From: [r--es--e] at [oracle.uucp] (Robert Jesse) Newsgroups: sci.med,alt.drugs,talk.politics.drugs Subject: Partial Prohibition of Cigarettes: A Modest Proposal Keywords: smoking, cigarettes, drug policy Date: Thu, 3 Mar 1994 05:18:05 GMT following is an op-ed piece written by a friend of mine who teaches public policy at harvard's kennedy school of government. he is also the author of a book on drug policy called Against Excess (BasicBooks 1992). the book offers a method of analysis - taking into account factual beliefs, values, and desired outcomes - to generate new policy ideas that will produce the desired results more effectively than policies that come from libertarian or conservative ideology. the op-ed is a sample (explored in more depth in one chapter of the book) of how this kind of analysis might apply to cigarettes. ------------------------------------------------------------------------------- February 27, 1994 A MODEST PROPOSAL FOR THE PARTIAL PROHIBITION OF CIGARETTES by Mark A.R. Kleiman The Food and Drug Administration tossed a bombshell into the smoking-policy debate this week by asking Congress for guidance about how to regulate the addictive drug nicotine. That is exactly the right question. But unless we can change old habits of thinking, about cigarettes and about addictive drugs generally, it risks producing the wrong answer. The key to greatly reducing the number of teenagers who get hooked on nicotine, without creating a huge new illicit industry, is to separate the market serving current nicotine addicts from the one serving new smokers. Debating whether nicotine in cigarette form is an addictive drug is a little like debating whether water is wet. More than four-fifths of those who smoke would like to quit but can't. Nicotine causes more death and disease than all the other legal and illegal drugs combined. Not all of this death and disease falls to the smokers; passive smokers, including prenatal passive smokers, also suffer. If tobacco products were not specifically exempted from the Controlled Substances Act, nicotine would be a Schedule I substance, completely prohibited except for research, like heroin and other drugs with high potential for abuse and no currently accepted medical use. But with 50 to 60 million active cigarette addicts, that would be a catastrophe. Simply prohibiting cigarettes could create a black market larger than the cocaine market: if half of the existing smokers continued to smoke a pack or two a day of black-market cigarettes at $5 a pack, criminals would have a $80 billion annual market to serve. (Annual sales of cocaine are about $30 billion.) In the very long run, prohibition would greatly shrink the number of smokers, both by causing some current users to quit and by reducing initiation among adolescents. But over the short run -- the next twenty or thirty years -- the results would be all too familiar: impoverishment of smokers and their families, crime by users, crime by dealers, and intrusive, expensive, and occasionally even corrupt enforcement efforts. For intoxicating drugs such as alcohol and cocaine, prohibition reduces some kinds of crime (intoxicated assault, for example) while increasing others (black-market violence and economically-motivated user crime). In the case of nicotine, prohibition would create new crimes while not preventing any current ones. The present hardly seems a good time to embrace a new crime-increasing public policy. Can we find more potent set of anti-smoking policies than we now have, short of a prohibition that would make current smokers into customers for criminals? Adolescents are the key target group, since the most smoking habits are established before age eighteen. Taxation, limits or bans on marketing, and "negative advertising" in the form of anti-smoking campaigns could all help, within limits. Higher taxes are especially effective in reducing smoking by teen-agers, who on average are less addicted and have less money than adults. Cigarette ads that target kids should be banned. (If you want to know whether a given ad targets kids, hire a market-research firm to ask some kids.) Anti-smoking advertising could try to make smoking seem unfashionable as well as unhealthy. The growth of no-smoking areas, especially in malls, fast-food joints, and other adolescent hangouts, will reduce the frequency of cigarette use as well as protecting non-users. But no plausible amount of persuasion and time-and-place restriction is likely to make a major dent in adolescent smoking. While higher cigarette taxes are clearly desirable, and even popular, above a certain level they begin to share some of the disadvantages of prohibition, as the Canadian experience with $5- per-pack taxes illustrates. The basic problem is that smokers who cannot or will not quit are faced with crushing financial burdens: a two-pack-a-day Canadian smoker who buys non-smuggled cigarettes pays more than $3500 per year to support his habit. The ideal system would make cigarettes available on reasonable terms to current smokers, but unavailable to potential new smokers, especially adolescents. Neither simple prohibition nor any level of taxation can do both at once. Why not, then, ban tobacco products, or at least cigarettes, from ordinary commerce, but provide maintenance supplies to current addicts? Since new smokers are fewer, smoke less, and are less committed to smoking than current addicts, the black market that would spring up to serve them would be much smaller and much easier to control than the one we would have to face if we banned cigarettes altogether. Such a system might work this way: Each current smoker could sign up, before a cut-off date, with one of a number of licensed tobacco-products retailers. The vendor (typically a chain pharmacy) would verify that the buyer was of legal age, was not registered with another vendor, and did not buy more than some predetermined number of packs per week (to prevent massive leakage to the juvenile market). The FDA would audit vendors' compliance with the rules. Such a system wouldn't be as easy to operate as it is to describe, it wouldn't be even nearly perfect in preventing the flow of cigarettes to juveniles, and it would generate enforcement costs and corruption. It only looks good by comparison with total prohibition of cigarettes. Or, of course, by comparison with our current policies, which sacrifice 400,000 American lives every year to tobacco and its promoters.