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Surgeon General Says Smoking is Addictive

May 16, 1988

WASHINGTON (AP) _ The surgeon general declared today that nicotine is addictive like heroin and cocaine, a finding that came as no surprise to researchers but which will provide new ammunition for anti-smoking forces.

The significance of the report by C. Everett Koop is not that it unveils new scientific evidence, but that he organized existing research into a systematic presentation lumping nicotine in with heroin and cocaine as physiologically addictive substances.

″Careful examination of the data makes it clear that cigarettes and other forms of tobacco are addicting,″ Koop wrote in a preface. ″An extensive body of research has shown that nicotine is the drug in tobacco that causes addiction.

″Moreover, the processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine.″

The report cites 171 separate studies, most of them conducted during the past decade, as references.

In a letter to Congress accompanying the report, Health and Human Services Secretary Otis R. Bowen said, ″A warning label on the addicting nature of tobacco use should be rotated with other health warnings now required on cigarette and smokeless tobacco packages and advertisements.″

Bowen said cigarette smoking is ″the chief avoidable cause of premature death in this country,″ causing more than 300,000 such deaths each year.

″The disease impact of smoking justifies placing the problem of tobacco use at the top of the public health agenda,″ Bowen wrote. ″The conclusions of this report provide another compelling reason for strengthening our efforts to reduce tobacco use in our society.″

In his opening remarks, Koop also called for an addiction warning on cigarette labels and advertising and said, ″Treatment of tobacco addiction should be more widely available and should be considered at least as favorably by third-party payers as treatment of alcoholism and illicit drug addiction.″

Koop handled some other controversial ideas as questions:

″With the evidence that tobacco is addicting, is it appropriate for tobacco products to be sold through vending machines, which are easily accessible to children?

″Is it appropriate for free samples of tobacco products to be sent through the mail or distributed on public property, where verification of age is difficult if not impossible? Should the sale of tobacco be treated less seriously than the sale of alcoholic beverages, for which a specific license is required (and revoked for repeated sales to minors)?

″In the face of overwhelming evidence that tobacco is addicting, policy- makers should address these questions without delay,″ Koop said.

Reaction was swift and predictable.

″This report and the surgeon general’s findings should compel federal and state authorities to treat tobacco as the addictivve drug that it is,″ said Dr. Alan R. Nelson, chairman of the board of trustees of the American Medical Association.

Nelson said federal and state authorities should raise the age of those allowed to purchase cigarettes to 21, ban the access of tobacco products through vending machines, label tobacco products as addictive, ban the advertising of tobacco products and regulate the development of new nicotine products.

The American Academy of Family Physicians was ready with a prepared statement saying the Koop finding ″confirms what many smokers and former smokers know very well - stopping smoking is a hard thing to do.″

Although details of the report were not made public until today, one of the many federal health officials that helped prepare it disclosed the essential finding - that nicotine is addictive - in a television interview earlier this month.

A Tobacco Institute spokesman, Walker Merryman, reacted to that disclosure by Ronald M. Davis, director of the federal Office of Smoking and Health, by saying it showed ″anti-tobacco zeal has overtaken common sense and good judgment.″

In a statement today, the Tobacco Institute said ″Smoking is truly a personal choice which can be stopped if and when a person decides to do so. The surgeon general’s own Public Health Service figures indicate that about 40 million Americans are former smokers and that 95 percent of them quit smoking without h elp. These figures, and common sense, contradict any claim that smoking is an ‘addiction’.″

The institute said the report ″trivializes the serious drug problem faced by society. The claim that cigarette smoking is a drug addiction similar to cocaine or heroin use, or alcohol abuse, is unfortunate and unwarranted. The message to the American public is that using illegal drugs, such as crack or heroin, has the same risk of addiction as smoking.″

Koop’s last smoking report concluded - again based on a compilation of existing studies - that nonsmokers’ health was endangered by inhaling smoke from other people’s cigarettes.

Issued just over a year ago, that report has wo hours or less that took effect April 23.

Just as it was impossible to predict the impact of Koop’s last smoking report, experts are not sure where the newest one will lead. But anti-smoking forces are elated.

Ahron Leichtman, president of a group called Citizens Against Tobacco Smoke, said the report should spur new warnings on cigarettes, further restrictions on tobacco advertising and a ban on cigarette vending machines.

″The cigarette companies have thoroughly failed to warn consumers as to the addictive powers of tobacco,″ he said. ″Smokers, unfortunately, are the victims of an industry whose product is highly addictive and dangerous.″

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