Cigarettes kill about half of all long-time smokers and cause far more deaths annually than any other commodity or activity: a billion people are predicted to die this century from tobacco-related diseases.
Despite intensive anti-smoking campaigns and a significant decrease in smoking rates, cigarette smoking remains a big problem in economically developed countries and is increasing in some poor countries. Health authorities in developed countries, where the most headway against smoking has been made, now talk about playing the "endgame" with tobacco, that is, reducing the percentage of smokers in the overall population, currently about 20 per cent, to 1 or 2 per cent. Some have suggested the licensing of cigarette smoking as a significant step towards achieving this end result.
In a highly cited article in Plos Medicine (November 2012), Simon Chapman, Sydney University public health academic, outlined the case for a smoker's licence, whereby smokers would apply for a smart swipe-card licence and retailers could sell cigarettes only to cardholders. Before receiving a licence, smokers would have to pass a test of smoking risk knowledge.
Three levels of licence would exist, corresponding to different levels of smoking: one to 10 cigarettes per day, 11-20 per day and 21-50 per day. Annual licensing fees of about €100, €150 and €200 respectively would apply to each of the three categories and smokers would precommit to a smoking category. This category could be changed later online or on annual licence renewal.
To purchase cigarettes, the smart card would be swiped through a card terminal in the retail outlet and smokers could purchase up to a 14-day supply of cigarettes at a time, but any attempt to buy extra cigarettes during this 14-day period would be refused at the card terminal.
Ninety per cent of smokers regret taking up the habit, 40 per cent attempt to quit the habit each year and many smokers support tobacco-control measures, hoping they will help them reduce or stop smoking. Chapman argues that many smokers would use the licensing system to set a daily limit of cigarettes lower than they would otherwise smoke in an effort to reduce consumption. Cutting down is a common approach before eventually quitting the habit.
There is evidence that financial reward can help smokers reduce or quit the habit. The licence fee in itself is a disincentive to smoking, but more significantly, smokers who stop smoking and surrender the licence would be refunded, with compound interest, all licence fees paid during their licence history. Licence surrender would be permanent and reapplication not permitted.
Chapman makes a strong case for licensing smokers. Tobacco is a dangerous drug. We strictly license the use of all other drugs that are potentially dangerous if improperly used, for example pharmaceuticals. When your GP writes you a prescription to treat your ailment, he/she gives you a temporary licence to purchase a limited supply of pharmaceuticals from a licensed pharmacy. In contrast, tobacco, a drug that kills half of its long-term users, can be purchased by any adult in unlimited quantity in any shop.
What about the “slippery slope” objection to a smoking licence? Would it not encourage the “nanny state” to call for a licensing system for alcohol drinkers, consumers of junk food and so on? However, Chapman argues that this slope is less slippery than we fear. Drastic controls, greater than apply to any other consumer product, have already been introduced to regulate tobacco marketing, packaging and public consumption – cigarette ads are banned across all media, tobacco sponsorship of sport is banned, plain packaging of cigarettes with graphic printed warnings is required, smoke-free zones are widespread – without significant spillover of such controls to other consumer goods, for example alcohol.
When I first heard the idea of licensing cigarette smokers I dismissed it as a crude Orwellian instrument of state control. I am a nonsmoker but I don’t like the state curtailing citizens’ personal freedoms. However, the cumulative health effects of smoking are so grave they may well justify this extra step.
William Reville is an emeritus professor of biochemistry at UCC. http://understandingscience.ucc.ie