Tobacco prescriptions proposed as way to cut smoking rates

I'm in favour of just about anything that would cut smoking rates in Canada but I'm not sure Bill Tieleman's proposal to effectively outlaw retail sales of tobacco products is a practical solution.

Tieleman, a B.C. political commentator and former NDP organizer, wrote in The Tyee on Tuesday that tobacco should become a controlled substance, like pharmaceutical drugs, and available only by a doctor's prescription.

Anyone else caught possessing or selling smokes could be subject to criminal charges.

"For those who think this way of taking on tobacco addiction is too extreme, here's my reply: I watched my mom Pat die painfully from lung cancer in 2010, more than 20 years after she had quit smoking," Tieleman wrote.

I sympathize. I watched my mother-in-law, also named Pat, die from lung cancer after a lifetime as an unrepentant smoker. My mother took up smoking as a teenager in war-torn Europe and though she quit in her seventies largely because of cost, it undoubtedly harmed her health.

I was an involuntary smoker for much of my life, breathing the second-hand stuff at home and just about everywhere else until smoking was banned in most public places and my wife finally quit, again because of the hit to her pocketbook.

[ Related: Hiking tobacco taxes best way to reach goal of cutting smoking by one-third ]

Tieleman approvingly notes a recent article in the New England Journal of Medicine that advocates countries boost tobacco excise taxes significantly as a way of reducing consumption, especially in the developing world where cigarettes are cheap.

"There are no magic bullets in public health. But tobacco taxes are as close to a silver bullet as you can think of," co-author Dr. Prabhat Jha of the University of Toronto told CBC News.

"Higher taxes are the single best way to get people to quit smoking. Quitting seriously would avoid something like 200 million premature deaths this century."

My experience with my wife and my mother suggests there's a direct connection between the rising cost of a carton of smokes and the willingness to finally butt out.

But there's also evidence that raising prices also stimulate the trade in smuggled, untaxed smokes. The underground trade in illicit tobacco is already large both in Canada and the United States, including cross-border trafficking especially in the St. Lawrence region.

This article last year on Foxandhounds.com noted one out of five cigarettes in California is smuggled and the proportion rises in states with the highest tobacco taxes. In New York, for instance, cigarette taxes have risen 190 per cent since 2006 and smuggling has climbed by 170 per cent.

[ Related: Five Ottawans arrested in cross-border cigarette smuggling bust ]

Tieleman notes Iceland has been mulling a plan to make cigarettes available only by prescription from a pharmacy. Steady price increases already have helped reduce smoking rates to just 15 per cent there, among the lowest in Europe, according to a 2011 Globe and Mail article.

He also cites legislation proposed in Oregon last year to declare tobacco a controlled substance and obtainable only by prescription. Offenders would be liable to fines of up to US$6,250 or a year in jail or both, according to KPTV.

Radically restricting access to tobacco for millions of users seems like an invitation to organized crime to dive deeper into the illicit tobacco trade. Unlike Iceland, an island nation with limited ports of entry, the Canada-U.S. border makes smuggling difficult to control.

At a time when we're debating decriminalizing the use and possession of marijuana, choking off legal tobacco sales risks handing much more of the trade to criminals.

In an interview Tuesday with Yahoo Canada, Tieleman acknowledged the problem but said it doesn't invalidate the idea.

"There is smuggling right now and it's basically around price and it would continue," he said. "With a controlled substance there's some level of smuggling and some level of non-compliance. But the reality is we already face that as things exist right now."

Tieleman told Yahoo Canada that once sales were restricted to drugstores, the government could conceivably lower the price, as is proposed in Iceland. That would discourage smokers from buying illicit smokes and also reduce the profit incentive for smugglers.

"The idea of going to prescription is to get people to stop using it by making it more difficult to get," without limiting accessibility, thereby reducing consumption, he said.

Smokers would get a prescription from their doctors, who Tieleman said are unlikely to give one to a non-smoker. Smoking would come to be seen as an addiction to be controlled rather than a "leisure activity." Ideally, smoking then would largely die out on its own.

Tieleman said he doesn't actually support charging people criminally for tobacco possession, as the Oregon bill proposes.

"I just put it up there for discussion," he said, noting no politician in the world advocates jailing smokers.