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.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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?