Tougher Laws on Tobacco Sale to Minors Urged

Surgeon General C. Everett Koop, calling nicotine as addictive as cocaine and heroin, recommended Monday that laws restricting the sale of tobacco products to minors be strengthened and expanded, including requiring establishments where tobacco is sold to have a license.

Releasing his annual report on smoking, which this year focused on nicotine addiction, Koop also called for health labels on cigarettes to include warnings about addiction.

“Is it appropriate for tobacco products to be sold through vending machines, which are easily accessible to children?” he asked at a press conference. “Is it appropriate for free samples of tobacco products to be sent through the mail or distributed on public property, where verification of age is difficult if not impossible?

License Required

“Shouldn’t we treat tobacco sales at least as seriously as the sale of alcoholic beverages, for which a specific license is required and revoked for repeated sales to minors?”

Koop also urged that stop-smoking programs be made more widely available “to smokers who need them” and that third-party payers such as insurance companies provide coverage for such treatment programs as they often do for alcoholism and drug addiction. “We should eliminate this double standard,” he said.

The 618-page report represented the contributions of more than 50 scientists on the addictive properties of nicotine, Koop said, and he cited numerous studies showing that nicotine can have harmful effects on the central nervous system, the muscles, the cardiovascular system and the endocrine system. Nicotine is absorbed readily from smoke in the lungs and smokeless tobacco in the mouth or nose, the report said.

“Nicotine is a powerful pharmacolic agent that acts in the brain and throughout the body,” the report said.

“The scientific data which establish these findings are now overwhelming; they are based on tens of thousands of studies conducted throughout the world,” Koop said. “Smoking is responsible for well over 300,000 deaths annually in the United States, representing 16% of all deaths.”

The report was immediately attacked by the Tobacco Institute, which said in a statement that, by comparing nicotine to cocaine and heroin, the report “trivializes the serious drug problem faced by society.” Further, the industry said that “smoking is truly a personal choice which can be stopped if and when a person decides to do so.”

Although Koop acknowledged that more than 40 million Americans have been able to quit, as have many users of other addicting drugs, he said that 75% to 85% of current smokers would like to stop but cannot.

“Smokers who want to quit should not be discouraged by this report,” he added. “For many smokers, a genuine desire to quit and, if necessary, persistent and repeated attempts to quit may be all that is necessary. For others, self-help materials, formal treatment programs and nicotine replacement therapy may be needed and should be readily available.”

Koop noted that 43 states have laws restricting the sale of tobacco to minors but called the laws “poorly enforced.” He said he believes that the federal government should bar the sale of tobacco to minors, “but this is a republic and we tend to do these things by states.”

When asked where he would set the age on prohibiting the sale of tobacco, Koop replied: “I would set it at about 75.”

The report was praised by health officials, anti-smoking groups and others. “It’s nicotine that keeps America smoking,” said Rep. Henry A. Waxman (D-Los Angeles).

Waxman said he plans to initiate legislation giving the Food and Drug Administration increased regulatory authority over products containing nicotine.

Scott Ballin of the American Heart Assn., speaking for the Coalition on Smoking OR Health, said the coalition’s member organizations “believe that it’s time that tobacco products be regulated . . . as we regulate other dangerous substances, especially addictive drugs.”