The National Association for Medical Direction of Respiratory Care

The Tobacco Wars

As an active member of NAMDRC for 30 years, and NAMDRC’s mission to advocate to reduce regulatory barriers to best care for our pulmonary patients. I strongly feel that we should be part of at least aware of the “tobacco wars”.

For 35 years I’ve been active in these wars, most recently as part of ”Koop’s troops”, the Tobacco Free NH network, and the Nashua Prevention Coalition. Why do I do this? Because unfortunately as Dr. Koop stated when surgeon general in the 1980’s, tobacco related disease was and STILL is the #1 cause of preventable death and morbidity in the USA – 480,000 deaths annually and > 20 million living poor QOL.

I’d like to make 3 points, all with robust evidence base.

1. This is a pediatric disease, because initiation of tobacco use is in childhood, > 80% addiction happens as a teen, and > 99% by age 25. The nicotine in tobacco changes kids’ brains forever, making this a gateway drug to other substance use, including alcohol and opioids.

2. This is a chronic disease, like HTN, DM, COPD, and asthma and most importantly other substance use disorders (SUD). So tobacco use disorder treatment (TUD-TX) needs be approached and treated as a chronic SUD. And data show that treating TUD in concert with other SUD and even mental health comorbidities has better outcome for ALL than treating any one at a time.

3. Finally, prevention is or should always be easier than treatment. And that is true with tobacco related disease. Indeed for > 20 years we have ongoing reproducible evidence that it is possible to eliminate tobacco use. Indeed, if used as intended combustible tobacco prematurely kills half its users! The I.O.M., CDC, USPHS’ comprehensive multifaceted evidence based approach can do this – tobacco use elimination in a generation! We even have potential public/private partnerships with CVS Health, Bloomberg and Gates philanthropies.

We just need the political will to do it. (There is one emerging issue – “OTP’s” (other tobacco products), such as ENDS, e-cig’s, water pipes (not so new), but this would be for another time).

Albee Budnitz, MD

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