CALIFORNIA, CIGARETTES AND PRISONS: Ban smoking, not tobacco


On Jan. 26, the California Assembly passed a bill that would ban all tobacco products in state prisons (AB 384). According to sponsor Tim Leslie, R-Tahoe City, the bill "is a win, win, win for California." But the ban may be a loser for everyone else concerned, including prisoners, staff and the prison system.
According to Leslie, about 80,000 California prisoners smoke. At 120,000 packs per day and $3 a pack, prison sales of cigarettes in California is worth $131 million.
A mere stroke of a legislative pen won't cause one hundred million dollar markets to disappear. Instead they transform -- and often in ways that don't please prison officials.
First, the California prison system will lose the revenue generated by sales of legal tobacco products. Over-the-counter revenue lost is under-the-table revenue gained, as smuggling takes over and entrepreneurs compete for the lucrative tobacco market.
In Colorado prisons, where tobacco prohibition was instituted four years ago, an $11 can of Bugler loose tobacco can generate $5,000 in hand-rolled cigarettes -- a 45,000-percent markup. In other words, the Colorado ban spawned an instant black market serviced by prisoners and their families, guards, teachers and supervisors. Officials have conducted 154 investigations -- at considerable additional cost -- and made dozens of arrests. All because Colorado officials chose in effect to ban nicotine, the consumption of which is absolutely legal everywhere in the United States except behind bars.
Absolutely legal. And almost absolutely safe. Nicotine is among the most powerful of addictive substances, but it is not the reason that smokers die. In fact, nicotine itself is about as safe as caffeine, another widely consumed addictive drug. It is the 3,000 other agents in tobacco smoke which are responsible for the diseases that kill smokers. Smokers who switch permanently to other, safer forms of nicotine, including smokeless tobacco products, live longer and healthier lives and don't pollute the air around them.
There is a very simple alternative to a complete ban on tobacco and nicotine: Corrections officials should offer smokers alternatives in the form of smokeless tobacco. Smokeless tobacco satisfies smokers and serves as an effective permanent substitute, because it rapidly delivers a dose of nicotine comparable to that from smoking.
For comparison, nicotine medications provide only about one-third to one-half the peak nicotine levels of tobacco products, which is unsatisfying for many smokers. In addition, medicinal nicotine is expensive and designed to be used only temporarily. All of these reasons are why nicotine replacement has a paltry 7 percent success rate among American smokers.
Smokeless tobacco use is vastly safer than smoking, which is entirely consistent with the stated health goal of Leslie's bill. Our research documents that smokeless use imposes only about 2 percent of the health-related risk of smoking. The only consequential adverse health effect from long-term smokeless tobacco use is oral cancer, but even this risk is much lower than that associated with smoking.
In fact, the average reduction in life expectancy from life-long smokeless tobacco use is only 15 days, while the average smoker loses almost eight years. For further context, the risk of death from long-term use of smokeless tobacco (12 deaths in every 100,000 users per year) is about the same as that from driving a car (15 deaths in every 100,000 users per year).
Newer smokeless tobacco products deliver the nicotine kick smokers crave and they can be used almost invisibly. Spitting, once the stigma of smokeless tobacco use, is nonexistent with these products. New products are neatly packaged as wafers or small pellets of tobacco. Some modern products are the size of breath mints and completely dissolve during use, leaving no tobacco residue.
Data from Sweden show that smokeless tobacco can be easily substituted for cigarettes. For 50 years, men in Sweden consistently have had the lowest smoking rate and the highest smokeless tobacco rate in Europe. The result: Rates of lung cancer -- the sentinel disease of smoking -- among Swedish men have been the lowest in Europe for 50 years. World Health organization statistics reveal that Swedish men have the lowest rates of lung cancer among 20 European countries.
In the United States, smokeless tobacco is already working for many Americans. Statistics from the Centers for Disease Control and Prevention (CDC) show that 1.5 million to 2 million former smokers have chosen this option on their own.
In summary, when prison systems provide smokeless tobacco as a substitute to inmates who smoke, they accomplish several goals. First, they promote the health of smokers by offering a cigarette substitute that is 98 percent safer for users, because smokers who switch to smokeless tobacco reduce their risk for all smoking-related illnesses, including mouth cancer.
Second, they ensure the health of nonsmoking inmates and staff, because passive smoke is eliminated. Third, they restore the prison tobacco market to its rightful balance, in which revenue from tobacco sales is removed from the black market and returned to the correctional facility.
In other words, corrections officials can meet both health and fiscal goals by providing an environment that is smoke-free, not necessarily nicotine and tobacco-free.

Brad Rodu is a professor in the Department of Pathology and senior scientist at the Comprehensive Cancer Center, University of Alabama at Birmingham. His research on tobacco harm reduction can be viewed at www.uab.edu/smokersonly.