Is tobacco control a good model for drug control?

It is sometimes argued that the success of tobacco control is evidence that we don’t need a ban to restrict the use of harmful substances.

Apparently, the picture is not so rosy red. The latest data from the World Health Organization show increasing smoking rates in many European countries, and particularly among girls and women.

The share of smokers in the United States has dropped, of course, but due to the growing population the number of smoker stoday is almost as high as at the height of the smoking epidemic.

Moreover, falling smoking rates in the West are offset by increasing smoking rates in developing countries, and according to the World Health Organization smoking is still on of the most important risk factors for morbidity and mortality globally, and the leading cause of disease in high income countries.

Incidentally, the tobacco industry remains one of the most profitable investments this side of themillenium, followed by another public health threat: alcohol.

Analogies and Anomalies

As the sale of recreational marijuana kicks off in Colorado it’s worth reflecting on the original proposition that was put before the people. Amendment 64 was called ”The Regulate Marijuana Like Alcohol Act”.

Harmful substances like alcohol and tobacco are legal. By analogy, why can’t we legalize marijuana? The answer is of course that we can. The crucial question is whether we should.

”Regulate marijuana like alcohol” may sound like an attractive proposition. But the fact remains that alcohol(and tobacco, for that matter) is among the leading risk factors for death and ill health in the world today – despite regulation and market restrictions. It is abused, smuggled, traded on the black market, sold to minors, affordable and widely available.

In Europe and the US, vested interests have vigorously fought evidence-based public health policies, such as restrictions on alcohol sales, marketing and excise duties. And despite a strong scientific basis, most countries have not implemented these ”best buys” of alcohol policy. Colorado, for instance, has one of the lowest alcohol tax rates in the US and tax rates have not been adjusted for inflation this side of the millennium.

This is not unique to alcohol. Indeed, many of the leading health threats in the world today can be described as industrial epidemics, i.e. epidemics associated with the commercialization of harmful products. Producers and retailers have an interest in increasing the acceptability of their products, as well as in reducing market regulation. Expect to see the same as the fledgling marijuana industry matures.

Furthermore, the truth is that alcohol is largely unregulated in many countries – often the countries that have the least resources for treatment, health services and rehabilitation – in short, countries where substance abuse problems are likely to have disastrous consequences for individuals and their families.

Alcohol and tobacco are anomalies among consumer goods. They are clearly harmful, and their legal status is less to do with their intrinsic properties than with historic and cultural circumstances. We should not make this anomaly a guiding principle for public health policies.