Proceedings of the Standing Senate Committee on
Social Affairs,
Science and Technology
Issue 23 - Evidence
OTTAWA, Tuesday, April 8, 1997
The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill S-5, to restrict the manufacture, sale, importation and labelling of tobacco products, met this day at 10:07 a.m. to give consideration to the bill.
Senator Mabel M. DeWare (Chair) in the Chair.
[English]
The Chair: Honourable senators, we are dealing with Bill S-5. This morning we have with us Dr. Richard Frecker. He is a full professor in the Institute of Biomedical Engineering in the Department of Pharmacology at the University of Toronto, and he is the chief medical staff at the Addiction Research Foundation.
His primary research interests have been in the development of new pharmacological treatments of tobacco addiction. His main clinical interest lies in the evaluation and dissemination of office-based approaches of smoking cessation.
His smoking treatment clinic at the Addiction Research Foundation provides clinical training for students, residents and community physicians.
Dr. Frecker has been the recipient of some $2.5 million in career research awards and has authored or co-authored over 150 scientific compositions or reports.
His busy schedule did not permit him to prepare a brief for us today. He will make a few opening remarks prior to welcoming questions from the members of the
Dr. Frecker, considering your busy schedule, we welcome you here this morning. Thank you for attending before the committee. Please proceed.
Dr. Rick Frecker, Associate Dean, Undergraduate Medical Education, University of Toronto and Chief, Medical Services, Addiction Research Foundation: Madam Chair and honourable senators, it is my pleasure to be here. I did not prepare a formal brief because I thought the greatest value might be to be available to answer questions which can be as free-ranging as you think necessary.
Thank you for inviting me to appear here as you consider Bill S-5. I do not come as an official representative of the University of Toronto or of the Addiction Research Foundation, but clearly my associations there are relevant, as your Chair has pointed out.
I am a physician. I have a Ph.D. in psychopharmacology. Until my appointment in 1974 as Associate Dean of Medicine at the University of Toronto, I was an active biomedical researcher whose primary interest was in the clinical pharmacology of nicotine and of tobacco smoking.
My particular expertise, if I can lay claim to any, is in the pharmacological aspects of treatment for tobacco users who wish to control their use. In the vast majority of cases, this control actually means achieving and maintaining abstinence from all forms of tobacco use and from the use of nicotine in other forms.
Perhaps it is important to note that, for equivalent doses, nicotine in pure form is less hazardous than nicotine delivered as cigarette smoke. While not without its own risks, its main danger lies in the fact that it is addictive. This underlies the repeated self-administration of carcinogens and other substances known to be harmful to health. As is well known to this committee, some 40,000 Canadian deaths per year are attributable to the use of tobacco.
For those unfortunate enough to become addicted to nicotine, effective treatments are needed. However, from my perspective as a physician, treatment is a secondary approach. From a public health perspective, it is clearly of most advantage to society to prevent the occurrence of nicotine addiction in the first place.
I am therefore strongly supportive of present efforts to control availability of tobacco to young people. Among these, I believe that the control of advertising, progressive increases in real cost and placing restrictions on availability to minors are all important measures, especially when employed together. This is not to diminish the importance of education relating to the hazards of smoking, of course.
Madam Chair, I would be happy to answer any questions as I am able.
The Chair: Dr. Frecker, we had the Joint Student Council of the Ottawa Roman Catholic Separate School Boards before us. We found their brief to be very encouraging. We asked them why young people start to smoke at an early age. From your research, could you give us some ideas of why they start at the age of 9 or 11 years old?
Dr. Frecker: I think the youth were probably more credible witnesses than I. However, I do have children and they do attend school. They are in these age brackets. In my opinion, the initiation of smoking is multi-factorial. Probably the most important influence is peer influence. Coming from a family of smokers certainly has an effect, but short of having a peer group where smoking is normative or, indeed, encouraged, I believe teenagers are less apt to take up smoking. Indeed, it is not just teenagers, as you point out. Children as young at 8 will smoke.
The motives vary from rebellion or wanting to assert independence because it is a proscribed activity in most of society in that it is no longer sanctioned or thought to be cool by society at large. However, as far as finding ways to assert independence, smoking is obviously one.
There is a twist for young female smokers in that those who are fighting to control their weight have heard, and have sometimes seen demonstrated, the value of nicotine as an appetite controller, so they can maintain the figures that God did not give them in an attempt to be Vogue-like models. That is a potent influence for females.
Price is a modulator or controller of acquisition in that, if prices are high, it is less likely that students will start because they are very sensitive to price.
In sum, the motives would be peer influence, a desire to rebel and, of course, availability. Later, there are the satisfactions which come from smoking, but I see these very much as a secondary effect because the initial experiences are not always pleasurable.
Senator Haidasz: Madam Chair, I, too, would formally welcome Dr. Frecker. I had the pleasure of listening to him in Toronto at different seminars on tobacco and its damaging effects.
Being a physician, my main concern is that smoking cigarettes especially is strongly addictive. Can you tell us something about the nature of the addiction? I have heard several times that it is, perhaps, as strong an addiction as one to heroin and that it is very difficult to kick the habit. I will ask for the different and better methods of controlling the tobacco smoking habit.
We attribute tobacco smoking as a cause of various diseases. My subject will be also the danger of the various tars which are emitted from a smoking cigarette. There is a real danger, too, from second-hand smoke.
Could you address some of these points for us, please, Dr. Frecker?
Dr. Frecker: I would be happy to try to address your questions, senator. You asked about the nature of addiction. Put in simplest terms, an addiction is a habit that you would like to give up and cannot. There are many pharmacological aspects which we can go over in some detail. The essential nature is a relationship, if you will, that is formed between a substance and an individual where the use of that substance gives perceived benefit; it could be pleasure or the relief of discomfort from withdrawal. That is coupled with regular use and the preparedness to exert work to obtain the drug. Work could be going to legitimate work or it could be getting out of bed at night in a snowstorm to get the supply of tobacco.
The salient feature, the sine qua non of addiction, in my view, is that it becomes involuntary in that even people who have strong motivation to quit find it exceedingly difficult to do so. You mentioned heroin. You could also have mentioned cocaine. The similarity of addiction to tobacco and heroin and cocaine lies largely in the similarity of difficulty that regular users have in quitting use. It is such that, at the end of one year of 100 people who attempt to quit the use of tobacco without special help, perhaps 3 per cent to 5 per cent will still be abstinent after one year. These statistics are worse than those for heroin or cocaine.
The literature, over the years, suggests that the rate of uptake of use for tobacco and nicotine, and for alcohol in the case of alcoholics, is very similar. They do not show markedly different patterns of relapse.
The social consequences are very different. They are different in time and in population, but without getting into that, they are very similar because they are equally hard to give up and to avoid once one has relinquished the habit in the first instance.
You talk about control of the habit. I am not sure if you are intending to imply that it might be possible to use tobacco in a controlled manner. I do not take that inference. Rather, in attempting to quit, what are the techniques which might be most successful or pertinent to individuals who want to quit. From my point of view, there is a singular criterion; that is the motivation to quit.
Without motivation to quit, clients whom I see in my clinic have a very poor prognosis in the first instance. The first part of treatment for these people becomes exploring possible reasons why they might want to quit through providing knowledge and through an analysis of the role that the drug plays in their lives. Motivation is the number one determinant of success. There are others, and I would be happy to go into detail if you wish.
You asked me to talk about disease. As you know, the excess mortality attributed to smoking in Canada accounts for 40,000 deaths per year. There is a total of some 200,000 deaths per year in Canada, so that is an enormous proportion of the total death toll from all causes in Canada.
In the case of cigarette smoking, because of the inhalation of tar particularly, some 83 per cent of cancer mortality is attributable to smoking. Some 90 per cent of deaths from chronic obstructive pulmonary disease and approximately one-third of deaths from cardiovascular disease are excess mortality attributable to smoking.
Tar is also a subject that we might want to discuss. As you know, tar is a gummy substance collected in machines which smoke tobacco. Tar has many constituents, some of which are known carcinogens. Others have effects on lung tissue and so forth that we can also talk about. Carbon monoxide is produced by smoke as well. It is not considered part of the tar burden, but has ill effects on people with heart disease.
You asked about second-hand smoke. It is fair to say that about 10 per cent of the mortality that one would attribute to smoking in active smokers would occur in the case of an individual who was exposed chronically to high levels of passive smoke or second-hand smoke. The health of others is affected when they are in the presence of smokers.
Perhaps you would like to ask some questions at this point, as I have gone over scantly the points you have made.
Senator Haidasz: Dr. Frecker, at a meeting in Washington sponsored by the American Medicine Addiction Society, some researchers mentioned a substance called mecamylamine as a possible suppressant of nicotine craving. Has that been proven? Is it used? How effective is it?
Dr. Frecker: Mecamylamine is a compound which has been explored for its use. It is similar to nicotine in the receptors that it attaches to in the brain.
Jack E. Henningfield, for example, of the American National Institute on Drug Abuse recently conducted some studies showing that, in small doses, mecamylamine does help and that used with the nicotine patch, mecamylamine may have reasonably good impact. It would not be considered by me to be a major therapeutic advance in the treatment of cigarette smoking. Of the agents available to us, other than behavioural treatments, which are important and should always be an adjunct to pharmacology, the nicotine replacement treatments are probably the most powerful treatments we have at the moment.
Much of my research has to do with chemicals that affect mechanisms in the brain which we now believe to underlie commonly addictive behaviours. We could talk about these, if you wish, as well. They are largely experimental and none have been shown yet to be worth marketing, if I may, for that purpose. There are compounds which are being investigated. In the next decade they may prove to be much more effective than mecamylamine and even more effective than nicotine replacement therapies such as nicotine gum, patch, sprays and so forth.
Senator Haidasz: Dr. Frecker, the object of my bill is to make cigarettes as harmless as possible. In my bill, after consulting with clinicians in Ottawa, I indicate that no cigarette should be manufactured which would give more than 0.3 milligrams of nicotine and no more than 1 milligram of tar.
Would you comment about the safety of these levels and whether it is a practical solution to our concern for the addiction and, of course, the carcinogenic effects of tar?
Dr. Frecker: As I read the bill, senator, 0.3 milligrams of nicotine, or equivalent, per gram of tobacco, is that how it is intended?
Senator Haidasz: Yes.
Dr. Frecker: Given that there could be 5 grams to 10 grams of tobacco, and there could be somewhat more than that, of course, the general notion of producing a cigarette with less nicotine and tar is laudable. There are some difficulties that arise, however.
On the positive side, if a cigarette contains sufficiently little nicotine, it appears not to be attractive to smokers. Teenage smokers do not smoke the lighter brands. There is some evidence that if a cigarette delivers less than 0.4 milligrams of nicotine it is unattractive to the established or would-be smoker. That is a positive thing.
The more tar is reduced, the less damage accrues through the use of cigarettes. In looking at clause 4 of the bill, I have a couple of questions which I might later ask about. However, in general, to produce a cigarette which is less addictive and, if used, less harmful, is a positive thing.
Senator Cohen: Dr. Frecker, in talking about youth and why they get into cigarette smoking, you mentioned peer influence, desire to rebel and women smoking to keep thin, which is one that I experienced myself many years ago. I want to ask you about advertising. We are reading a lot about advertising and tobacco.
Do you feel that advertising increases smoking in youth, especially advertising in sporting arenas and concert halls? Do you feel it is a major proponent to the increase of tobacco smoking like peer pressure and rebellion?
Dr. Frecker: My opinion is that it is important. It is not as important as price, for example. However, I personally have no doubt that the presence of logos associated with a healthy lifestyle, risk-taking and exciting events like car racing and so forth, or even culturally acceptable things like classical music or jazz, associate the use of tobacco, no matter how implicitly, with a positive effect rather than revulsion, which should be the response.
In my opinion, and I am no expert in this area, I can assure you, first, it is hard to imagine that advertising is not attractive when you see it and one's own eye is caught; and, second, that the industry would not spend as much money on advertising if it were to no effect. These are cost-conscious folks who are experienced. The evidence that they spend money on advertising is probably the primary evidence that they at least see a value in it. I am sure they have done the appropriate market research.
Senator Cohen: In a question submitted to us by the Canadian Cancer Society, they say that Player's Light has 13 milligrams of tar. How can a cigarette with 13 milligrams of tar be considered light?
Dr. Frecker: The word "light" has no meaning.
Senator Cohen: It is like diet foods; it is the same thing.
Dr. Frecker: It is not a regulated term. It has no attributes which it has to meet to be used. Ultra light, light, smooth and silky are words used to connote in the last analysis reduced hazard to health or attractiveness. It has no meaning in law and no meaning, indeed, by convention.
Senator Cools: Neither do these words have any meaning in science.
Dr. Frecker: Certainly.
Senator Cohen: There should be some type of law that prevents the use of the word "light" on any product, be it diet, food or cigarettes. Its use gives the wrong impression to the Canadian buying public.
Dr. Frecker: I must agree. In fact, not only am I compelled to agree, I should like to agree.
Senator Cools: Senator Cohen touched on a subject-matter which is larger even than this particular issue, that is, the content of advertising and the use of flattering and attractive terminology in advertising and, perhaps, at some time in the future this committee could spend some time looking at the social impact of advertising and the delusion and illusion to seduce people into believing they are buying products that are less harmful to themselves.
I will tell you why. The whole phenomenon of advertising and regulations of products and protection of consumers is enormous. I understand, for example, in advertising and directions on food products, one must be careful. If it is written on a package, "products of orange" or "orange products," if you are trying to buy orange juice, then you may be buying Tang. One has to be careful.
Senator Cohen has hit on an important subject-matter. I put it on the record because at some point in time we should return to it in order to study it.
The Chair: I do not think there is a person in this room who has not received a letter in the mail from Reader's Digest or somebody else telling us that we are an instant millionaire.
Senator Cools: It is a critical thing. I am amazed. You see diet salad dressings and diet this and that. Maybe diet chocolates are on the market but I do not know about them.
Dr. Frecker: I agree with what you are saying, senator. We have a lesson to learn from the regulators, especially south of the border, of foods and package labelling for food. Whether or not you call a particular cereal high in fibre or a cookie low in fat, at least the measure per unit mass is given on the package. It then becomes a matter of education as to what the implications of so many grams of fat are. I have an interest in nutrition. I totally resonate with what you say.
Senator Forest: You make the point, doctor, that if people could be persuaded to use tobacco products with less nicotine and tar in them, it would be a positive thing. On the other hand, we hear from the tobacco industry that these types of cigarettes are so unattractive that consumers will go into the black market to get the kind of cigarettes with the kick, if you will, that they want out of them. What is your response to that?
Dr. Frecker: First, to use a less hazardous product is one thing; to use it less hazardously is another. Light cigarettes can be smoked in a manner to make them equivalent to heavy cigarettes, which you notice are not advertised as such. The ventilation systems used in cigarettes and the manner of smoking can adjust the delivery, which is important from the nicotine point of view, of a cigarette up to the level that gives satiety to the user. It is only when you get down to cigarettes that are able to deliver less than 0.3 or 0.4 milligrams of nicotine that they truly become unattractive and people do not wish to smoke them, either to start or to maintain an established habit. Eight hundred micrograms to 1 milligram of nicotine seems to be the amount that is comfortable for most people to obtain from their cigarettes.
As to the second part of your question, that is, if we forced the industry to produce only light cigarettes, there would develop a black market in heavier cigarettes, I have no doubt that might happen, as happened before the legislation in 1994. To me, that is a matter of regulation and having the will to prevent smuggling. To say that we have smuggling, for example, and that is justification for lowering taxation, about which I have strong feelings, is to say we do not know how to regulate export or to put excise taxes on tobacco going out of the country. That is a political question I should be careful to not get into in detail here. It is an equation where you have to balance availability, cost, alternate availability, and satiety. It is not a simple question. It is easy to play with one of the variables, neglecting the others.
The Chair: A few years ago I had the opportunity to accompany a patient with a liquor addiction to Homewood in Guelph, Ontario. I could not believe the amount of smoking there was there. It was incredible. Whether their problem was with drugs or liquor, they all were heavy smokers and, of course, it was allowed. Sometimes at the meetings the air was absolutely blue. In your clinic, do you find that the same thing applies?
Dr. Frecker: There is a very high association between the abuse of alcohol and smoking. I think it is fair to say that virtually 100 per cent of alcoholics -- and we may not want to use that term except in inverted commas -- smoke. Until recently, treatment programs for people with alcohol problems permitted tobacco use.
The Chair: They still do.
Dr. Frecker: Some still do. There is literature which is contradictory as to whether giving up both at the same time or doing one and then the other is optimal. However, there is no doubt that alcoholics in recovery tend to be heavy drinkers of coffee and heavy smokers.
Senator Cools: Do you have data to support that?
Dr. Frecker: I do not personally but there is a great deal of literature on it.
The Chair: In the clinic with which you are associated, when you are trying to decrease the addiction to tobacco, do you use group therapy and support teams and that sort of thing?
Dr. Frecker: In my particular clinic, it is one-on-one, if I may use that expression, with the availability of Nicotine Anonymous and other groups for people who would benefit from it. When a client who comes to see me, because it is a smoking clinic, it would be to quit smoking so I do not have to do what a normal practitioner would have to do, which is to assess whether a person smokes and whether they would like to give it up. The presumption is they come to the clinic because they would like to quit.
The first thing I try to assess is their reasons for wanting to quit. We sit down together and try to decide whether these are sufficient to suggest success, and if not, what might be done about helping them come to a decision based on a firmer set of resolves. So the nature and the strength of the motivation, the context of their life at the time, other stresses they may be experiencing, and various reasons they might have for giving up smoking are assessed. These may be life events. They may have recently coughed up blood. A loved one may have died from a smoking-related disease. We try to find out what stage of wanting to quit they are at and then try to capitalize on the strengths they have, through previous attempts to quit, which are often present, or through the way they normally deal with changes in life. We try to match the treatment to the individual need as it changes over time during treatment.
I do not have a panacea. I do not have a magic bullet. What we have is a dialogue with clients or patients, trying to assess what stage they are at, how to help them move toward cessation in a way that will assure cessation by not pushing them too hard on one hand but not being too lenient in terms of saying, "It does not matter. You can quit when you like."
The Chair: I suppose in all cases the client has to make a decision that that is what they want to do before it could even start, that they are ready to take that step.
Dr. Frecker: Before quitting, yes, but there is a process that goes on before even a firm decision to quit is made, which is exploration of the reasons why one might want to quit. Some people come in who are pressured by significant others to quit smoking, and when I find that out, it becomes necessary to look at the relationship that underlies this will to quit, and whether there are things that would bode poorly for their success because they have a smoking partner at home.
The Chair: That is a very interesting point. I am pleased that you brought it up because I would not have thought of that particular relationship.
Senator Losier-Cool: I do not know if you are the person to answer my question but you have a clinic and you are talking about people who want to quit smoking. I have been told, by those who have tried the patch, that it works, but it costs a lot of money. Are you aware of any programs, either health programs or through medicare, to help people who want to quit smoking?
Dr. Frecker: There are many.
Senator Losier-Cool: I mean programs funded by the government or free programs.
Dr. Frecker: Which would include the provision of nicotine patch?
Senator Losier-Cool: Or something like that. I am using that as an example because I have been told that it costs too much. The people start smoking again.
Dr. Frecker: There are programs available through the Lung Association, through various self-help groups, and through various clinics and hospitals around the country, to help people quit smoking. The cost of nicotine replacement is not borne generally by the program, and in only a limited way by private insurers. When the nicotine patch was released in Canada around 1992, the cost to Blue Cross was enormous and they removed the nicotine patch from medications that they covered. Very quickly, that was followed by other insurers. So, at most, one gets one crack, as it were, at patch treatment, which is not necessarily enough, and the time is limited.
The patch is a modestly expensive alternative to tobacco. It used to be equivalent in price before taxation was dropped to present levels, so one could argue in treatment that smoking and patch use were equivalent, and we can go into that in more detail if you wish. With the reduction in taxation in Canada on tobacco, on cigarettes in particular, the patch became an expensive alternative. I know of no programs that provide patches for free. There is a limited number of private insurers who give unlimited access to patches.
Senator Losier-Cool: Perhaps I have not been clear. I know the programs exist. What I am asking is this: Are the provincial or federal governments helping in any way? I understand with the patch is covered by insurance, if you can afford insurance. However, suppose that someone has no insurance and what works for them is the patch. Can this individual go to the government for funding? Is there funding for a program like that?
Dr. Frecker: None that I know of provide the patch. The federal and provincial governments all have various support programs, such as Quit for Life. I stand to be corrected, but I know of none that provide pharmacological aids such as the patch, which does have modest efficacy.
Senator Cohen: In relation to the question just asked by my colleague, would it not be an incentive and eventually save governments money if governments made funding available to help people get away from smoking cigarettes? Down the road they would not have to deal with the long-term cases of cancer, heart disease and high blood pressure. Would it not be better to spend the money at the front as opposed to later on?
Dr. Frecker: I think it would be a good investment both in terms of the chronic diseases to which you refer, senator, and in terms of getting people to quit at an early enough stage that they are more amenable to quitting.
The social costs of smoking are enormous. The costs of free provision of pharmacology aids for smoking is a moot point because it is a mixture between private industry and government, and government should be involved.
Over the years, I have had many patients who I would have liked to provide a nicotine patch to free of cost because they were sincere in their desire to quit. Indeed, one of their motives for quitting was the cost of cigarettes, and the cost of the patch was prohibitive.
When tobacco was more expensive, one could create a scenario in which it was difficult for them to argue in favour of a course of treatment for the patch when it was more or less the same price, which was limited in time. In the long run, they would save a modest amount of money.
That is a tricky question. I do not mean "tricky" in terms of tending to deceive, but it is an interesting question. Should government be involved in the provision of pharmacological aids for the treatment of any disease, such as hypertension, for example, because the ravages of the disease are well known? I am not an expert sufficient to give a meaningful opinion on the economy and the econometrics and politics of that question.
With respect to smoking, the answer seems clear, but as you extrapolate that to other diseases, it gets fairly grey.
Senator Cohen: Yes, it opens up a can of worms.
Senator Rose-Marie Losier-Cool (Acting Chair) in the Chair.
Senator Cools: At the outset of your remarks, you attempted a definition of "addiction." I think you relied on the term "involuntary." In other words, people may use these substances for comfort for whatever reasons, and eventually the cravings, need, and desire for these substances become involuntary.
Somewhere in the recesses of my memory, I remember some studies on addiction. My understanding of the definition of "addiction" was that it was even broader than that. A craving, wish, desire or need for any substance becomes an addiction when that substance had found its way into the natural bodily functions or the natural physiological and biological functioning of that person's biology organism. I do not remember, but I think the word was "homeostasis." It had become an homeostatic process. It is that process which accounts for alcoholics and drug addicts having real physiological symptoms of withdrawal.
I am a little older than many. We used to use the word "narcotics." They use "drugs" these days, but in my time we used to say "narcotics."
Could you comment on that? To what extent does cigarette addiction become part of the homeostatic condition of the user?
Dr. Frecker: You raise an interesting point, senator. In not addressing it directly, I did not mean to diminish its importance. Clearly, an addict takes a substance which has an impact on physiology and pharmacology.
I have in front of me a definition of "addiction" which I think covers some of the aspects you have raised. In 1989, the Royal Society of Canada asked an august committee under the chairmanship of Professor Harold Kalant to opine on what might be the best term to use with regard to cigarette use and tobacco use. Is it a dependence, a moral defect, a bad habit, an addiction, et cetera? They defined "drug addiction" after a period of reflection as follows:
Drug addiction is a strongly established pattern of behaviour characterized by (1) the repeated self-administration of a drug in amounts which reliably produce reinforcing effects, and (2) great difficulty in achieving voluntary long-term cessation of such use, even when the user is strongly motivated to stop.
The society went on to give six or seven criteria, which if I were to read them would answer your question rather directly, if it is the pleasure of the chair for me to do so.
The Acting Chair: Certainly.
Dr. Frecker: The society goes on in its report to state:
Cigarette smoking can, and frequently does, meet all the criteria for the proposed definition of addiction:
I. It is used regularly (usually many times a day) by the majority of users, and most of those who experiment with cigarette smoking become regular daily smokers.
II. The amounts and patterns of use by regular smokers are in most cases sufficient to maintain pharmacologically sufficient blood levels of nicotine throughout most of the day.
II. Such nicotine levels have been shown to produce a variety of effects on the brain, altering chemical and electrophysiological aspects of brain function, and producing subjective effects that the smoker recognizes, differentiates from those of other drugs, and usually finds pleasurable.
IV. Sudden cessation of smoking gives rise to a withdrawal syndrome which can be alleviated by the administration of nicotine. Other drugs which act on nicotine receptors in the brain also modify smoking patterns.
V. In experimental studies, both laboratory animals and humans will expend considerable effort to self-inject nicotine intravenously, in a manner similar to that shown in studies of heroin, cocaine, and other drugs that are generally regarded as addicting, i.e., the effects of nicotine are clearly reinforcing.
VI. Regular cigarette smokers have great difficulty in giving up smoking, even when motivated to do so by the occurrence of respiratory, cardiovascular or other diseases caused by or aggravated by smoking. Relapse rates among those who do stop smoking are high. The urge to smoke among those who are also heavy users of alcohol or other drugs, is, in over 50 per cent of cases, as strong as, or stronger than the urge to use these other substances.
VII. Although much less evidence is available concerning other forms of tobacco use, including cigars and pipes, snuffs, and chewing tobacco, they are capable of giving rise to plasma nicotine concentrations as high as, or higher than, those achieved by cigarette smokers. Though somewhat more slowly. The risk of addiction to these forms of tobacco use therefore warrants further study.
This is a careful balance between the behaviour, the properties of the drug and the impact of the drug on the organism.
Clearly, when one has an addiction, the manifestation of that through withdrawal syndromes through a disequilibrium of a body used to having regular presence of that drug was typically the sine qua non and is still now an important part of what we call an addiction.
I hope that was not too wordy, but I think they are important words coming from the Royal Society.
Senator Cools: I will ask you to opine, doctor. There is an enormous legislative thrust to control tobacco use. Conversely, and simultaneously in society, I hear a strong urge to decriminalize the use of marijuana. I do not understand the two things happening together. Have you wrapped your mind around it at all? Do you have any opinions or musings that you could share with us?
Dr. Frecker: I feel as if I am on thin ice. However, I will give you an opinion.
This is not the opinion of either the university or the Addiction Research Foundation but a personal one. That is to say, the decriminalization of marijuana will lead inevitably to its provision under initially controlled government outlets similar to those for the sale of liquor. Inevitably, we will derive a tax revenue from it.
Our motivation to abate its use when we find that per gram it has the same or worse effects on lungs as does the regular use of smoking, notwithstanding that marijuana is used typically and currently in smaller amounts, would be ill advised. Against that, one still must consider the fact that it is an illegal substance and we know certain folk use it. The grey zone in which we exist is probably sociologically optimal at the present time. Therefore, I am suggesting that decriminalization is ill-advised at the moment.
Senator Cools: I thank this witness not only for his profound insight and candour but also for his exquisite turn of phrase and clear reasoning. It is wonderful to have a witness with such clarity of mind and such well-honed thoughts.
Senator Forest: I think we all agree that smoking is hazardous. That is beyond question at this point. Anything we can do to prevent addiction is the main thrust.
With Bill S-5, obviously that is the intention. Have you wrapped your mind around whether this bill will do the trick or help to do the trick? That is the big question. We are all agree with its intention.
Dr. Frecker: There is no question that the intent and the impact of the bill would be positive, if enacted, and there are certain minor changes -- maybe even improvements -- which could be suggested. I have one concern, namely, that it be reconciled with Bill C-71 so that they speak the same language and address the matter in complementary if not the same terms. It would be unfortunate to have on the books two forms of legislation which spoke differently around the same issue. I am sure senators are well aware of that concern. It is not a worry to me but it is an opinion.
In clause 4, the bill deals with the content of nicotine in tobacco. That is a very sensible thing to do. It is rather like labelling the grams of fat per serving in a portion of food. I wonder whether or not it might be a good idea to talk about the content and expected delivery of nicotine under standard methods, for the whole cigarette, given that nicotine can be put into almost any component of a cigarette.
The one strong suggestion I have to make to the committee is that possibly the number of grams of tobacco per cigarette should be indicated on the package so that you not only know the concentration but also the contents. You can then multiply the two and come up with the actual mass to which you might be exposed.
Stating the content is better in many ways for nicotine because it gets away from the manipulation of dose that can occur through manufacture, through intentional manufacture and through use -- inadvertent and intentional.
However, there is a point in clauses 4 and 5 in which we talk about content of tar. From a scientific perspective that is a little tricky because the tar is not created until the tobacco is combusted. It might be better to talk about delivery of tar as opposed to content.
I am very strongly supportive of the bill.
Senator Haidasz: Apart from the things that you have mentioned about the bill such as the delivery of tar, how could you control non-combustible tobacco products in this bill? For example, can you control them? I am talking about snuff, chewing tobacco, and whatever else there is.
Dr. Frecker: I noticed that they were not present in the bill and I thought about why that might be. I concluded that the intent of the drafters of the bill -- and, I gather, Senator Haidasz, that was you to a large extent -- intended to get at 90 per cent of the problem in a simple way by regulation. If one tries to make the bill a panacea or comprehensive in the extreme, it may weaken it. Although one would like to get at smokeless tobacco and other forms of delivery, I understood the intent to be to try to get to the nub of the matter and, as such, support it.
Another bill might be brought forward, based on a successful enactment of this bill, which would further refine the legislation to cover other forms of nicotine delivery. I am not strongly of one opinion or the other, but I think I understand why it was not put in this bill.
Senator Haidasz: That was our concern. It is difficult to include in legislation like this the so-called non-smoking tobacco products such as snuff and chewing tobacco.
You talked about the ventilation in cigarettes, that is, the holes around the filter. Do you have any comments about how we can improve the filter, for example? Can we make it law or legislate certain things contained in the tobacco paper?
Dr. Frecker: You could attempt to forbid the inclusion of tobacco in components of the cigarette that are not considered tobacco. For example, you must not put nicotine in cigarette paper or in filter materials, et cetera.
With respect to the ventilation holes, their intent is to design a cigarette in which it is of lower yield because the mainstream smokers dilute it by air that passes through the filters. There is good evidence that the filters are normally partially blocked. It might be interesting to require the manufacturer to state the maximum yield possible from the cigarette so that the holes are blocked before they are used in smoking machines so that you do not get nominal but maximal yield.
The Acting Chair: Dr. Frecker, your presentation was very interesting. Thank you for your contribution.
Dr. Frecker: Thank you for inviting me.
The Acting Chair: Next, we will deal with the budget authorization for the Subcommittee on Post-Secondary Education. We need a motion to adopt this budget. We have heard from many witnesses, which is why the section on witness expenses is a little high.
Senator Cohen: I move its adoption, Madam Chair.
The Acting Chair: Honourable senators, is it your pleasure to adopt the motion?
Hon. Senators: Agreed.
The committee adjourned.