There are good ideas and there are others

Newsroom reports, An Otago University researcher, who has just had a report on smoking published in an international medical journal, believes a countrywide ban on smoking is inevitable.

Shane Bradbrook of the Maori Smokefree Coalition was on the TV3 last night again pushing the idea of making tobacco available only thorugh pharmacies. Last week the DomPost ran a column by an Otago University law lecturer advancing the same idea. Watch it gain traction.

Here is my analysis of it:

Otago senior law lecturer Selene Mize advances the idea that a ban on tobacco sales (but not use) be implemented alongside an addict’s maintenance programme, similar to the one now providing methadone to heroin addicts through pharmacies. Maori Party MP Hone Harawira has also promoted such a plan.

Mize says,” Current tobacco users would have a set period of time in which to visit their GPs, be diagnosed as tobacco dependent, and receive a prescription that would enable them to purchase a set supply of tobacco from the pharmacy every two weeks or month.”

The theory is that with no legal tobacco for sale there will be no new smokers and existing addicts being supplied through a pharmacy will gradually give up or die. We will then be smokefree.

Unfortunately there is no evidence to back up this theory. Despite the methadone programme, the number of opioid dependents continues to grow. There is little documentation about the programme but a 2001 report estimated the number of dependents would continue to increase at the rate of 15 percent each year. Of the then estimated population of addicts, 13,500 to 26,600, only 3,774 were being treated through a methadone programme. Many were on waiting lists; many more, unofficially waiting.

There have always been problems with funding, client willingness and specialist addiction services. Despite opioid dependents costing the community an estimated $1,000 per week there seems to be little political will to expand the programme.

There are around 700,000 smokers in New Zealand. Even if half could be persuaded to quit if tobacco products disappeared from the supermarket and dairy shelves, the remainder would need to be managed through their GP and pharmacy. A GP would need to see an average of 125 tobacco addicts and a pharmacy around 395. Which raises obvious questions.

Have either got the resources to manage that level of “clients” and, for that matter, do they even want to? Pharmacists will have ethical concerns about dispensing products that damage health. Doctors will have qualms about prescribing a harmful substance. There may also be security fears. Pharmacies are already common targets for criminals operating in existing drug black markets.

And there can be no doubt that a tobacco black market will develop. Selene Mize believes with supply through pharmacies the black market will be small. But the market will be driven by price and accessibility. Illegal suppliers will make both more attractive, especially at the ban onset. Tobacco will present a lost-leader opportunity to expand market share of other illicit drugs, especially to young users. Has Mize failed to see use of the cannabis growing despite prohibition?

Methadone programmes have reduced the amount of crime committed by addicts and offered a chance of rehabilitation for a small number. These are not considerations affecting smokers.

Methadone programmes have done nothing to diminish the number of addicts or reduce the black market, both aims of a ban on tobacco sales. Denying the evidence is a facet of wishful, rather than innovative thinking.