The Impact of Marijuana Legalization in Colorado 2016

The Impact of Marijuana Legalization in Colorado

The statistics are in, and they show that Colorado’s marijuana legalization has not only resulted in the increase of use by people of all ages in the state, but has also impacted the incidences of:

 Impaired driving while under the influence of marijuana  Emergency room admissions of marijuana cases
 Marijuana exposure cases
 Diversion of Colorado marijuana

The Rocky Mountain High Intensity Drug Trafficking Area (RMHIDTA) provides important data on how the presence of marijuana has impacted the state in its recently released The Legalization of Marijuana in Colorado, The Impact. Colorado and Washington State serve as experimental labs for the nation as states debate the passage of marijuana laws. This report provides an important overview of “before and after” portraits and provides data for coalitions to use as they continue to address the challenges associated with marijuana legalization.

Colorado’s Marijuana Law

In 2010, Colorado’s legislature passed legislation that included the licensing of medical marijuana centers (“dispensaries”), cultivation operations and manufacturing of marijuana edibles for medical purposes. In November 2012, Colorado voters legalized recreational marijuana allowing individuals to use and possess an ounce of marijuana and grow up to six plants. The amendment also permits licensing marijuana retail stores, cultivation operations, marijuana edible factories and testing facilities. Washington voters passed a similar measure in 2012.

Supporters of the marijuana legalization say that the benefits of marijuana legalization far out- weigh the disadvantages. Law enforcement time would be freed up; there would be less arrests for possession and sale; reduced traffic fatalities since users would switch from alcohol to marijuana; no increase among youth because the regulations would be so tight; added tax revenue; and the black market on marijuana would be eliminated. Those opposed to legalization say that there will be adverse consequences, including increased marijuana use among youth and young adults; increased marijuana-related traffic fatalities; and a rise in the number of marijuana-addicted individuals in treatment.

Here’s where Colorado stands on some of these factors, six years after the legalization began:

 Impaired driving: Increased 48 percent in the three‐year average (2013‐2015) since Colorado legalized recreational marijuana compared to the three‐year average (2010‐2012) prior to legalization. Marijuana-related traffic deaths increased by 62 percent from 71 to 115 people after recreational use of marijuana was legalized in 2013.

  •   Youth marijuana use: Also increased by 20 percent since Colorado legalized marijuana, while national youth marijuana use declined by four percent during that same time period.
  •   Adult marijuana use: Adult past-month use increased 63 percent since Colorado legalized recreational marijuana, and Colorado’s college students ranked #1 in the nation for past month marijuana use since that time.
  •   Emergency Department Marijuana and Hospital Marijuana‐Related Admissions: These, too increased from 14,148 in 2013 to 18,255 in 2014. And the number of hospitalizations related to marijuana – increased from 6,305 in 2011 to 11,439 in 2014.
  •   Treatment admissions: While data does not appear to demonstrate a definitive trend, marijuana still remains as one of the top three drugs involved in treatment submissions over the last 10 years.
  •   Marijuana‐Related Exposure: Overall exposure increased by 100 percent in the three‐year average (2013‐2015) and for children aged 0-5, marijuana exposures increased 169 percent since Colorado legalized recreational marijuana compared to the three‐year average (2010‐2012) prior to legalization.

    The bottom line – coalitions, policymakers, and ultimately citizens should review this and similar data before major legalization decisions are made on this important topic.
    You can read the full report here. Other reports on Colorado marijuana legalization can be viewed through the RMHIDTA’s website under the Reports tab.

    CADCA Community Anti-Drug Coalitions of America

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San Juan County Fair our SJIPC Booth 2016!

A favorite activity for young and old alike at the Fair, the FREE Healthy Message T-Shirt activity at our booth! This year, we thank Community Treasures for donating to support these efforts! They helped cover the cost of over 450 t-shirts and the art supplies to decorate them for our community to engage in this worth while message! Choose Health! Thanks to everyone that volunteered or stopped by and shared your creativity by making a t-shirt!

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Knowns and Unknowns about e-Cigarettes and Teens

February 03, 2015

Photo of e-cigs showing their variety Photo ©istock/ kitiara65

The recent Monitoring the Future survey of students’ drug use and attitudes revealed that adolescents have taken to e-cigarettes in a big way. When asked in early 2014, 17.1 percent of high school seniors and 16.2 percent of 10th graders reported using e-cigarettes in the previous month (see infographic, bottom). We are still wrestling with whether or not e-cigarettes pose a danger, but their popularity among youth combined with society’s past experiences with tobacco and other addictive substances demands that we urge caution around these products.

E-cigarettes are being aggressively marketed as glamorous devices that empower users—such as by giving them the freedom to “vape” in public places where cigarette smoking is banned or taboo. And even though sellers are often careful not to make explicit health claims, another part of the “freedom” being sold is, implicitly, the freedom to enjoy the smoking experience without fear of long-term health consequences such as death from cancer or heart disease.

Those who know the history of cigarette marketing in America will experience a sense of déjà vu. Freedom was the concept used in the 1920s and 1930s to market cigarettes to women, a vast then-untapped market for what had previously been only a male pleasure. Cigarette smoking was sold to women as an image to help them feel liberated and empowered.

Although the vapor produced by e-cigarettes contains no tar—the main cause of lung cancer—it may contain other potentially harmful chemicals. There are currently no regulatory controls over these products, most are made in China, and testing of some products’ vapor has shown toxic metals, possibly produced by the vaporizing mechanism itself. And that is to say nothing of the risks of nicotine exposure. Whether or not e-cigarettes turn out to have fewer physical health harms than traditional cigarettes, it is still ridiculous to describe any product containing an addictive substance as “freeing.”

E-cigarette fluids vary widely in their nicotine concentrations, and the amount a user is exposed to probably depends on a range of factors (like how many puffs they take, how deeply they inhale, and how long they hold it), but there is clearly a potential for these products to promote addiction—especially when users start in their teens. Recent research in rodents suggests nicotine may even promote addictive behavior by altering gene expression: A 2011 study by Eric R. Kandel and colleagues at Columbia University found that nicotine exposure increased mice’s sensitivity to cocaine’s rewarding effects via an epigenetic pathway; if the same holds true in humans, nicotine could serve as a gateway to abuse of other substances.

Apart from the possible dangers of nicotine, e-cigarette use is normalizing and even glamorizing smoking behavior, which had been successfully stigmatized through public-health campaigns of the past decades. The MTF survey found that many kids who are using e-cigarettes are also smoking traditional cigarettes. It would be tragic if e-cigarettes re-opened the door to teen tobacco use, which has been slowly but surely declining since the late 1990s.

As scientists, we should be cautious and not sound alarm bells prematurely. It will be good if future research shows e-cigarettes are indeed helpful aids for smokers who have trouble quitting otherwise. But if vaping is hooking new users on nicotine—young people and those of any age who had never smoked before—then that could pose a serious problem. We should not allow e-cigarettes, with their promised “freedoms,” to rewind public health to the 1920s.

See text description belowPast month use, 8th grade – Cigarettes: 4.0%, e-Cigarettes: 8.7%; 10th grade – Cigarettes: 7.2%, e-Cigarettes: 16.2%; 12th grade – Cigarettes: 13.6%, e-Cigarettes: 17.1% (Only 14.2% of 12th graders view e-cigarette use as harmful, which is less than 5 students in the average class)
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Resources Available to Help Families

Other Useful Resources

There are numerous resources, many right in your own community, where you can get information to help you talk to your children about drugs. Consult your local library, school, or community service organization. You may also contact the government organizations listed below.

National Institute on Drug Abuse (NIDA)

NIDA, as part of the National Institutes of Health, offers an extensive collection of publications, videos, and educational materials to help parents talk to their children about drug use. Resources include:

  • Family Checkup, which provides parents with research-based skills, including conversation tips on video, to help keep their children drug free
  • Drugs: Shatter the Myths, which parents can give to their teens to help answer frequently asked questions about drugs and drug abuse
  • Step-by-Step Guide, which offers guidance on what parents can do if their teen or young adult has a drug use problem

Visit our Parents & Educators page for a list of other materials.

NIDA has more information about marijuana and other drugs on both our main website and our NIDA for Teens site.

Select NIDA publications are available free of charge through the NIDA DRUGPUBS Research Dissemination Center.
phone: 1‑877‑NIDA‑NIH [1‑877‑643‑2644] or 240‑645‑0228

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Visit NIAAA at for information about a variety of alcohol-related issues, which frequently intersect with other drug use problems.

National Institute of Mental Health (NIMH)

NIMH provides the latest research findings and numerous other resources covering a variety of mental health disorders, which often co-occur with drug abuse.

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA’s treatment locator can help you find a drug abuse or alcohol treatment program near you. Visit for more information about drug abuse prevention and treatment policies, programs, and services.

Drug Enforcement Administration (DEA)

Visit for information about various drugs, controlled substances laws (including drug scheduling), and U.S. regulations. The DEA offers two resources specifically intended for parents and teens:

Tips for Parents

  • Be a good listener.
  • Set clear expectations about drug and alcohol use, including real consequences for not following family rules.
  • Help your child deal with peer pressure to use drugs.
  • Get to know your child’s friends and their parents.
  • Monitor your child’s whereabouts.
  • Supervise teen activities.
  • Talk to your child often.
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Marijuana: Facts Parents Need to Know

A Letter to Parents

We at the National Institute on Drug Abuse (NIDA) are pleased to offer two short guides for parents and their children to review the scientific facts about marijuana: (1) Marijuana: Facts Parents Need to Know and (2) Marijuana: Facts for Teens. Although it’s best to talk about drugs when children are young—when drug use often begins—it’s never too late to start the conversation.

Marijuana remains the most used illegal substance among youth. By the time they graduate from high school, about 45 percent of U.S. teens will have tried marijuana at least once in their lifetime. In 2015, nearly 22 percent of high school seniors reported current marijuana use, and 6 percent used marijuana daily.1 The annual Monitoring the Future survey has been tracking teen attitudes and drug use since 1975. Currently, the number of teens who think marijuana use is harmful is declining. This is concerning because there is growing scientific evidence that heavy, regular use of marijuana that begins during the teen years may lower a person’s IQ and interfere with other aspects of functioning and well-being. The good news is that marijuana use did not increase significantly among youth from 2010 to 2015.

Survey results show that we still have a long way to go in our efforts to prevent marijuana use and avoid the toll it can take on a young person’s life. NIDA recognizes that parents have an important role in this effort and can strongly influence their children’s attitudes and behaviors. However, the subject of marijuana use has become increasingly difficult to talk about—in part because of the mixed messages being sent by the passage of medical marijuana laws and legalization of marijuana in some states. In addition, many parents may have used marijuana when they were younger, which could make talking openly and setting rules about its use more difficult.

Talking to our children about drug use isn’t always easy, but it is crucial. You can also get involved in your community and seek out drug abuse prevention programs that you and your child can participate in together. Sometimes, just beginning the conversation is the hardest part. I hope these booklets can help.

Nora D. Volkow, M.D.

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International Overdose Awareness Day is next Wednesday, August 31st.

Please join the effort to raise awareness about overdoses.

An informational event will be held in Friday Harbor from 6:30 -8:30 p.m. at San Juan Island Public Library.  Presenters will be Compass Health, San Juan County Sheriff’s Office, SAFE San Juans, and San Juan Island Emergency Medical Services.

Refreshments will be served.  San Juan Island Prevention Coalition (SJIPC) has assisted Compass Health in organizing, marketing, and implementing the event because this is a very important issue that must be addressed collaboratively.

Members of the coalition are collaborating to help educate community members about the signs of overdose and the signs of depression, anxiety, and suicidal ideation that often lead to self-medicating and overdosing.

Please circulate the attached information within you circle of influence.

IOAD FlyerPoster.08312016.Final

Recognize and Respond AGENDA

Learn How to Prevent OverDose

August 31, 2016

6:30 – 8:30

San Juan Island Public Library


  • 6:30 to 6:45  Welcome and overview of purpose and outline of event, Barbara Starr, Mental Health Professional and Program Manager, Compass Health


  • 6:45 to 7:10  Presentation by Shannon Reitan, Chemical Dependency Professional, Compass Health


  • Prevalence of overdoses with various substances
  • Importance of co-occurring disorders treatment
  • Signs of overdose


  • 6:10 to 7:30 Presentation by Ron Krebs, Sheriff, San Juan County Sheriff’s Office


  • First responder actions
  • Education for prevention and intervention
  • Community collaboration efforts


  • 7:30 to 7:50 Presentation  by Kim Bryan, Director, SAFE San Juans


  • Education for prevention and intervention
  • Working with youth
  • Community collaboration efforts


  • 7:50 to 8:10 Presentation by Chief Jerry Martin, Chief and Lainey Volk,  Education and Prevention Director, San Juan Island Emergency Medical Services (EMS)


  • First responder actions
  • Education for prevention and intervention
  • Community collaboration efforts


  • 8:10 to 8:30 Dialogue and Refreshments



What is an overdose?

An overdose means having too much of a drug (or combination of drugs) for your body to be able to cope with. There are a number of signs and symptoms that show someone has overdosed, and these differ with the type of drug used. All drugs can cause an overdose, including prescription medication prescribed by a doctor. It is important to know your correct dosage, what drugs definitely should not be mixed, and know to seek help if you feel you are not in control of your drug use.

Depressant overdose

Opioids, benzodiazepines & barbituates (medical Depressants), and alcohol all slow the central nervous system to produce a calming effect These substances are often prescribed to relieve pain, help you sleep, or in the case of alcohol, used recreationally when socialising. depressants, which means they slow the central nervous system, including breathing and heart rate. However, when taking in excessive amounts or in combination, they can depress normal functions such as breathing and heart rate until they eventually stop, resulting in death.

Opioids are narcotics which are either derived from opium (called opiates) or share a similar chemical structure but are manufactured without opium. Fentanyl, methadone, morphine and heroin are all opiates. Examples of opioids include oxycodone and hydromorphone.

Benzodiazepines are used medically to reduce anxiety, help people sleep and to relax the body. They include diazepam or Valium, oxazepam or Serepax , alprazolam or Xanax and a number of other drugs. Taken in high doses or in conjunction with alcohol they are responsible for many overdoses. Taking these kinds of drugs in higher than prescribed quantities can slow your breathing to dangerous levels or stop it altogether. Mixing these drugs can be extremely dangerous.

People’s tolerance to a drug can drop quickly and for a variety of reasons, such as having not used for a while (eg: having been in custody or having done detoxification/rehabilitation) or cutting down.

Signs of depressant drugoverdose (e.g. heroin, morphine, oxycodone, fentanyl, methadone) include:

  • shallow breathing or not breathing at all
  • snoring or gurgling sounds (this can mean that a person’s airway is partly blocked)
  • blue lips or fingertips
  • floppy arms and legs
  • no response to stimulus
  • disorientation
  • unrousable (can’t be woken up) unconsciousness.

If you can’t get a response from someone, don’t assume they are asleep. Not all overdoses happen quickly and sometimes it can take hours for someone to die. Action taken in those hours could save a life. This is a medical emergency: call the ambulance immediately if you can’t rouse them.

Alcohol poisoning/overdose

Generally people do not automatically think of alcohol when they think of overdose, but alcohol is a depressant and it is all too possible to overdose on it. Acute alcohol poisoning, which is usually a result of binge drinking, is an example.

Our bodies can process about one unit of alcohol an hour. If you drink a lot quickly the amount of alcohol in your bloodstream (blood alcohol concentration, or BAC) may become dangerously high, which can stop your body from working properly. In extreme cases, alcohol poisoning could stop you breathing, stop your heart or cause you to choke on your own vomit.

Signs of alcohol intoxication to the point of overdose include:

  • disorientation
  • loss of coordination
  • vomiting
  • seizures
  • irregular or slow breathing (less than eight breaths a minute)
  • blue-tinged or pale skin
  • low body temperature (hypothermia)
  • stupor (being conscious but unresponsive)
  • unconsciousness (passing out).

Stimulant overdose

It is possible to overdose on amphetamines such as speed and ice. Amphetamine overdose increases the risk of heart attack, stroke, seizure or drug-induced psychotic episodes.

Amphetamine overdoses look different from an opioid OD, and signs and symptoms include:

  • chest pain
  • disorientation/confusion
  • severe headache
  • seizures
  • high temperature (overheating, but not sweating)
  • difficulty breathing
  • agitation and paranoia
  • hallucinations
  • unconsciousness.

Understanding tolerance and half-life

When a person uses a drug regularly they develop tolerance to it. This means they need to use more to get the same effect. Similarly, if a person hasn’t been using regularly – or if they’ve not been able to get drugs – their tolerance will drop. When people take their usual amount of drugs after a break from using, it could be too much for the body to cope with and lead to an overdose. This is why high-risk situations for drug overdose include post-release from prison, detoxification and rehabilitation. Someone on naltrexone can also be at risk if they use soon after stopping oral medication, or skipped a dose, or when the effects of a naltrexone implant have ceased.

“Half-life” refers to the time it takes for a drug to drop to half the strength of its original dose. Some drugs have a long half-life, for example some benzodiazepines. If a person has used yesterday, they may still have enough in their system today to overdose if they use more. Diazepam (Valium) has one of about 24 hours, so if you took 20mg yesterday you would still have approximately 10mg of diazepam active in your system today. If you were then to use heroin or morphine, you would have an increased risk of overdose as you would be using the opioids in addition to that 10mg of diazepam.

Mixing drugs

Taking more than one kind of drug at a time puts strain on the body and can increase both effect and the risk. For example, most heroin-related overdoses are caused when other depressant drugs are taken too. Alcohol and benzos like alprazolam (marketed as Xanax) and temazepam (Temaze) are depressants, and mixing them with drugs like heroin, oxycodone (Oxycontin®) or morphine (MS Contin®) greatly increases the risk of an overdose.
What to do if someone is overdosing

  • stay with them and assure them everything will be okay
  • if they appear unconscious, try to get a response from them (eg: call their name).
  • If you can’t get a response put them in the recovery position and call an ambulance.
  • Commence first-aid. Emergency operators can give CPR instructions.
  • Keep an eye on them. People can go in and out of consciousness.
  • If stimulants such as amphetamines are thought to be involved, a person may feel hot, anxious or agitated. Try to move them somewhere cooler and quieter. Or try to make the place quieter.

When to call an ambulance

People are often reluctant to call an ambulance for fear of police involvement or concern about the cost of a call-out. The police will only attend if there is a fatality or if their presence is requested, for example if the ambulance crew feel threatened. This is an issue worldwide.

In addition to unconsciousness, call for emergency help when someone is:

  • having a seizure
  • experiencing severe headache
  • experiencing chest pain
  • experiencing breathing difficulties
  • extremely paranoid, agitated and/or confused.

It is not necessary for someone to have all of these signs or symptoms for them to be overdosing. Exhibiting only a few could still mean they are in trouble and need emergency help.

Don’t ignore gurgling and snoring

Snoring and gurgling can mean a person is having trouble breathing.

With substance use, especially substances that slow down the systems of the body (eg: benzodiazepines, opioids, GHB), snoring may indicate a serious and potentially life threatening obstruction of the airway.

The noise generated results from reduction in the size of the airway, and the result is a reduction in the volume of air that is able to move in and out of the lungs with each breath, and vibration of tissues around the airway as the comatose person struggles to move air in and out of the lungs. The larger the obstruction, the smaller the amount of air that gets in, and the greater the effort that is required to try and get air into the lungs. The obstruction occurs when the person is unable (due to their substance use) to move their head/neck/body to allow better air flow, and because collapse of the airway due to decreased muscle activity around the airway that normally keeps it open – this is because they are unconscious, not because they are sleeping.

In the setting of substance use, snoring is not something that should be seen as ‘normal’. Don’t let people ‘sleep it off’ if they are snoring – this may be a sign of significant and life threatening emergency – attempt to wake them immediately.

If they do wake then the snoring (airway obstruction) will resolve. If they do not wake, call emergency services and ask for an ambulance. Follow the instructions from the operator (you will probably be asked to roll the snoring person onto their side and open their mouth to maximise the flow of air).

Naloxone half-life

Naloxone (also known by one of the brands Narcan®) is the used by paramedics to revive people who have had an opiate or opioid drug overdose. Anyone who has been revived using naloxone needs to understand the danger of taking more drugs afterwards because they can overdose a second time. Naloxone can precipitate withdrawal symptoms which bring a powerful urge to take more drugs.  Because naloxone has a half-life of 1-1.5 hours, considerably less than heroin and morphine, taking more opiates can bring on a second overdose. Drugs like methadone, and sustained-release opioids like OxyContin® and MS Contin®, provide the drug over 12 hours or more, so the effect of naloxone will wear off long before those drugs have exited your system.

Permanent brain damage and overdose

Hypoxic brain injury, which is caused by a lack of oxygen to the brain, is an under-reported consequence of heroin overdose. These brain injuries can cause coma, seizures and, in worst case scenarios, brain death. The long-term consequences of hypoxia depend on how long the brain is without adequate oxygen supply. Basically, the longer a person is not breathing, the more potential damage is being done to the brain. In many overdose cases such information is unknown. Health outcomes depend on the success of damage control measures, the area and extent of brain tissue deprived of oxygen and the speed with which oxygen was restored to the brain.

A brain injury can result in mild to severe impairment of:

  • movement, balance and co-ordination
  • senses such as hearing or vision
  • spoken and written communication
  • thinking, concentration and memory.

In severe cases, brain injuries from overdoses can leave people in a vegetative state.


Get the App

The Overdose Aware app aims to raise awareness amongst those who are experiencing drug use and their families, of how to recognize overdose signs and respond accordingly. More>>


International Overdose Awareness Day is committed to providing a platform to acknowledge the grief felt by families and friends who have lost a loved one to overdose. We aim to raise awareness that the tragedy of overdose death is preventable. Support our work today.



  • My son, Travis, died of an overdose on July 28, 2015.  He was only 23.  He had been sober 3 months at the time of his death.  I know that he fought so hard, and he was a beautiful soul trapped in the hell of addiction.  I miss him every day and so wish I could tell him how much I love him and that I know he tried.  Rest in peace sweet boy!
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Fair Flash Mob 2016 DANCE 4 HEALTH

Saturday, August 20th at 6pm Main Stage with the Fashion Trashion Show, join our Rock Solid Youth in a Flash Mob! DANCE 4 HEALTH!

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What are Tobacco, Nicotine and E-Cigarettes Products?

Cigarettes: Also known as: “smokes,” “cigs,” or “butts”

Smokeless tobacco: Also known as: “chew,” “dip,” “spit tobacco,” “snus,” or “snuff”

Hookah: Also known as: ”waterpipe,” “narghile,” “shisha,” “hubble-bubble,” or “goza”

Tobacco is a leafy plant grown around the world, including in parts of the United States. There are many chemicals found in tobacco or created by burning it (as in cigarettes), but nicotine is the ingredient that can lead to addiction. Other chemicals produced by smoking, such as tar, carbon monoxide, acetaldehyde, and nitrosamines, also can cause harm to the body. For example, tar causes lung cancer and other serious diseases that affect breathing. Carbon monoxide causes heart problems, which is one reason why people who smoke are at high risk for heart disease.

Tobacco use is the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC), cigarettes cause more than 480,000 premature deaths in the United States each year—from smoking or exposure to secondhand smoke—about 1 in every 5 U.S. deaths, or 1,300 deaths every day.1 An additional 16 million people suffer with a serious illness caused by smoking. Thus, for every 1 person who dies from smoking, 30 more suffer from at least 1 serious tobacco-related illness.2

1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Oct 9]. or…. [accessed 2015 Oct 9].

2. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Oct 9].


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Tobacco and Nicotine Effects on the Body

When nicotine enters the body, it initially causes the adrenal glands to release a hormone called epinephrine (adrenaline). The rush of adrenaline stimulates the body and causes an increase in blood pressure, heart rate, and breathing.

Most of the harm to the body is not from the nicotine, but from other chemicals contained in tobacco or produced when burning it—including carbon monoxide, tar, formaldehyde, cyanide, and ammonia. Tobacco use harms every organ in the body and can cause many problems. The health effects of smokeless tobacco are somewhat different from those of smoked tobacco. But for both types of tobacco products, the risks are real.

Smoking Tobacco Effects

  • Cancer. Tobacco use can be blamed for about one-third of all cancer deaths, including 90% of lung cancer cases. Tobacco use is also linked with cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, ureter, bladder, and bone marrow (leukemia).
  • Lung or respiratory problems. Bronchitis (swelling of the air passages to the lungs), emphysema (damage to the lungs), and pneumonia have been linked with smoking.
  • Heart disease. Smoking increases the risk for stroke, heart attack, vascular disease (diseases that affect the circulation of blood through the body), and aneurysm (a balloon-like bulge in an artery that can rupture and cause death).
  • Cataracts (an eye condition). People who smoke can experience this clouding of the eye, which causes blurred vision.
  • Loss of sense of smell and taste.
  • Lowered lung capacity. People who smoke can’t exercise or play sports for as long as they once did.
  • Aging skin and teeth. After smoking for a long time, people find that their skin ages faster and their teeth discolor or turn brown.
  • Harm to the unborn baby of a pregnant woman who smokes. Pregnant women who smoke are at increased risk for delivering their baby early or suffering a miscarriage, still birth, or experiencing other problems with their pregnancy. Smoking by pregnant women also may be associated with learning and behavior problems in children.
  • Accidental death from fires. Smoking is the leading cause of fire-related deaths—more than 600 deaths each year.6

Secondhand Smoke

For people who do not smoke, secondhand smoke—exposure to exhaled smoke and smoke given off by the burning end of tobacco products—increases the risk for many diseases. Each year, an estimated 58 million Americans are regularly exposed to secondhand smoke and more than 41,000 nonsmokers die from diseases caused by secondhand smoke exposure.3

Inhaling secondhand smoke increases a person’s risk for developing:

  • Heart disease. Secondhand smoke increases the risk for heart disease by 25% to 30%. It is estimated to contribute to as many as 34,000 deaths related to heart disease.4
  • Lung cancer. People exposed to secondhand smoke increase their risk for lung cancer by 20% to 30%. About 7,300 lung cancer deaths occur per year among people who do not smoke.5
  • Lung problems. Secondhand smoke causes breathing problems in people who do not smoke, like coughing, phlegm, and lungs not working as well as they should.
  • Health problems for children. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, lung infections, ear problems, and more severe asthma.

Smokeless Tobacco Effects

People who use smokeless tobacco products, such as chewing tobacco, snuff, or dip, are at risk for several health problems:

  • Tooth decay, gum problems, and mouth sores. Smokeless tobacco increases the chance of getting cavities, gum disease, and sores in the mouth that can make eating and drinking painful.
  • Cancer. Close to 30 chemicals in smokeless tobacco have been found to cause cancer. People who use smokeless tobacco are at increased risk for oral cancer (cancers of the mouth, lip, tongue, and pharynx) as well as esophageal and pancreatic cancers.
  • Other potential health problems. Recent research shows smokeless tobacco may play a role in causing heart disease and stroke.

3. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Oct 9].

4. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Secondhand Smoke Facts. Updated August 2015.

5. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Secondhand Smoke Facts. Updated August 2015.

6. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Department of Health and Human Services. Smoking and Tobacco Use. Tobacco-Related Mortality. Updated August 2015.

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What About E-Cigarettes?

E-Cigarettes have emerged over the past decade and researchers in the early stage of investigating what the health effects are for people who use these products or who are exposed to the aerosol (vapor) secondhand.

E-Cigarettes are designed to deliver nicotine without the other chemicals produced by burning tobacco leaves. Puffing on the mouthpiece of the cartridge activates a battery-powered inhalation device (called a vaporizer). The vaporizer heats the liquid inside the cartridge which contains nicotine, flavors, and other chemicals. The heated liquid turns into an aerosol (vapor) which the user inhales—referred to as “vaping.”

There are conflicting studies about whether or not e-cigarettes help smokers to quit. For tobacco cigarette smokers, e-cigarettes may be a safer alternative, if the goal is not to quit nicotine all together. However, health experts have raised many questions about the safety of these products, particularly for teens:

  • Testing of some e-cigarette products found the aerosol (vapor) to contain known cancer-causing and toxic chemicals, and particles from the vaporizing mechanism that may be harmful. The health effects of repeated exposure to these chemicals are not yet clear.
  • There is animal research which shows that nicotine exposure may cause changes in the brain that make other drugs more rewarding. If this is true in humans, as some experts believe, it would mean that using nicotine would increase the risk of other drug use and for addiction.
  • There is an established link between e-cigarette use and tobacco cigarette use in teens. Researchers are investigating this relationship. The concern is that e-Cigarette use may serve as a “gateway” or introductory product for youth to try other tobacco products, including regular cigarettes, which are known to cause disease and lead to early death.
  • The liquid in e-cigarettes can cause nicotine poisoning if someone drinks, sniffs, or touches it. Recently there has been a surge of poisoning cases in children under age 5. There is also concern for users changing cartridges and for pets.

Are E-Cigarettes Regulated?

Yes. The U.S. government’s Food and Drug Administration (FDA) announced on May 5, 2016 that effective in 90 days, the FDA will now regulate how and to whom e-cigarettes, as well as hookah tobacco and cigars are sold. This means that the FDA will now regulate these types of tobacco products in much the same way they regulate cigarettes.

This means that beginning on August 5, 2016:

  • It is illegal to sell e-cigarettes, hookah tobacco or cigars in person or online to anyone under age 18;
  • Buyers have to show their photo ID to purchase e-cigarettes, hookah tobacco or cigars, verifying that they are 18 years or older.
  • These products cannot be sold in vending machines (unless in an adult-only facility); and
  • It is illegal to hand out free samples.

FDA regulation also means that the Federal government will now have a lot more information about what is in e-cigarette’s, the harmfulness of the ingredients, how they are made, and what risks need to be communicated to the public (for example, on health warnings on the product and in advertisements). They will also be able to stop manufactures from making statements about their products that are not scientifically proven.

Regulation does not mean that e-cigarettes are necessarily safe for all adults to use, or that all of the health claims currently made in advertisements by manufactures are scientifically proven. But what it does mean is that e-cigarettes, hookah tobacco, and cigars now have to follow the same type of rules cigarette manufacturers have been following since 2009.

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