Surgeon General C. Everett Koop announced unequivocally Monday that cigarettes and other tobacco products are addicting - like heroin and cocaine - and called for restrictions on their sale and distribution.
"This report addresses why people continue to smoke despite the known health hazards. The short answer to that is that cigarettes are addicting," Koop said at a news conference.In a report on the health consequences of tobacco use, Koop stressed that nicotine is the drug in tobacco that causes the addiction because it is readily absorbed from tobacco smoke in the lungs and from chewing tobacco or snuff in the mouth or nose.
Levels of nicotine in the blood are similar in magnitude in people using different forms of tobacco, said the report. Once in the bloodstream, nicotine is rapidly distributed throughout the body, especially the brain and central nervous system.
"This report shows conclusively that cigarettes and other forms of tobacco are addicting in the same sense as are drugs such as heroin and cocaine," said Koop, in the seventh such report issued during his tenure.
"Most adults view illegal drugs with scorn and express disapproval - if not outrage - at their sale and use. This nation has mobilized enormous resources to wage a war on drugs - illicit drugs. We should also give priority to the one addiction (smoking) that is killing more than 300,000 Americans each year."
The 618-page report, "The Health Consequences of Smoking: Nicotine Addiction," is expected to add to the recent mounting drumbeat of criticisms on smoking.
Previous surgeon general's reports reviewed medical and scientific evidence showing that cigarette smoking and tobacco use damage health or cause particular diseases, such as cancer. This is the first to specifically say that tobacco is addictive.
"Some people may have difficulty in accepting the notion that tobacco is addicting because it is a legal product," said Koop in the report. But he noted it fits the standard definition of drug addiction used by the World Health Organization and other health groups.
With drug addiction, and with cigarettes, Koop said the user's behavior is mainly controlled by a substance that stimulates the brain to alter moods. There is compulsive use of the drug despite damage to the individual or others. Also, physical dependence can occur and is characterized by a withdrawal syndrome that occurs during abstinence.
The surgeon general rebuffed arguments that tobacco is relatively harmless compared to other addictive substances, noting tobacco results in 320,000 deaths in the United States each year, compared to 125,000 for alcohol, 4,000 for heroin and other opiates and 2,000 for cocaine. But he stopped short of saying that tobacco should be made illegal.