious cardiovascular side effects. And the state of Oregon mandating no smoking or be disqualified from state-supported treatment programs.
Posted on June 24, 2011An addiction "boom" is happening to people in 50s and 60s - too young to be old, often caring for parents, or under-employed adult children often with their own families, and still working to try to make ends meet - is causing many baby-boomers to have more issues with addiction and substance abuse then perhaps earlier in their life.
Posted on December 1, 2010The Rolling Stone and "sex, drugs and rock 'n' roll" somehow seem to go together. Guitarist Keith Richards chronicles his life experience in a new autobiography, which talks alot about his passion -- music, and how that helped him overcome his addictions without quitting all drugs and drinking. Dr Inaba comments.
Posted on October 20, 2010FDA and its expanded role of supervising tobacco - today's discussion focusing on menthol and e-cigarettes; also proposals to consider increases to alcohol taxes for possible health and safety benefits.
Posted on July 21, 2010
Teen smoking was falling, but has leveled off, missing the CDC goal of reducing the number of young smokers to 17% or less. And a Toronto metropolitan hospital has loosened its prohibition of smoking on campus, owing to the disruption smokers from the hospital were causing the neighborhood. Also a glimpse at new wide-spectrum addiction-mediation medication.
CNS: Howard LaMere here with Dr. Darryl Inaba, we’re commenting on news about smoking - one article highlights the CDC’s (Center for Disease Control) goal of reducing smoking among teens – apparently it was going down for awhile and now it has leveled off. I don’t know if that means more teenagers are smoking or if they’re not smoking as much. Another interesting story from Canada… about a hospital in Toronto reversing its policies on smoking on campus after banning it a few months ago because of the profound effect that smokers from the hospital were having on the local community in downtown Toronto. These issues remind us that smoking is and continues to be one of our strongest addiction and health care issues and how best to address it is an ongoing question. What do you make of the story about Toronto?
DARRYL: Well, it’s not very explicit in the article, but it seems the decision to allow smoking in the hospital rather than making their staff and patients who do smoke go outside was made not because of health concerns, but because of their image and how the hospital was interacting with the local community. I don’t think anywhere in the article…or anywhere else is anyone saying that smoking is actually healthy, but in this case the hospital was in the downtown community so when their smokers left the campus to go smoking, they cluttered up the sidewalks…they fogged up windows in local shops and messed with the pedestrian traffic, so because of complaints, the hospital is allowing people to come back in...onto the campus and smoke in designated areas. They also said that there was some concern because patients and drug addicts in the hospital had the most difficulty trying to quit. It caused them a lot of stress and then to make them go outside of the hospital grounds ….it created too much of a problem. As you know here in southern Oregon, Rogue Valley Medical Center banned smoking on their huge campus and got a lot of complaints. Staff claimed they would be out sick more because of exposure to bad weather, and they would have to take longer breaks in order to get completely off campus to smoke. All that has pretty much died down and because the hospital is not located near a lot of downtown businesses or anything, they won’t be getting the complaints that the Toronto hospital did. I really think that’s a short-sighted decision by the hospital. Maybe they’ve given up…believing they can’t stop people from smoking, but …instead of lifting the ban, I think they should have done more to promote and provide treatments for those who do smoke. That’s one thing the hospital here did, they provided Chantix, they provided smoking cessation classes and a lot more resources. One reason the complaints died down is a lot more people were able to quit smoking and were appreciative of that fact. I don’t see it very likely that that there is going to be a lift on smoking bans in public places like hospitals because the evidence is just so strong. For every 8 smokers that die, one nonsmoker will die from exposure to side stream smoke. Someone who has been exposed to secondhand smoke gets the toxic effects and cardiovascular effects instead of lung effects, believe it or not because they are exposed to a smoker. With that strong evidence, I think it is going to be difficult for anyone to lift any kind of ban on smoking.
CNS: And that ties right into the change in the habits of teenagers and they're continuing to smoke. The rate is still significantly reduced from when we were kids. I think it was closer to half the population smoked cigarettes and now it’s down to about 1 in 5, that’s a significant reduction and that’s a good thing. But we know….how overwhelmingly addicting tobacco is.
DARRYL: Yes, it’s significant, but it’s disappointing. The CDC set a national goal…that by 2010 the percentage of teens smoking would be 16% or lower, so it would be less than 1 in 5. And when they did their survey recently, they found that 20% smoke, so 1 in 5 are still smoking in terms of the teenage population. As you said, it is a significant drop from a decade or 2 decades ago, but it’s not what the CDC was hoping for. They cited a lot of good reasons why that decline did not occur the way they wanted to. They said that because the decline was so dramatic, we lost sight of it …it wasn’t important anymore. We just let it happen. But more to the point - the economic straights that we’re in on a national basis, state is just battling to stay afloat…..I think Governor Schwarzenegger in California just announced that he is going to cut every state worker’s salary to minimum wage because they just can’t afford to pay ….and they’re going bankrupt. One of the first things cut is always….no matter how they sold it on a political basis, - spending on education and on campaigns, anti-smoking campaigns. They’ve certainly raised taxes on cigarettes overwhelmingly to try and discourage smoking. I never believed cost is a deterrent. If you’re an addict, you’re going to do anything you can to continue in the action. Higher cigarette taxes were a way to make money and originally that money was to go into anti-smoking ads and campaigns. Well, the tobacco industry fought that heavily because they knew that ad campaigns were an effective way to promote smoking and they didn’t want an anti-smoking campaign. Whatever the situation - states have dramatically decreased spending for anti-tobacco and anti-smoking campaigns… decreased funding of educational programs in the schools so now the only voice out there for tobacco is coming from the 12 billion dollar advertising budget of the American tobacco industry. There are a lot of accusations, despite their denials, that they are heavily targeting the teenage smoker because the younger you get them, the more addicted they’re going to be and they’ll be a lifetime purchaser.
CNS: If you go to a convenience store or any place that sells cigarettes, and just look at the packaging you can see a clear intent to make smoking look more fun.
DARRYL: You know, they’re so good at their marketing techniques, when you attack them on that they say….no, that’s made for the adult population…. it’s not made for blacks…menthols aren’t made for blacks…we’re not targeting Hispanics by advertising in these special venues, but it’s obvious. They market to teenagers, but claim vehemently that they’re not trying to market to younger smokers. But they certainly are. They spend 12 billion dollars just to advertise their product and the states are making huge revenues… they keep raising the taxes. I think chewing tobacco or snuff is 5 or 6 dollars for a little tin which will last a person half a day or something like that. The price is way up there but I don’t see the states spending the money that they originally promised on…discouraging smoking. I think the revenues go into the general fund to try and make up for these huge deficits that are happening.
CNS: And the deficits of course come from some place else like…oh, Wall Street maybe?! Or mortgage companies maybe, perhaps! Nonetheless, I mean we are in dire straights financially as a country.
DARRYL: Right and it’s a bad thing in terms of health because there’s no question that tobacco, especially smoking …damages each and every organ and system in the body. It is toxic and causes horrendous damage to our bodies. We all pay heavily to care for smokers later in life. The states would have more money if we didn’t have to take care of people who were damaged by smoking and yet decisions are made to abandon some of the efforts to discourage smoking. An interesting side story to this is…I was looking at a recent approval by pharmaceutical firms to add a second regime medication for those people who are treated for pain or chronic pain with very addictive opiates, like OxyContin, Vicodin and methadone which has dramatically increased addiction problems in recent years. And that was sort of the use of a GABA blocking drug. Or a drug that is known to block GABA, called Vigabatrin. Vigabatrin prevents the impact of GABA which enhances the euphoric and enhances the effectiveness of the dopamine in the body. So anytime you take an addictive drug like opiates, you get this dopamine rush, which is part of that go switch or reward/reinforcement center that causes a tremendous compulsion to keep using the drug or keep in the activity. Approval has been granted to use this medication on anybody who is treated with very addictive opiates to see if it will cut down on the number of people developing addiction because of prescription medications for chronic pain. Well I see that as I see every addictive drug - nicotine included. And this is why I see it as a link to the nicotine story. It releases dopamine in the reward/reinforcement center. It activates the shell and core of the nucleus accumbens septi - what we call the “go switch” and people develop this compulsion to continue exposing themselves to it. Well, if this is effective with opiates, I am sure it would be an effective new tool - (if it didn’t have a lot of side effects and problems) something more effective than Chantix and other drugs in the treatment of nicotine addiction.
CNS: We know there were a lot of side effects with Chantix.
DARRYL: Right…a lot of mental health side effects were the interesting ones. So…Vigabatrin, we will have to wait and see how it works. But if that does occur, there might be a new tool to treat addictions and to help people with addictions and especially when we prescribe medications such as anti-anxiety drugs, anti-pain medications, maybe even the stimulants for ADHD and ADD. This medication would be either added to other medication in a combination form or taken separately, so someone can be treated without worrying about developing an addiction. Now one of the drawbacks of that is that many people still relate the efficacy of the medications they’re taking for pain or for anxiety or for depression or for restlessness or whatever, based upon how they feel from taking that medication. Like, they’re looking for a certain effect, rather than a relief of their symptoms. So, if that continues, then maybe people will say that adding Vigabatrin while they are taking OxyContin…makes OxyContin ineffective. They don’t get any pain relief or something like that.
CNS: Because then they don’t feel good any more.
DARRYL: Right. There are a lot of questions, we’ll have to see. There continues to be developments in medications and new resources to treat addiction. I sure hope we are getting better and better at helping people with chronic persistent disorder like addiction, helping them discontinue their dependence or their compulsion to continue using drugs.
CNS: Well, as we know…the human with its ability to think and do strange and sometimes irrational things, is a constant mystery and a constant challenge. Well, I’m sure we will talk more about this. What we didn’t mention because there is no news about it is the alternatives to smoking - the electronic cigarette that I have personally toyed with and it did work for awhile and then it kind of stopped working. I’m sure that will come up again soon. If our readers have comments, questions, or observations, please drop us a note and we will share your thoughts or respond if appropriate.
Items 1 to 6 of 10 total