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Tel 03-5360-8233 FAX 03-5360-6736

Tobacco is a drug
It creates a greater dependence than cocaine, heroin, alcohol, and other stimulants
It has the largest health risk by killing of tens of thousands of people every year
Michiyuki Matsuzaki, Director
Manabu Sakuta, Chairperson
General incorporated association Japan Society for Tobacco Control
24 June 2018

Tobacco is one of the biggest causes of shortening and sickening the lives of Japanesepeople. More than 120,000 deaths from active smoking were estimated in 2007; 6800 deaths
from passive smoking were estimated in 2010, and 15000 deaths from passive smoking wereestimated in 2016. Since past smoking behavior continues to affect current health, the total
number of deaths from tobacco is estimated to have currently risen to 150,000 people.
27 February 2012 Tobacco Alcohol Personnel Seminar, Ministry of Health, Labor and Welfare,
Health Department, General Affairs Division, Lifestyle Disease Countermeasure Office
The two main factors of death from noninfectious diseases and injuries for adults are smoking and hypertension
Source) THE LANCET Japan Special Issue (September 2011).
Note: Japan has maintained national health insurance for 50 years.

Why are Japanese citizens healthy? (Welfare Science Research: comprehensive empirical research on the health caresystem of Japan, published by Kenji Shibuya)

Annual deaths due to active
smokingAnnual deaths due topassive smoking
600,000 people

SourceWorld

5.4 million people

WHO, Report on the Global
Tobacco Epidemic, 2011
editionJapan

120,000-130,000 people ※1-3

6,800 people ※4※ 1. Katanoda K, et al., 2008

About 10% of the annual death
toll of 1.9 million people (H22)

Only lung cancer and ischemic
heart disease are recorded※ 2. Murakami Y, et al., 2011
※ 3. Ikeda N, et al., 2011
※ 4 Kato Noda et al., 2010

Comparison of deaths (Japan)
Cause of death
Passive smoking
Traffic accidents
Asbestos pollution
Work-related accidents
MurderFood poisoning

Number of annual deaths
15000
3904
1505
972
314
6

Survey period
conservative estimate, 2016
2016
from mesothelioma, 2015
2016
2015
2015

Sources:Work-related accident deaths: http://www.mhlw.go.jp/stf/houdou/0000124353.html
Murder: http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei15/dl/11_h7.pdf
Food poisoning deaths: http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/shokuhin/syokuchu/04.html
Asbestos deaths: http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/tokusyu/chuuhisyu15/dl/chuuhisyu.pdf
Traffic accident deaths: http://www.jtsa.or.jp/topics/T-274.html

To substantially reduce the number of victims from tobacco, it is necessary to overcome
nicotine addiction and to stop smoking.
Those who think that "narcotics" and "stimulants" create a stronger dependence than tobacco
are not always correct because much research has shown that tobacco is a "drug" thatcreates a stronger dependence alcohol and many stimulants, although heroin and cocaine arestill more addictive.
For example, in a paper published in the Medical Journal Lancet in 2007, tobacco (nicotine) was
the third strongest dependent drug after heroin and cocaine, according to the calculation of 20
dependency scores of legal and illegal drugs. Alcohol was ranked the 6th most dependent drug,
amphetamine (a stimulant) was ranked 8th. Thus, tobacco creates less dependence than only
heroin and cocaine, and creates more dependence than alcohol, other stimulants and manyother drugs.
Drug name
HeroinCocaineTobaccoDependency score Comments
3.00
2.39
2.21

Street methadone
Barbiturates
AlcoholBenzodiazepines
Amphetamine
Buprenorphine

2.08
2.01
1.93
1.83
1.67
1.64

Synthetic narcotics
Sleep medication

Sleep medication
Synthetic stimulant (Hilopon and similar types)
Sedative opioid from morphine (Repetane)
Designated as a “drug" based on the Narcotic
Ketamine
1.54 and Psychotropic Control Law (Japan)
Cannabis
1.51
α-methyl 4-methyl oophenethylamine,4-MTA
1.30 designer drug
Methylphenidate
1.25 ADHD therapeutic medication (Ritalin)
LSD
1.23 Psychedelic experience
GHB
1.19 Hydroxybutyric acid, designer drug
Ecstasy
1.13 Synthetic drug MDMA
A common plant grown in the mountains ofKhat
1.04 Africa. Used as a stimulant.
Solvents
1.01 Paint thinner, Organic solvent
Anabolic steroids
0.88 For muscle strengthening
Alkyl nitrites
0.87 “Rush” stimulant[Source] Nutt D, et al. Development of a rational scale to assess the harm of drugs ofpotential misuse. Lancet 369:1047-53,2007.
(Revised based on Table 3 in the paper with added commentary)
Based on such scientific research, domestic and foreign administrative agencies have statedthat "tobacco is a drug".
US Public Health Secretary
Addiction exists from tobacco products such as cigarettes
Nicotine is a dependence-forming drug contained in leaf tobacco
The pharmacological / behavioral process for tobacco addiction resembles addiction to heroin
and cocaine[Source] 1988 Report of the Public Health Secretary "Nicotine Addiction"

World Health Organization
Nicotine is a potent drug that meets the diagnostic criteria for an addiction-forming drug
characterized by dependence and withdrawal symptoms. Nicotine has a similar addictionforming effect to heroin and cocaine.
【Source】 2010 Gender, women, and the tobacco epidemic
http://www.who.int/tobacco/publications/gender/en_tfi_gender_women_addiction_nicotine.pdf

Diagnostic and statistical manual of mental illness, 4th edition (DSM - IV - TR)
In DSM-IV, nicotine dependence is described under the category of "substance use disorder",together with narcotics, stimulants, alcohol et cetera.
Substance use disorder
Alcohol related disorder
Amphetamine related disorders
Caffeine related disorder
Cannabis related disorders
Cocaine related disorderHallucinogen related disorders
Inhalant related disorders
Nicotine related disorders
Nicotine use disorder• Nicotine dependence
Nicotine-induced disorders• Nicotine withdrawal
Opium related disorders
Phencyclidine related disorders
Sedatives, hypnotics, or anxiolytics-related disorders[Source] http://rnavi.ndl.go.jp/mokuji_html/000004326569.html

Ministry of Health, Labor and Welfare
About dependency
Dependence refers to a condition in which strong craving exists such that even though one
thinks of stopping an activity, it is not stopped. Dependence from nicotine, a component oftobacco, is described in the "Diagnostic and Statistical Manual 4th Edition of Mentally Disabled
Persons" (DSM - IV), which is used in the International Classification of Diseases (ICD - 10) in
the field of psychiatry. It is treated as a separate disease, and dependence on tobacco has
been established by scientific tests.
【Source】Ministry of Health, Labor and Welfare, Understanding smoking and health problems (Q & A)
http://www.mhlw.go.jp/topics/tobacco/qa/detail4.html

Ministry of Health, Labor and Welfare
The basis of habitual smoking is nicotine addiction• Concerning the dependence of nicotine, we have discussed the existence of physicaldependence.
• In a report published in 1988, the Commissioner of the US Public Health Service reviewed
previous studies and concluded that the nicotine that is contained in tobacco createsdependence similar to narcotics and alcohol.

• Thus, the basis for habitual smoking is nicotine addiction.
• Nicotine addiction has been recognized internationally, particularly in the WHO International
Disease Classification 10th edition (ICD - 10) and the American Psychiatric Association'Guide to Classification and Diagnosis of Mental Disorders, 4th Edition' (DSM-IV), wherediagnostic criteria are indicated.
• That is, tobacco smoking is classified as a disease with drug addiction as the object oftreatment, and health care providers need to treat it.

【Source】Ministry of Health, Labor and Welfare, Text support for smoking cessation
http://www.mhlw.go.jp/topics/tobacco/kin-en-sien/manual/01-3-1.html

Japan Medical Association
Smoking cessation medicine
Nicotine is about as addictive as illegal drugs
The ease of nicotine addiction is caused by the rapid absorption of nicotine by the lungs assoon as tobacco smoke is inhaled. Since nicotine affects neurons about 7 seconds after smoke
is inhaled, the brain quickly realizes that smoking eliminates irritation and feels good, thereby
creating nicotine dependence. However, as effect of nicotine soon dissipates, irritability andstress arise as withdrawal symptoms, and the brain feels that "nicotine will be cut off" asabstinence continues. It is said that getting out of nicotine addiction is about as difficult as
quitting heroin and cocaine.
Nicotine creates as much dependence as drugs
like such as heroin and cocaine!
•Percentage of users that are addictednicotine> heroin> cocaine> alcohol> caffeine•

Strength of withdrawal symptoms for addicted people
alcohol> heroin> nicotine> cocaine> caffeine•Degree of difficulty to quit for addicted people【cocaine = heroin = alcohol = nicotine】> caffeine
From Royal College of Physicians: Nicotine Addiction in Britain: A Report of the Tobacco Advisory Group ofthe Royal College of Physicians.
[Source] https://www.med.or.jp/forest/kinen/medical/

Cabinet Office(1) The meaning of drug dependenceWith repeated use, “the condition in which the drug can not be easily stopped even as one tries
to stop,” is called drug dependence. Drug dependence is classified into two types, psychologicaldependence and physical dependence. The basis of drug dependency commonly starts withpsychological dependence and the progresses to physical dependence. Upon ingesting one ofvarious addictive drugs, the dopamine (A10) intracranial neural system is activated, thereby
creating strong feelings of intoxication and euphoria, possibly leading to psychologicaldependence. Repeated ingestion can cause readjustments or rewiring of intracranial neuralsystems, leading to physical dependence. As the effect of the drug dissipates, physical neuralreadjustments cause an intense desire to replenish the drug in the brain, commonly called"craving", making very difficult to stop using the drug. Persistent behavior to reacquire thedrug despite its costs is commonly called "drug seeking behavior", and cases where tobaccosmokers can not quit tobacco despite its costs are a common examples. (underlined foremphasis)【Source】 Youth adviser training program, Section 2, Problems that young people have (forunderstanding young people with complex needs), Section 3 Dependence on drugs (narcotics,stimulants, psychotropic drugs, alcohol, et cetera)
http://www8.cao.go.jp/youth/kenkyu/h19-2/html/3_2_3.html

Conclusion
1. Tobacco (nicotine) possesses a high degree of dependence after cocaine and heroin
2. The dependency of tobacco exceeds alcohol and stimulants other than cocaine
3. Active smoking and passive smoking kill tens of thousands of people every year, making
tobacco smoking the largest preventable causes of death in Japan
4. Perceiving tobacco smoking as drug dependence is required to end smoking and to extend
healthy lives