Continued tobacco ban could lead smokers to ‘contemplate attempting suicide’

Opposition to the ban on tobacco sales during the national lockdown is mounting, with a psychiatrist specialising in substance abuse saying it is “illogical and harmful” and “unlikely to have any meaningful effect on the prevalence of smoking”.

Dr Michael West, of the Akeso Clinic in Milnerton, Cape Town, said in a report commissioned by the Fair-trade Independent Tobacco Association (FITA): “Therefore any health-related benefits and/or relief of pressure on the healthcare system is likely to be minimal to none.”

The report forms part of FITA’s urgent application to lift the ban – which is expected to be argued before a full bench next week – and was filed in the High Court in Pretoria on Friday.

In it, West pointed to the record of decision – including a cache of research and thousands of public submissions – government last week filed together with an affidavit penned by Co-operative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma, outlining the reasons for the ban.

He said that in his opinion, the ban was “based on low- to very low-quality evidence for which the data is not wholly available, does not consider short-term harms associated with voluntary and involuntary smoking cessation, does not consider WHO-recommended best practices in supporting smoking cessation to improve successful quit attempts, does not acknowledge the negative impact [the ban] is likely to have on vulnerable South Africans and does not reference any of the more recent literature that makes reference to the complex relationship between Covid-19 and smoking”.

West outlined the “numerous physical and psychological symptoms” of nicotine withdrawal and said certain people – including those with mental illnesses – were at higher risk of protracted withdrawal.

“Some individuals are at an increased risk of suicidal ideation and suicidal behaviours that may arise during the period of nicotine withdrawal,” he went on.

“The [withdrawal] syndrome can be so unpleasant for some people that they may contemplate attempting suicide. In some tragic cases, these suicide acts are completed. It is not possible to predict with certainty who will or will not have a complicated withdrawal.”

In the documents filed last week, Dlamini-Zuma cited evidence “that about 95% of smokers also quit on their own without any medication or formal help”. But West rubbished this claim as “outdated and inaccurate” and said it originated from a book published in 1990.

“The statement provided by [Dlamini-Zuma] would be relevant if it were 1990. The simple fact is that over the last 30 years we have improved our knowledge of nicotine dependence and have several far more sophisticated strategies to assist smokers in successfully quitting,” West said.

“[Government] has essentially forced a population of approximately 8 million smokers into an unpleasant physical and psychological withdrawal syndrome without making any efforts to provide support, treatment or evidence-based behavioural interventions,” West went on – adding that “cold turkey” withdrawal only had a success rate of about 6%.

“This is seemingly informed by an incorrect belief that 95% of smokers quit without any sort of assistance. The truth of the matter is that the vast majority of smokers will be unable to successfully quit without some form of intervention.”

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