Tobacco has a history of 7000 years. Kings and administrators, philosophers and scientists, health professionals and ordinary people, have used tobacco alike. Tobacco helps in generating revenue for different governments ranging up to 12% of their total GDP and is great employer1. It has a definite place in adolescent mind as a tool for style status. It is a matter of adult choice. Tobacco is a legal product, but tobacco is injurious to health. Smoking is an increasingly important problem in the World. Millions of people have used or currently use and abuse, illicit drugs. Substances most likely to be abused include agents that cause euphoria and/or provide relief from stress or boredom2. SUBSTANCES OF ABUSE3 1. Commonly available Nicotine Alcohol 2. By prescription only Amphetamines Barbiturates 3. Illicitly used Morphine Cocaine Heroin Hashish, ganja, marijuana CAUSES OF SUBSTANCE ABUSE 1. Physiological 2. Genetic, and/or 3. Environmental factors Cigarette smoking is the most preventable cause of illness and premature death in India and the whole world. Nicotine, a volatile liquid alkaloid, is the constituent of tobacco that causes dependence. The amount of nicotine absorbed is varies according to the type of tobacco used, the length of the cigarette smoked, and the presence and type of filter used. Tobacco exposure also depends upon the number of cigarettes smoked per day and the amount of smoked inhaled. Nicotine causes an initial CNS stimulation. The drug increases catecholamine release from peripheral adrenergic neurons. It also increases respiratory rate, coronary blood flow, heart rate, and blood pressure. Salivary and bronchial secretions are initially increased but later decreased. CNS depression follows the initial central stimulation. Nicotine causes a temporary depression of appetite and decreased taste sensations. Cigarette smokers have elevated carboxyhaemoglobine (COHb) levels due to inhalation of excess CO from combustion of tobacco. Because COHb cannot carry oxygen, less oxygen can be transported by the circulatory system. This deficiency may contribute to decreased exercise tolerance among smokers. Respiratory tract disorders and Bronchitis, in general, are more prevalent, not only in smokers, but also among their nonsmoking family members. PROBLEMS CAUSED BY SMOKING (Incidence higher than non-smokers) Tobacco is the cause of serious illness and many premature deaths in both developed and developing countries. Dependence on tobacco is a chronic condition, which is difficult to overcome. The treatment of medical conditions induced by tobacco use is a major cost factor in health care4-7. 1. Respiratory diseases, e.g. halitosis (bad breath), chronic obstructive pulmonary disease (COPD), emphysema, Lung cancer 2. Cardiovascular diseases: Hypertension, Heart attacks 3. Diabetes 4. Strokes 5. Peripheral vascular disease and cerebro - vascular insufficiency 6. Gastrointestinal (GI) disturbances: Peptic ulcer, epigastric discomfort, gastritis and ulceration of gastric and duodenal. 7. Wrinkles on the face, discolored fingers and lips, psoriasis 8. Lack of stamina 9. Periodontal disease, tooth decay 10. Impotency and infertility 11. Cataract 12. Uterine cancer and miscarriage Cigarette smokers tend to die at an earlier age than non-smokers. Every year four million people die because of the use of tobacco among them eight Lakh Indians. Lung cancer is a major contributor to this mortality. Cigarette smoking causes approximately 70 to 80% of lung cancers. Smoking also increases an individual’s risk of the larynx, mouth, urinary bladder, pancreas, cervix, and kidneys. One out of three smokers will die of this habit; half of them in middle age. Average life of a smoker is 7-12 years less than that of non-smokers8-9. Smoking during pregnancy is associated with higher than normal rates of miscarriage, spontaneous abortion, prenatal mortality, and premature birth. The newborn of woman who smoke during pregnancy are more likely to be underweight, be short in stature, and have a smaller head2. It is also causes immeasurable suffering to humanity through other diseases. It is compounding factor, which adversely affects the outcome of few treatments, e.g. a smoker afflicted with tuberculosis has five times more chances of dying from it than a non-smoker5. Other form of tobacco like smokeless tobacco, dipping snuff, cigar and cigarillo are also addictive and produces same effects like tobacco. Even passive smoking kills. PHARMACIST’S ROLE TO SAY GOOD-BYE TO SMOKING Pharmacists, in common with all other health professionals, have a responsibility to help people who wish to do so, to give up smoking or other uses of tobacco and to encourage others to do so. Pharmacists are committed to taking relevant action to eliminate tobacco use in the communities the serve9-11. 1. Take a more active role by providing services to those who wish to quit the use of tobacco and to those who have tobacco induced disease, the services to include group and individual cessation programme. 2. Tell addict and give confidence to him that he can quit smoking; provide an example and leadership by being free of tobacco themselves. 3. Tell never try to smoke in public area. 4. Lead and participate in media campaign designed to highlight the dangers of use of tobacco and to help people to quit. 5. Advise when there is great desire to smoke than drink cold water or eat chewing gum (now a day’s chewing gums and transdermal patches available with nicotine and bupropion for smoking cessation). 6. If s/he a chain smoker then suggest try to reduce the no. of smoking. 7. Show and make a good picture of him for a future when s/he quit smoking. 8. Motivate victims to see towards children and their future. 9. Advise to save time, money and life through activities of â€pharmacist action against smoking. 10. Make them aware that for making 300 cigarettes we need to cut down one tree, it is very much detrimental to environment. 11. Create anti-tobacco awareness as a part of health awareness programme through programme such as â€aid for new year quitters’ and â€prison education’. 12. Participate in accredited continuing education programme on tobacco use, associated health risks and quitting processes, to equip them to lead cessation programme. 13. Deglamorize tobacco through discussions and smoking cessation benefits. 14. Provide guidance and counseling to patients who have got caught in the trap of tobacco pursues them to choosing health. 15. Apply the anti-tobacco law effectively. Do not allow smoking in pharmacy and in clinics. 16. Raise public awareness of health problems linked to use of tobacco by taking part in population-based programs such as the â€Quit and Win’ campaign and No-Smoking Day on April 12 and World No-Tobacco Day on May 31 every year by means of various forms like campaign against tobacco, poster competition, drama, slogan competition and other people activities. 17. Use window displays, provide suitable information and support and educate your staff against tobacco. 18. Include smoking habits in patient medication records, as smoking can interfere with the effect of medications. It is ironical that the single biggest cause of death and suffering is actually preventable. In fact these are the true weapons of mass destruction and they are not hidden either. Smokers shouldn’t hesitate to seek help. It’s never too late. Quit smokingâ€it erodes your self-esteem.
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