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.