Tobacco Documents Online

CR3 5601.'0 OM"_'/s jg 1 2 3 4 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 THE TOBACCO INSTITUTE * * * UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON ENERGY AND COMMERCE SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT * * * HEARING ON THE SURGEON GENERAL'S REPORT ON "THE HEALTH CONSEQUENCES OF SMOKING: NICOTINE ADDICTION" ROOM 2123, RAYBURN HOUSE OFFICE BUILDING FRIDAY, JULY 29, 1988 9:13 A.M. TIMN 0025452 ACE-FEDERAL REPORTERS, INC. 202-347-3700 Nationwide Coverage 800-336-6646

4n10 01 01 OMT/bc 1 2 3 4 5 6 7 8 9 10 11 12 13': 14' 2 (9:13 a.m.) P R 0 C E E D I N G S CHAIRMAN SCHEUER (Presiding): In the absence of -- in the temporary absence of Chairman Waxman, I'm going to get things started this morning. We have an especially attractive and productive group of witnesses here this morning for this first hearing. It's a specia]l pleasure -- DR. KOOP:- is your microphone on? CHAIRMAN SCHEUER: It should be. I guess I'm not speaking out of it. It is on. Better now? All right. (Pause.) Okay, am I on? 15ii It's a very great pleasure for us to welcome back 16 to the Subcommittee Dr. C. Everett.Koop, the U.S. Surgeon 17; 18 , 19 20 ;i 21 II 22 ' ) 23 li 24 25 General. He has been a superb head of our government's health effort over the years and has given us repeatedly very productive and very helpful testimony. Dr. Koop is accompanied by Jack Henningfield, who is Chief of the Dependence and Abuse Potential Assessment Laboratory of the National Institute on Drug Abuses Addiction Research Center. We are also pleased to welcome back Dr. Frank Young, Commissioner of the Food and Drug Administration, who TIMN 0025453 ACE-FEDERAL REPORTERS, INC. Nationwide Covera e 202-347-3700 g 800-336-6646

"10 01 01 3 OMT/bc 1 also is an old friend of this Subcommittee's. 2 Now, Dr. Young, I understand that your schedule 3 is tight and it will be necessary for you to leave about 10 4 o'clock, no later than 10, and we very much appreciate your 5 willingness to spend even this limited time with us. 6 So I presume this panel will be over about 10 or 7 a few minutes after. All of us up here have agreed that we 8 will defer our opening statements so that we will have time 10 both to hear your tegtimony and to use that time most productively in questions and answers. And I very much 11 appreciate my colleagues' consideration in joining me in 12,; deferring our opening statements. ' 13 Your testimony, as it's prepared, will be printed 14'! in full in the record. So I suggest that each of you chat 15;: with us for perhaps 10 minutes informally, as if we were all H 161 ! in the living room together. - 171; And then, after the three of you have testified, 18;! we'll use the remainder of the period for questions and 19;' answers. Okay? 20 ;; So, Dr. Koop, why don't you begin. 2111 DR. KOOP: Thank.you, Mr. Chairman., I would 22 ( remind you that the time constraints apply to all of us and 23 24 25 we are grateful for the Subcommittee's understanding that, due to these prior commitments, we have to leave here at 10. CHAIRMAN SCHEUER: You all have to leave at 10. TIMN 0025454 ACE-FEDERAL REPORTERS, INC. 202-347-3700 Nationwide Coverage 800-33b-b641.

4010 01 01 4 OMT/bc 1 Let me ask you to keep your opening statements to 2 about six or seven minutes. 3 DR. KOOP: All right. 4 CHAIRMAN SCHEUER: That will be 20 minutes of 5 opening statements and another 25 minutes of Q&A. Okay? 6 DR. KOOP: Thank you. 7 STATEMENT OF DR. C. EVERETT KOOP, M.D., SC.D., 8 SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE, 9- DEPARTMENT OF HEALTH AND HUMAN SERVICES, 10 DR. KOOP: I will be talking primarily about the 11 Surgeon General's Report, which was released May 16th, the 12: Health Consequences of Smoking, Nicotine Addiction. 13 This is the first such Surgeon General's Report 14 : that focuses exclusively on smoking behavior, and it 15' examines the question of why people continue to smoke 161` u despite a desire to quit, and despi,te the known health 17~j ' hazards of smoking. It represents a most comprehensive review of the 19: evidence that the use of tobacco is addictive behavior. 20j; Let me summarize the scientific evidence that led iV . 21;; to three overall conclusions in this report. 22II First, cigarette and other forms of tobacco are 23ii addicting. 24 25! Second, nicotine is the drug in tobacco that causes addiction. TIMN 0025455 ACE-FEDERAL REPORTERS, INC. 202-347-3700 Nationwide Coverage 800-336-6646

9010 01 01 OMT/bc 1 2 3 4 5 6 7 8 10 11 12 5 And, third, that the pharmacologic and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine. The determination that cigarettes and other forms of tobacco are addicting is based on standard criteria used to define drugs as addicting. And all of these criteria are met by tobacco just as they are met by other addicting drugs, such as heroin and cocaine. There are three primary criteria. One is that there is a highly-controlled or use of the drug. This means that drug-seeking and drug-taking 13. behavior is driven by strong, often irresistible urges and 14": can persist despite a desire to quit, or even repeated 15;• attempts to quit. .~ 161~ Second, the drug in thisL case, nicotine, has 17;; psychoactive or mood-altering effects in the brain. 81; • And, third, the drug itself is capable of 19. 20 '~ functioning as a reinforcing agent that directly strengthens behavior leading to further drug ingestion. 21~' The report also considers additional criteria i 22'i that characterized drug addiction. Nicotine, like.other 23;i 1 drugs commonly recognized as addicting, meets these criteria 24 i1 also. 25 For instance, the patterns of drug use are - UNIN 0025456 ACE-FEDERAL REPORTERS, INC. _0, ~ Nationwide Coverage _ z47-3700 R00-336•6646

9010 01 01 OMT/bc 1 2 3 4 5 6 7 8 9- 10 11 12 13; .14: 6 consistent and repetitive. Drug use may persist despite adverse physical, psychological or even social consequences. And after quitting episodes, the resumption of drug use or relapse often occurs; urges or cravings to use the drug may be recurrent and persistent, especially during drug abstinence, and diminished responsiveness to the effects of the drugs occurs over time, a phenomenon which is called tolerance. Withdrawal symptoms often occur after cessation of drug intake and, finally, the drug itself can provide effects which are considered pleasant and euphoric to the drug user. Like other addictions, tobacco can be effectively treated and a wide variety of behavioral interventions have 15;' been used for years. 16II Now we have even a physiologic response to be 17;1 used as treatment, and that is nicotine replacement therapy 18' in the form of a nicotine chewing gum. And these treatments 19: are not widely available to the smokers who need them, 20;, unfortunately.. Most third party insurance payers do not 21! provide coverage for smoking cessation but, on the other ~` 22:; hand, they do for alcoholism and elicit drug use. 2311 Many smokers are'able to quit on their own but, 24 25 similarly, many users of other addicting drugs are also able to quit on their own. These individuals have learned to TRMN 0025457 ACE-FEDERAL REPORTERS, INC. 202-347-3700 Nauonwide Coverage 800-336-6646

4010 01 01 7 OMT/bc 1 deliver effective treatment to themselves, or perhaps their 2 environmental circumstances have changed in such a way as to 3 support cessation and abstinence. 4 And I should like to emphasize that those who 5 want to quit should not be discouraged by anything in this 6 report that I presented. National surveys indicate that 75- 7 85 percent of smokers would like to quit; more than 40 8 million Americans have done so, despite the addiction. And, 91 for many smokers, a desire to quit and, if necessary, 10 persistent and repeated attempts to quit may be all that is 11 necessary. 12 There are public health implications to all of 13 -this, such as: 14 How should we address the problem of tobacco use 15`; now that we recognize it as an addiction? 161; Children especially should be warned about J! 17:: tobacco addiction through school and community education 18,; programs. Many children and adolescents who experiment with 19 tobacco believe that they will be able to quit in later 20;~ years, unaware that initial use can lead to a life-long 21~;: addiction to nicotine. 221 I And we, you and I, in concert with citizens of 23 24 25 this country, civic leaders, should establish appropriate public policies on how tobacco products are sold and distributed to our society. TIMN 0025458 ACE-FEDERAL REPORTERS, INC. 2n2_z47-17nn Nationwide Coverage 40n_136-6fi4A

9010 01 01 8 OMT/bc 1 Most importantly, we must give tobacco and 2 tobacco addiction the sincerity and attention that it 3 deserves. We have waged enormous resources in a war on 4 drugs, elicit drugs, but we should also give pri~irity to the 5 one addiction -- tobacco -- that is killing more than 6 300,000 Americans each year. 7 That's a very brief summary of my remarks, Mr. 8 Chairman. I'll be happy to respond to questions later. 9- CHAIRMAN SCHEUER: Dr. Henningfield. 10 STATEMENT OF DR. JACK E. HENNINGFIELD, PH.D., 11 CHIEF, BIOLOGY.OF DEPENDENCE AND ABUSE 12; POTENTIAL ASSESSMENT LABORATORY, 13 ADDICTION RESEARCH CENTER, ~14; NATIONAL INSTITUTE ON DRUG ABUSE 151' DR. HENNINGFIELD: Mr. Chairman and Members of 16i' the Committee, I'm Dr. Henningfield_. I am grateful for the 17, opportunity to participate in this hearing on nicotine 18;' addiction. 19;' Adam Hau, through the NIDA instrumental grant 20;j program and the Addiction Research Center, has supported 21: studies directed towards the understanding, treatment and 22!i prevention of tobacco use. 23 24 25 . This research has had practical public health benefits, such as more objective and accurate diagnostic criteria for nicotine dependence and withdrawal. The TIMN 0025459 ACE-FEDERAL REPORTERS, INC. 202-347-3700 Nationwide Coverage 800-336-6646

9010 01 01 OMT/bc 1 2 3 4 5 6 7 8 9 10 11 12 9 research has also led to the development of more effective nicotine dependence treatments; since approximately 80 percent of the more than 50 million Americans who smoke would like to quit, these steps could have considerable public health impact. In addition, the involvement of nicotine dependence in the involvement and course of other addictions has also been increasingly recognized as one of the many factors to consider in the current war on elicit drugs, especially at the prevention level with programs aimed at youth. The conclusion that nicotine is a drug that can 13;:. result in a similar addictive process as that produced by 14` drugs such as morphine is supported by many lines of 15;; evidence, including surveys of polydrug abusers and even the 16 more recent neural research, which is investigating the 17' mechanisms by which nicotine activates functional nicotine 18; brain receptors. 19 Let me begin by describing some features of 20; nicotine dependence. ~~ - 21" Nicotine dependence, like other drug addictions, 2211 is a progressive., chronic and relapsing disorder. It can be 23i; objectively diagnosed. Levels of use range from low levels ~ 241. of intake to those which are highly resistant to change by 25I either the individual or others. TIMN 0025460 ACE-FEDERAL REPORTERS, INC. 202-347-3700 Nationwide Coverage A00-?36-6646

9010 01 01 OMT/bc 1 2 3 4 5 7 8 9 10 11 12 10 Let me tell you how addictive nicotine can be as viewed by the so-called hard drug users and by alcoholic populations. Three surveys of cigarette smokers, some of whom were alcoholic and of whom abused elicit drugs showed that by several measures tobacco was highly addictive. The results of these three studies -- in Canada, Great Britain and the United States -- were consistent. They showed that when asked to rate how much they needed the drugs and how much they liked the drugs and how difficult it would be to quit that they rated cigarettes and other forms of tobacco as addicting as heroin and alcohol and that they 13' needed heroin and alcohol -- or tobacco as much as heroin 14 '' and alcohol. 15~~ Of course, many behaviors can become reigular, il 16!, habitual and hard to give up, and they may also involve the , - ; 17' ingestion of a substance. What sets drug addictions apart 18; from these other so-called addictive behaviors is primarily 19C that administration of the substance results in the delivery 20;; of a drug that is known to be addictive. 21;; For example, the drug in opium-derived products' 2211 is morphine. The drug in alcoholic beverages is ethyl 23!~ alcohol. The drug in marijuana is tetrahydrocannabinol. 2411 And the drug in tobacco is nicotine. 2511 Without the drug factor, none of these TIMN 0025461 ACE-FEDERAL REPORTERS, INC. 202-347-3700 Nationwide Coverage 800-336-6646