Cigarettes kill no one

There! Can you imagine a more obviously stupid claim? Cigarettes kill about 400,000 people per year in the U.S. alone, and tens of millions more worldwide.

But, so far as I know, it is not physiologically possible to absorb a fatal dose of nicotine by smoking. Nicotine can be lethal if swallowed or injected, but a cigarette contains perhaps 2% of the median lethal dose. There are no published reports of acute fatal overdose from cigarette smoking. When smoking kills, it does so through chronic disease.

Acute alcohol poisoning is the primary cause of about 400 deaths per year and a contributing cause in another 1000 (mostly overdoses of other drugs). That’s out of about 100,000 total alcohol-related deaths, the rest being from chronic disease, accident, suicide, and crime.

So if we looked at acute overdoses alone, we would miss all of the lethality of cigarettes and about 99% of the lethality of alcohol.

That’s why its so outrageous to for Andrew Sullivan to post a headline reading “Cannabis kills no one.”

Cannabis intoxication can lead to accidents (more rarely, crimes). Long-term cannabis dependency can cause respiratory illness (especially when combined with cigarette smoking) and there’s no reason do doubt that some of those illnesses will be fatal. (For reasons unknown, cannabis does not seem to be carcinogenic, though some of the components of cannabis smoke undoubtedly are; there’s evidence of some anti-tumor properties in other cannabis constituents.) The net effect of cannabis use on all-cause mortality remains unknown.

As Sullivan notes, cannabis increases the risk of traffic accidents, though less so, if taken in isolation, than does alcohol. What he doesn’t note is that the two drugs can be used together, with (apparently) more-than-additive risks. What is absolutely certain is that some people die on the highway due to their own or someone else’s cannabis use. Thus “Cannabis kills no one” is simply, utterly, totally false. I wish pot advocates would stop saying it.

Cannabis is a relatively benign drug compared to alcohol or tobacco, both with respect to the risk of addiction and with respect to the damage done by addiction and intoxicated behavior. But cannabis has risks, and any sensible policy discussion has to start from a concrete appreciation of what those risks are and how they might vary under alternative policies.

Footnote This seems an opportune time to reiterate the RBC “Play nice” rules for commenters. We’re proud to have maintained an extraordinarily civil – though hardly conflict-free – comments section. That’s been much less true on drug-related posts, with a fairly high rate of bullying behavior from the pro-legalization side. There are plenty of places for anti-drug-warriors to vent in peace; Pete Guither runs one. But the RBC is not such a place. From now on, offending comments will be zapped and the posters warned; repeat violations will lead to bans.

Comments

  1. Laertes says

    Firm moderation is always a good idea. Of course, the main posters also do a lot to set the tone. Unfortunate footnotes like the one below:

    “And can we hear some more about how it’s only the dumb drug laws that convert the purely personal, medical problem of drug abuse into a criminal-justice problem?”

    convey to a reader the impression that this is a place for snarky, dismissive, dishonest, and hostile paraphrases of one’s opponent’s positions. With good enough moderation, commenters can rise to the level of the hosts. No amount of moderation can get them to exceed it.

    • Marcel says

      How about firm moderation in the pursuit of justice, eh? Not such a good idea, is it? It’s certainly not a virtue!

      (… speaking of snarky, dismissive, dishonest, and hostile paraphrases of one’s opponent’s positions)

      ;)

    • Mark Kleiman says

      The quoted phrase is a completely accurate re-statement of one of the anti-drug-warriors’ primary rhetorical tropes. An example at random from Gary Johnson: “Abuse of hard drugs is a health problem that should be dealt with by health experts, not a problem that should be clogging up our courts, jails, and prisons with addicts.”

      https://www.garyjohnson2012.com/issues/drug-policy-reform

      If you don’t like it, talk to them about it.

      • Laertes says

        The thing that makes it hostile and arguably dishonest is the word “purely.” It turns a reasonable point like “prohibition of marijuana turns a minor public health problem into a major criminal justice problem” into something crazy and worthy of mockery. (And also, one suspects, afraid of fire and an excellent dancer.)

  2. says

    Another footnote might be a paragraph stating your rational approach to cannabis legalization. From reading some of the threads, many of your new readers seem to be a little murky on where you stand and appear to argue against positions you don’t hold. Here is a link to your Dartmouth lecture where you begin to talk about Marijuana:

    http://youtu.be/pnHHYQX8exc?t=41m52s

  3. agorabum says

    I can imagine many more stupid claims; we hear them made by the Republican party on a daily basis. ;)
    And while in an overall aspect, do people on MJ increase risk factors for actions like driving, yes. But I feel like the spirit of the comment was “no one has ever overdosed on marijuana.”
    People can and do drink themselves to death. Rarely through an LD overdose. More often through massive, chronic abuse (think: Leaving Las Vegas). And far more often through lesser levels of abuse causing long term damages and early demise.

    We know enough today to know that cigarettes really are toxic things , and will hasten your demise. But you do seem to admit that marijuana is far away from it on that scale.
    It also seems dangerous to say that something should be illegal because it may have negative impacts on aggregate lifespans. The mortality rate, as it stands, is 100%. Kale salad with fruit and pine nuts is good for you (and pretty tasty), and undoubtedly better for you than a 20 oz bone in rib-eye consumed with a half bottle of wine. But of those two options, people often choose option 2. And that should be ok.
    If started from a tabula rosa, with all consumable substances known to man set forth for assessment, and balanced on both metrics of reduction of harm (both physical and physiiological harms, and the harm to the rule of law to the disrespect of law and unnecessary incarceration / enforcement costs), and allowances for pleasure (acknowledging that throughout recorded history, people often want to consume these things), then it is highly unlikely that marijuana, or steak, would be illegal. And that substances with high overdose potentials would be more heavily regulated.

  4. Seitz says

    Isn’t that kind of the point of Sullivan’s post, though? That cannabis ought to be regulated more like cigarettes and alcohol? “Cigarettes kill no one” is a bad comparison for Sullivan’s headline. A better one would be “Nicotine kills no one”. And I’m pretty sure I don’t need to tell you that there’s more than one way to get cannabis into one’s system. What am I missing?

  5. Fred Bush says

    At first I thought that the filter toxicity would mean that you could pull it off if you were sufficiently determined, but now I realize that if you could kill yourself by eating cigarettes then people would be doing that all the time in prison.

    • darkcycle says

      I have been told that they did, but since smoking is no longer allowed in prisons, it is not a common means anymore. I understand it is also a very unpleasant way to die. I got this from my predecessor at the County Jail where I served a Psychologist for the Involuntary Treatment Court. I do not have the statistics, since only the primary drugs involved in most suicides are listed, and Tobacco would therefore fall under the category “other CNS drugs”, and would not have been broken out. P.S. Nicotine is very poisonous, but the result is death from heart arrhythmia and would be listed as such if the poisoning were not detected.

  6. MobiusKlein says

    I certainly would estimate my driving skills as deficient when stoned. (key word estimate – I decline the chance to scientifically test it.)

    But the claim of “Kills no one” is just odd. Like saying rock climbing kills no one, just the landing on the ground that happens sometimes with it.

  7. Ebenezer Scrooge says

    When Mark writes about Republicans, he swings from the heels. (And often connects prodigiously! And sometimes strikes out.) When he writes about drug policy, he is very very careful. That’s all well and good.

    Mark doesn’t seem to mind it when others swing from the heels on Republicans. He objects when people do so on drug policy. I’m not sure that this is particularly good. Mark is in a good position to decry bad faith, because I never see it from him. He is not in as good a position to decry lurid overstatements.

    • Mark Kleiman says

      1. “Swinging from the heels” is different from “hitting below the belt.”
      2. Political warfare is not the same as policy discussion.
      3. I have no objection to full-throated libertarian legalizers, as long as they’re honest about their principles and about the facts. I treasure my long friendship with the late Thomas Szasz, who swung about as far from the heels as humanly possible. It’s the b.s. – “Legalization will reduce drug abuse” – that gets my goat.
      4. Posters on this site are allowed to be rude to third parties. Commenters are not allowed to be rude to posters or to one another.

      • says

        “It’s the b.s. – “Legalization will reduce drug abuse” – that gets my goat.”

        Legalization, being a precondition to alternative regulatory models, such as we have for alcohol, tobacco, food and pharmaceuticals, would not reduce abuse, but the alternative regulatory models prohibition forbids would. Prohibition also soaks up the lion’s share of our finite drug abuse reduction budgets. Reallocating those resources would reduce drug abuse.

        BTW, I assume you don’t use the words “use” and “abuse” interchangeably.

        It is, for all intents and purposes, physically impossible to fatally overdose on cannabis. Read past the poorly worded headline and that is the argument Sullivan was making.

        Yes, cannabis can play a role in fatal accidents. Alas, no one to my knowledge has studied how many accidents cannabis prevents. If we add fatal accidents that happen under the influence of cannabis to the “people killed by cannabis” side of the ledger, then surely we need to determine how many people don’t have accidents because, being under the
        influence of cannabis, they elect to stay home and order in a pizza.

  8. says

    I think there is a legitimate difference in how people approach culpability.

    If you smoke cigarettes for a long period of time, there’s a certain chance that that the chemicals in the cigarettes will cause your death. Drinking too much alcohol over a long period of time can damage your liver, and lead to death. As Mark said, there is no firm evidence of similar proximate causation when talking about marijuana.

    Drinking alcohol does not cause traffic fatalities. Drinking alcohol AND THEN doing something really stupid leads to traffic fatalities. The difference between what Andrew Sullivan is saying and what Mark Kleiman is saying is that Andrew blames the doing something stupid. Mark blames the alcohol.

  9. says

    If you want to be absolutist about it, then is there anything that “kills no one”? I’m pretty sure there have been cases of profound literary works (in conspiracy with gravity) killing someone, never mind the many deaths incurred in the pursuit of art.

    But in normal conversation, or in blog posts, asserting that cannabis won’t kill you is hardly more outrageous than saying that a short walk in the fresh night air won’t kill you. Both probably won’t.

    Do you happen to have any stats on lives shortened by infuriating blog posts?

    • says

      To be clear – I do not at all mean to imply that this blog post is infuriating. It’s more on the order of sigh-worthy. Sullivan’s headline may be incorrect in the most technical sense, but it just doesn’t seem to rise to the level of “outrageous”.

  10. Nick says

    “Cannabis intoxication can lead to accidents”

    Relative risk of MVA = ~1.25: http://www.sciencedirect.com/science/article/pii/S0001457512002412

    So what you’re saying is that there’s scientific proof that Mark is correct?

    “The net effect of cannabis use on all-cause mortality remains unknown.”

    “the burden of disease is estimated to be almost 40 times greater for tobacco (7.8%) than cannabis (0.2%) …

    The fact that you can’t just look at disease is basically the main point of the post. I really can’t imagine how you missed that.

    • strayan says

      Yes Nick, there is scientific proof that getting behind the wheel of a car with cannabis in your system puts you at roughly the same risk of injury as getting behind the wheel of a car with over counter anti-histamines in your system or doing ~3mph over the speed limit.

      The threat to road safety is overstated.

      • strayan says

        And yes, if you combined cannabis with anti-histamines there would probably be additional risk (blindingly obvious once again).

  11. Alec Munro says

    If I may defend Andrew Sullivan a little bit (blech).

    iPhones kill more people each year than pot does. Yet we keep allowing Apple to release new ones? Distracted driving is of course the biggest one, but they often also lead to crime, which can have violence associated with it. There’s also the fact that we know exposure to radiation CAN cause cancer, and we certainly don’t have adequate very-long-term studies to prove that cell phone radiation doesn’t cause cancer ever.

    But to bring it back to pot, alcohol and tobacco. We know the horrifying effects of the latter two on the populations that use them, and there’s not even a conversation about banning either of them outright. We have pretty strong evidence that the populations that use or abuse pot have much better outcomes. Not perfect outcomes, but no worse than iPhones.

    So is Andrew being a bit inaccurate with his headline? Sure. But in the grander context of things that are harmful, pot (based on the data we have), ranks below iPhones and many other things.

    • says

      I want to agree with you because you are opposing an absurdly overstated post. But your example is horrible.

      Cellphone radiation has about 10^6 too little energy to break chemical bonds, the mechanism by which ionizing radiation causes cancerous mutations.

      Radiation too weak = no ions.

      No ions = no disrupted DNA = no cancers caused by the source of the too-weak radiation.

      We can say with absolute certainty that we have yet to observe a single cancer caused by cellphones, and we don’t even have a plausible mechanism by which it could happen, absent opening up the phone and consuming the circuit board and it’s chemical nasties.

      Moreover, this is a nice case when reality and intuition align: anyone reading this blog is likely to have lived through an explosion in the global exposure to cellphone use. The rates of brain cancer have not increased at all.

      • RMerriam says

        I believe you misunderstood the post. The reference was to distracted driving, not RF leading to cancer.

        • Freeman says

          Ummm… The post also referenced RF radiation as a possible health threat:

          There’s also the fact that we know exposure to radiation CAN cause cancer, and we certainly don’t have adequate very-long-term studies to prove that cell phone radiation doesn’t cause cancer ever.

          I’m only guessing but I think that’s what JMG is referring to here. And as someone who works with RF radiation every day for a living, I can confirm JMG’s position on the topic. Either that or I should be dead by now from regularly exposing myself to RF radiation about 2 orders of magnitude stronger than your average cell phone for the past 35 years.

    • Student says

      Ignoring the near-certainty that many sleepy drivers would have nodded off and crashed were it NOT for caffeine. If caffeine has a major effect on car accidents, I am almost positive it would be a net benefit rather than harm. Driving sleepy is much worse than driving buzzed and awake…

  12. Free man says

    I still fail to appreciate why other people feel the need to moderate and control my consumption of cannabis. The real debate is this; who gave you the right to have an opinion on my cannabis use? I don’t need anyone’s expensive study or debates. I’d just like to be able to grow a plant, and smoke it. I’d rather it be out the hands of criminal gangs, but legalising it will just put it in the hands of the same type of psychotic individuals, I.e. profiteering corporations. Carry on the pointless arguments for and against, and I’ll carry on taking those substances I choose to take, and accepting the risks of doing so. Thanks for caring though x

    • RMerriam says

      When your private behaviors impact others they require regulation. Your argument could be posited for alcohol or tobacco. Tobacco causes long term health problems that cost society enormous amounts of money. Alcohol often leads to public behaviors that range from disruptive to destructive so there are laws about distribution, consumption locations, and the consequences of misbehavior. (Incidentally, in TX, DWI means Driving While Impaired. It does not matter if it is alcohol, cannabis, or medications.)

      It is yet to be fully determined how cannabis affects your health, although indications are it may be relatively benign, and the health of, say, children and teens exposed to primary or secondary cannabis.

      • says

        “When your private behaviors impact others they require regulation.”

        Regulation yes, criminal prohibition no.

        Free man is essentially saying, no victim, no crime. You say society is the victim when people fail to look after their health, and
        therefore (I guess) failing to keep yourself healthy is a crime.

        Most diseases and injuries are preventable. For example, if you play contact sports or allow yourself to become obese, then you are costing society enormous amounts of money. Why single out cannabis? What makes cannabis exceptional?

  13. Meeman says

    There has NEVER been a single reported death attributed to Tobacco smoking!!! FACT!!!
    ALL the deaths are from the toxins that are put into the plant; from radioactive fertilisers, to pesticides and herbicides, all the way to toxic preservatives when manufacturing the cigarettes.
    It’s NOT the plant that kills, it’s what the Tobacco companies have done to the plant that makes it toxic.

    GET YOUR FACTS STRAIGHT AND LAY OFF THE PROPAGANDA, EVEN IF IT’S JUST FOR A FKING DAY!!!

  14. Freeman says

  15. Freeman says

    Wow. Totally mangled my links by closing them improperly. D’oh! Can I try again?

    That’s why its so outrageous to for Andrew Sullivan to post a headline reading “Cannabis kills no one.”

    As one who cringes every time someone says something “outrageous” like “Of course, ‘putting people in prison for getting high’ is utter fantasy”, I can relate. On the other hand, while we can all readily cite examples of people dying from alcohol or tobacco use, directly and otherwise, I can’t think of a single example of a death attributed to anyone’s cannabis consumption, and I’ve never seen one offered by those making the sort of assertion Mark makes here:

    What is absolutely certain is that some people die on the highway due to their own or someone else’s cannabis use.

    Now I’m not denying that this can happen, just pointing out that it’s much harder to come up with a solid example of it than just about anything else that might distract or impair a driver, like cell-phone use, for example. That means something to me in terms of risk assessment.

    Thus “Cannabis kills no one” is simply, utterly, totally false. I wish pot advocates would stop saying it.

    And I wish (and I hope this isn’t considered “bullying”) control freaks would stop ignoring or downplaying the negative externalities involved in the restriction of liberty by force, and give that the weight I think it deserves when considering public policy. And I also want a pony.

  16. Brett Bellmore says

    I think it is worth pointing out that, while alcohol itself is toxic, with an LD50 terrifyingly close to the recreational dose, the gap between the recreational dose of nicotine, and the LD50, is comparable to that with caffeine; Both are stimulants, CAN kill by excessive stimulation, but essentially nobody ever doses themselves to that degree.

    The actual toxic effects of concern in the case of nicotine are due to the tobacco itself, and the practice of burning it in order to volatilize the nicotine. Not just general toxins such as the tars, but actual carcinogens in the tobacco tissue, biologically produced by the plant. (Perhaps a defense mechanism?)

    If you administer nicotine entirely apart from tobacco, it’s a fairly safe stimulant, about as dangerous as a cup of tea.

    So, of course, considerable regulatory effort was deployed to discourage the nicotine industry from selling their product in forms which weren’t accompanied by the toxic tobacco leaf…

  17. Richard P Steeb says

    What is outrageous is the fact that cigarettes and alcoholic beverages are legal while Cannabis is a “Schedule I ‘Drug’”.
    See “Tashkin Study” if that is at all unclear.