Sep. 5 1996
Washington, DC - Whether Republican or Democrat, I think both parties would agree on one fact: Drug use is on the rise among teens. But we should not use this tragic fact to imply that tobacco use among youth is somehow less important, or to dismiss the much-needed FDA rule as a "gimmick" to deflect attention away from the drug problem. The health of our children is not a partisan issue. Tobacco use and drug use are not separate issues. As a cancer surgeon, I can assure you that they are very closely linked, since nicotine is a drug as addictive as other abused drugs, and tobacco is its delivery system. First, let me emphasize, nicotine is a drug. Tobacco nicotine is an addictive drug, the use of which will result in the premature deaths of at least 1 of every 3 of our youth who will begin smoking today and every day. Tobacco use among teens in this country is at a 16-year high. While tobacco use among teens in the 1980’s remained level, in the 1990’s we’re seeing a reversal. Among high school students, smoking increased from 28 percent in 1991 to 35 percent in 1995. Second, not only should we be concerned about tobacco use in its own right, but we need to realize that tobacco is the major "gateway drug." The Surgeon General and numerous studies have identified tobacco as a drug that leads users to other deadly drugs. For example, studies show that among those youth who had used both cigarettes and marijuana by the 12th grade, 65 percent smoked cigarettes before marijuana, but only 23 percent began using both in the same year. This relationship was even more pronounced for cocaine. Some 98 percent of those persons who had used both cocaine and cigarettes smoked cigarettes first. A report from the Center on Addiction and Substance Abuse at Columbia University provided a comprehensive national analysis of the relationship of cigarette smoking and other drug use among children and adults. They found that children 12-17 years old who smoke are 19 times more likely to use cocaine as a child than children who have never smoked. The younger an individual uses tobacco, the more likely that individual is to experiment with cocaine, heroin or other illicit drugs. An adult who started smoking as a child is 3 times more likely to use marijuana and 4 times more likely to use cocaine as an adult than one who did not smoke as a child. More than half of adults who start smoking before age 15 use an illicit drug in their lifetime, compared to only a quarter of those who did not start smoking until they were beyond age 17. Individuals who start smoking before age 15 are more than 3 times more likely to use cocaine than those who start smoking after age 17 and 7 times more likely to use cocaine than those who never smoked. Researchers from Columbia University concluded that "if your child makes it through the teenage years without smoking cigarettes or repeatedly drinking beer or alcohol, the odds are overwhelming that he or she will never smoke marijuana; and if your child makes it through those years without using any of the gateway substances, your child is almost certain to make it through his or her entire life without using hard drugs." Therefore, to control drug use in our society, we must eliminate the use of tobacco in children under 18 years of age. Every state has laws that prohibit sales of tobacco to children; we need to enforce these laws. And that’s what our goal should be. For kids to lead drug-free lives, they must lead tobacco-free lives. There are many obstacles to overcome to achieve this goal. One thing is clear: the FDA rule goes a long way to overcoming one of the major hurdles in a child’s life and Americans overwhelmingly support the FDA proposals. by Blake Cady, M.D., Chief of Surgical Oncology at Deaconess Hospital, Boston, Massachusetts; Chair, Public Issues Committee, American Cancer Society; Member, Executive Committee, American Cancer Society.