Chapter 10: Tobacco
- A legal product used by a significant proportion of adults
- But a substance responsible for more adverse health consequences and
death than any other drugs
- Cultivated and used by Native Americans for centuries
o Presented tobacco leaves as a gift to Colombus in 1492
- The word “Tabaco” was adopted by the Spanish
o Possibly from the Arabic word ‘tabbaq” meaning “medicinal hers”
- 1500s: Recognition of the medical potential grew
- French physician Jean Nicot: early proponent
o Nicotine (the active ingredient) and Nicotiana (the plant genus
were named after him)
- 16 and 17 centuries: viewed as having many positive medical uses but
as having a negative reproductive effect
- 1890s: Nicotine dropped form the U.S. Pharmacopoeia
- Two major species grown today (out of more than 60)
o Nicotiana Tobacum: Large-leaf species indigenous only to South
America but now cultivated widely
o Nicotiana rustica: small-leaf species from the west Indies and
Eastern North America
- Tobacco Products: snuff, chewing tobacco, cigars, cigarettes
o Snuff 18 century: snuff use became widespread as smoking
o Snuff: In U.S., perceived as a British product; American use declined
after the Revolution
o Chewing tobacco 19 century: most tobacco used in the U.S. was
o Chewing tobacco: smoking did not surpass chewing until the 1920s
o Cigars: A combination of chewing and smoking
o Cigars: peaked in popularity in 1920
o Cigarettes: Native Americans used thin reeds filled with tobacco
o Cigarettes: Factories appeared in 19 century
o Cigarettes: Habit spread widely with the advent of inexpensive
o Cigarettes: currently most popular form of tobacco use
- Cigarette product milestones:
o 1913- Camels: low-prices domestic tobacco
o 1939- Pall Mall: king size cigarettes
o 1954- Winston: filter cigarettes
- Filter cigarettes have over 90% of the U.S. cigarette market
- 1604: King James of England published an anti-tobacco pamphlet
o “harmful to the brain, dangerous to the lungs”
o Note that he also supported the American tobacco trade
- 1908: New York made it illegal for a woman to use tobacco in public
- 1930s and 40s: Reports linking smoking and cancer
- 1952: Readers’ Digest article “Cancer by the Carton” - Tobacco companies’ response to Readers’ Digest article:
o Formation of the council for tobacco research
▪ Not independent and tried to undermine health risk claims
o Mass-marketing of filter cigarettes and cigarettes with lowered tar
and nicotine content
▪ Promoted as a ‘safer’ alternative
- 1964: Surgeon General’s report states that smoking causes lung cancer in
- Tobacco sales began a decline that continued for 40 years after Sergeon
General’s report release.
- 1965: Congress required warning labels on cigarette packages
- 1971: TV and radio cigarette ads banned
- 1990: smoking banned on interstate buses and domestic airline flights
- 1995: FDA proposed further regulation of tobacco and ads
- Lawsuits seeking compensation for the health consequences of smoking
- 1998 settlement between 46 states and major tobacco companies
o 205$ billion in payments to the states
o Advertising regulations
o Enforcement of laws prohibiting sales to minor
- Possible reasons for legal victories
o Changing legal climate
o Revelation of tobacco companies actions in hiding information on the
adverse effects of smoking
- For ‘safer’ cigarettes lower levels of nicotine and tar.
o Caveat: people adjust their smoking behavior to obtain a
consistent amount of nicotine
o By taking more puffs and inhaling more deeply
o Tar is the sticky brown material seen on the filter of a smoked
o Based on changes in smoking behavior, there may be no
advantage to seitching to a low tar low nicotine cigarette
- Current Cigarette Use: 25% men. 20% women
- Education is the single biggest influence on smoking rates
- Percentage of smokers by education: High school diploma: 28%,
undergraduate degree: 11%, full time college students: 5%, non college
- 1970s: use of smokeless tobacco increased as smokers looked for an
alternative with lower risk of lung cancer.
- Most common form of smokeless tobacco is moist snuff or nicotine
absorbed through mucous membranes
- Smokeless tobacco advantages over cigarettes include: unlikely to cause
lung cancer, less expensive, and more socially acceptable in some
- Smokeless tobacco is still hazardous
- Smokeless tobacco health concerns include: increased risk of dental
disease or oral cancer - Smokeless tobacco contains potent carcinogens such as nitrosamines
- Smokeless tobacco causes leukoplakia
- Smokeless tobacco can lead to nicotine dependence
- In recent years, cigar smoking has increased
- In 2008, 9% of males and 2% of females reported smoking a cigar in the
- Hookahs are a large ornate water pipe imported from Arab countries
- Hookahs produce milder, water filtered tobacco smoke
- Prevalence of hookah smoking is unclear
- Major diseases linked to smoking include: lung cancer, cardiovascular
disease, chronic obstructive lung disease including emphysema.
- Risks increases for those who: start young, smoke many cigarettes, and
continue to smoke for a long time.
- Smoking is the single greatest avoidable cause of death.
- Second hand smoke is cigarette smoke inhaled from the environment by
- Components of environmental smoke include mainstream smoke and
side stream smoke.
- Mainstream smoke: the smoke inhaled/exhaled by the smoker.
- Sidestream smoke: the smoke rising from the ash of a cigarette, more
carcinogens in smoke but smoke is more diluted.
- Second hand smoke health effects difficult to fully determine but include
lung cancer and cardiovascular disease.
- 1933: Environmental Protection Agency classified secondhand smoke as
a known human carcinogen.
- Smoking causes five million deaths worldwide each year
- Estimated by 2030 that smoking related deaths will rise to 8 million.
- Demand for American Cigarettes in Asia and third world countries has
- Smoking while pregnant increases risks of: miscarriage, low birth weight,
sudden infant death syndrome (SIDS)
- Several studies indicate smoking while pregnant effects on physiological
and cognitive development such as neurological problems, problems with
reading and math, and hyperactivity.
- Nicotine is a naturally occurring liquid alkaloid that is colorless and
- Tolerance and dependence for nicotine develop quickly
- Nicotine is highly toxic in large enough doses.
- Lethal dose of nicotine is 60mg
- A cigar contains 120mg of nicotine.
- 90% of inhaled nicotine is absorbed
- 80-90% of nicotine is deactivated in the liver and then excreted via the
- Use of nicotine increases the activity of liver enzymes responsible for
- Nicotine mimics acetylcholine - Nicotine first stimulates and then blocks receptor cites.
- Nicotine causes the release of adrenaline and has an indirect
- Low level nicotine poisoning symptoms: nausea, dizziness, and weakness
- Acute level poisoning symptoms: tremors, convulsions, paralysis of
breathing muscles, death.
- CNS and circulatory system nicotine effects: increased HR, BP, O2 needed
for the heart, decreased O2 carrying ability of blood.
- Nicotine reduces hunger by inhibiting hunger contractions, increasing
blood sugar and deadening of taste buds
- Nicotine has both stimulant and calming effects
- Tobacco industry claims that its products do not cause dependence
- There are more than 40 million ex smokers in the U.S.
- The five A’s: Ask, Advise, Assess, Assist, and Arrange.
- The average smoker takes 8-13 attempts before they are successful
Chapter 15: Marijuana
- Marijuana is a preparation of leafy material from the Cannabis plant
that is usually smoked
- Three Marijuana species: Cannabis sativa, Cannabis Indica, and
- Cannabis sativa: used primarily for its fibers from which hemp rope is
- Cannabis indica: grown for its psychoactive resins
- Cannabis ruderalis: grows primarily in Russia
- THC is the primary psychoactive agent in Cannabis and is
concentrated in the resin
- Potency of Cannabis preparations depends on the amount of resin
- Most resin is in the flowering tops, less in the leaves
- Hashish is the most potent preparation and in its purest form it
consists of pure resin that has been carefully removed from the
surface of leaves and stems
- Sinsemilla is the 2 most potent preparation.
- Sinsemilla consists of died flowering tops of plants with pistillate
flowers, average THC content is 11%
- Earliest mention of Marijuana was 2737 BC: Chinese pharmacy book
- 1000 AD: Social use of the plant had spread to the Muslim world and
- 1926: series of newspaper articles linked marijuana and crine, public
- 1936: all states has laws regulating the use, sale, and/or possession of
- most early regulation efforts: based on concerns about use and
criminal behavior, not based on direct evidence. - Marijuana Tax Act of 1937 followed the regulation-by-taxation theme
of the 1914 Harrison Act
- Marijuana Tax Act of 1936 state laws made possession and use of
- 1969: U.S. Supreme Court declared the Marijuana Tax Act
- After the Marijuana Tax Act cost of marijuana increased significantly.
- LaGuardia Report in 1944 concluded that marijuana use had less
serious effects than commonly believed.
- Use of marijuana increased throughout the 1950s-1960s
- After smoking THC is absorbed rapidly by the blood and travels to the
brain and then to the rest of the body.
- After smoking peak mood-altering and cardiovascular effects occur
within 5-10 minutes.
- After oral administration THC is absorbed more slowly, peak effects
occur about 90minutes following ingestion
- THC has