Cannabis and public health: informing a future role of nicotine in society

In this presentation, Prof Benowitz will consider the commonalities and differences between cannabis and nicotine use including safety and health impacts and the implications for potential societal acceptance. The use of cannabis products has become normalized in the U.S. over the past 75 years, including the legalization of recreational cannabis use in many states and Canada. The transition from an illicit drug to a socially acceptable drug was driven by evidence of possible medicinal benefit and a marked change in public perception about its harm. Combusted tobacco use has had a devastating effect on public health in the U.S. for more than 100 years.  Many former smokers would like not to smoke for health reasons but would like to use nicotine in a less harmful form. In recent years a number of non-combustible nicotine products, both inhaled and oral, have been marketed. However, these products have not gained general public acceptance. This appears to relate in part to the tobacco industry’s role in promoting cigarettes, raising public skepticism of industry marketing of nicotine as a legitimate drug, and due to concerns about youth adoption of nicotine use. While nicotine drives combusted tobacco use, most of the harm from smoking is caused by products of combustion of tobacco leaf, not from nicotine. However, public perception strongly links nicotine to the harms of smoking. The experience with cannabis normalization suggests that the public perception of nicotine will need to change before non-combusted nicotine products are accepted as appropriate for public health. Part of this education might include a comparison of the benefits vs risks of cannabis v nicotine.