Giving up smoking is the easiest thing in the world, I know because I have done it thousands of times

‘Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.’ – Mark Twain (1835-1910)

As an anesthesiologist, on a purely pragmatic level, it is hard not to bear some animosity toward those who smoke. The simplest anesthetic case in a seemingly healthy individual can quickly degenerate into a multitude of care issues solely because the patient smokes. I am certain that in the pantheon of “gross medical stuff,” a big, slimy, brown-yellow mucus plug produced from the smoke-damaged airways of anesthetized smokers at the end of a case must hold an exclusive position. These unnecessary, smoking-induced challenges in patient care motivate me to never miss an opportunity to tell a smoker, “Quitting smoking is the single most important thing you could do to improve your health.”  

The United States has historical ties to tobacco that are undeniable. Early colonists depended on the trade with Europeans of tobacco (referred to as “brown gold”) to drive the fledgling nation’s economy. The first black slaves were imported to the colonies in support of tobacco cultivation. Many East Coast cities owe their existence to the business of cultivating and trading in tobacco. For many, tobacco has been, and is, a means to legal economic prosperity that has few peers.

Yet, according to the Centers for Disease Control and Prevention, the adverse health effects from cigarette smoking account for nearly one of every five deaths annually in the United States. That is more deaths annually (443,000 estimated) from tobacco use than from drug use, alcohol use, vehicular trauma, suicides, murders and human immunodeficiency virus (HIV) combined. Imagine the social repercussions today if the United States sustained more than 400,000 casualties in a year of war. Yet, despite the overwhelming evidence of the dangers of smoking, the tobacco industry continues to grow and thrive throughout the world. The reality of tobacco’s continued success in the face of modern understanding of its devastating effects defies reason. 

Admittedly, I had a three-month period as a graduate student when I dated a smoker and briefly became one myself. Fortunately, my taste for smoking dissipated as fast as the relationship. For many others, the tobacco habit quickly turns into a life- threatening addiction and serious danger to general health due to cardiovascular, lung and many other smoking-related diseases. In reality, smoking is only a method to ingest a drug – nicotine. Like other drugs (cocaine, heroin, meth, alcohol), nicotine stimulates dopamine pathways in the brain that mimic satisfying feelings associated with eating, drinking, bonding, nurturing, achieving and sex. For many, environmental and genetic factors conspire to reinforce the user’s need for nicotine that gradually hijacks the brain’s dopamine pathways, creating a need for nicotine that becomes as basic as the need for food. Certainly this is a highly oversimplified explanation of addiction, but the reality of the nation’s nicotine drug problem is very real. 

It is estimated that the federal government will have invested more than $23 billion on the War on Drugs budget, yet nicotine is expected to kill 17 times more Americans than illegal drug use.  From my perspective, nicotine addiction is a real and ongoing national public health disaster. The fact that nicotine has played a prominent role in our nation’s economic and social development should not bestow on this dangerous drug a “bye” in the nation’s drug war.  Jack Henningfield,  a researcher at the Addiction Research Center of the National Institute on Drug Abuse in Baltimore, found that “nicotine was between 5 and 10 times more potent in producing a euphoric effect than cocaine” when these drugs were given intravenously in equal amounts. It seems reasonable, based on the clear dangers and addictive nature of nicotine to humans, that it should be controlled at least as stringently as other known drugs of abuse. 

In this month’s issue of U.S.Medicine, some of the latest federal research on smoking and addiction are highlighted. As we begin this new year in federal medicine, this issue should serve as another call to action for federal healthcare providers to ensure our patients understand the impact nicotine abuse and addiction have on their health (despite its legal status) and rededicate ourselves to reducing the impact of this national (preventable) healthcare problem.

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