When I was a wee lad, like many others of my generation, I attended public school. There I was inundated with anti-smoking and anti-drug propaganda. Propaganda; I use  this word advisedly because the information I was given was curated in such a way as to present a predetermined and prescribed conclusion. Some of the facts, as they were presented, had been rephrased in ways that made them more compelling, but inaccurate. One such bizarre manipulation was the oft repeated claim that cigarettes were more addictive than Heroin. The purpose of this claim, of course, was to taint tobacco with the already demonized public perception of heroin. I don’t say opioids because heroin had acquired and still possesses- a very specific dread associated with it. Most of the public, let alone children in school, had no idea what heroin was, but they knew it was a life-ruining addictive drug. To put cigarettes on par with it was a strategic, and likely effective, scare tactic. However, this claim -that cigarettes are more addictive than heroin-  is highly suspect. Allow me to explain why.

Addiction itself is not a clinical term in use today for the simple reason that it does not describe a metric but rather a series of habitual behaviors. Thus, saying something is more addictive than something else is imprecise, at best. Instead, addiction is described through dependency, which falls into two categories: : physical and psychological. Physical dependence refers to the effects on your body when the drug is no longer available. Both nicotine and opioids (like heroin) have symptoms of this kind during the period known as withdrawal, when the drug is no longer taken by someone who is physically dependent. The effects when nicotine is abstained from in this way include irritability, craving and anxiety. The symptoms of opioid withdrawal include extreme discomfort, inability to eat or sleep (for the days or weeks), diarrhea, vomiting and sensitization to pain. The dehydration as a result from continuous purging can literally cause an opioid dependent person to die if they do not force themselves to stay hydrated.  Hallucinating  is not uncommon after the second or third sleepless night on sheets damp with sweat. There is no comparison between these two withdrawal syndromes. Don’t get me wrong, quitting smoking  can be extremely uncomfortable and is not a trivial problem, but the physical aspect is much less painful than stopping opioids. To compare the two and say that cigarettes are worse, is to be ignorant or deceitful.

So clearly, if there is some argument to be made that smoking is more addictive than opioids, we should investigate the other kind of addiction; psychological addiction. Psychological dependence involves continuing a behavior even though we know it to be harmful. All our behaviours were learned at some point. For example, brushing our teeth. At some point, we learned how to do it, and we received some kind of reinforcement for that action, such as our mother telling us it was good to brush our teeth. This would be an example of positive social feedback as a reinforcer. It might also feel good to have clean teeth and to know we won’t get cavities. . These are other examples of reinforcement. Rewards encourage us to continue in a behavior, and the more times we reinforce it, the stronger the behavior becomes in our brain. As I have mentioned before in my blog, this literally causes the neurons to grow physically and create new connections, bolstering the neural pathway. The more you repeat a behavior, the more connections are built and the harder the habit is to change. Another factor in what motivates us in a behavior is the size of the perceived reward, which is also relevant to addiction. The more we like how something makes us feel, the more likely we are to repeat behaviors associated with that thing.

So, how do cigarettes and narcotics stack up against each other under this framework of psychological dependence? Well, first it must be said that shorter acting drugs are considered to be more addictive than longer acting ones because they require more frequent behavior to maintain the high. This is one of the reasons we prescribe long acting opioids like methadone as a therapy for those in recovery instead of shorter acting opioids like morphine. This is also why fentanyl is so damn addictive: it is shorter-acting. Every time you are engaging in drug taking behavior you are reinforcing that habit a little bit, so taking a drug multiple times a day is simply going to help it build that neural pathway faster and solidify that behavior. When we compare cigarettes to heroin, we can see that by this metric, cigarettes have a greater potential to produce addictive habitual behavior. One might take heroin twice or three times a day if they are injecting it, however a pack-a-day smoker is going to engage in her habit 20 times a day or more. Not to mention that cigarette smokers don’t just engage in the behavior every time they smoke a cigarette. Because of the short-acting nature of nicotine, the smoker gets a reinforcement for the behavior every time she inhales smoke and brings the butt to her lips. This is perhaps why one could make the argument that cigarettes are more addictive than heroin. However, this too has problems. It does not consider the hedonic nature of heroin’s rewards, which are much stronger than those of nicotine . It also does not acknowledge that heroin or fentanyl can also be smoked, which makes it arguably more addictive for the same reasons I just mentioned.

When I first heard this myth in high school, it was heavily implied that scientific evidence existed to support it. I once heard a teacher repeat it as an interesting and established fact. When I was young, such a proclamation from an authority figure was trustworthy. However, since I have grown into a skeptical and scientifically minded adult, I no longer have blind trust in authority when my experience conflicts with what is stated. I need evidence to believe something extraordinary, and if such a claim is true, this evidence would be found in the scientific literature.

So, to complete this article, I endeavoured to find the root of this myth. Although it sounded absurd from first principles, I was still curious if any empirical studies had been done that could be interpreted in such a ways as to support this hypothesis. I suspected that some study could have given rats both morphine and nicotine, measuring the amount of lever presses for each, and concluded that nicotine was more addictive. There are many experimental methods that can be used in a similar vein to measure all sorts of specific behaviors caused by drug taking. Addiction is a behavior, so if we are to make any claims about it, this is the kind of experiment that we would need. Thus, I went in search for studies that might fir the bill. I checked google scholar and PubMed for these and came up completely empty. No such studies have ever been conducted. And why should there be such a study? No scientist who studies the neuroscience of addiction would think there is merit in comparing two completely different drugs, to see which one is more addictive. Scientists do studies to find the answers to specific questions of interest. An experiment comparing opioids and nicotine would only have merit as a political talking point to demonize smokers and would not give us any significant scientific knowledge. The results of such a study would be extremely difficult to interpret and would tell us almost nothing. This is why this experiment didn’t happen.

However, this myth has indeed been floating around the public consciousness for a long time. There was a study in 1991, comparing the addictiveness of nicotine to cocaine. In its abstract it acknowledges the existence of a myth that nicotine is more addictive than cocaine. However, this study was not of the kind mentioned above, testing rats or mice on a lever task. This was a meta-analysis comparing a variety of data sets based on “patterns of use, mortality, physical dependence potential, and pharmacological liability measures”. More importantly it concluded that “on the current evidence nicotine cannot be considered more addicting than cocaine.” Thus, I can say with some confidence that the scientific evidence in no way supports the absurd myth I have been railing against. Furthermore, it’s clear that our heroin myth is a mutation of an older myth about cocaine, which has been propagated by word of mouth, and has been altered through this game of telephone unchecked.

The most damning critique of the argument that nicotine is more addictive, however, is that I don’t think it needs to be made in the first place. Given that we have such tenuous evidence to begin with, why are we trying to contrive such a fatuous point? I mean, I could argue that cigarettes are worse than heroin because they are carcinogenic and lead to diseases, while safe use of opioids can be maintained without any deleterious effects as long as the dose is given in a stable and sustained manner. But, does this argument need to be made? I contend that it does not, and in fact is more harmful than helpful.

This is my problem with what I mentioned in my opening paragraph as propaganda. It takes a well-intentioned message for children and exaggerates it to make a point. By doing so it does two things that I think are counterproductive. The first is that it generates a plethora of potentially harmful myths that we could easily do without (some of which demean those living with addiction). The second is that, by virtue of making such extreme statements, it causes more skeptical youngsters to become cynical about information coming from this source. Once you realize one claim is false or implausible, it is perfectly reasonable to begin questioning the other claims. A source that is deemed unreliable is unlikely to be heeded.

Thus, I think that we must take a new approach to the teaching of drug education. The scare tactics are not working, and worse, they result in an uninformed and unrestrained enthusiasm for exploring psychoactive drugs in an unsafe way. Like any ethical endeavor we must be committed to honestly. We must build the foundation of our drug education on facts and not a predetermined outcome we want to achieve. If we build our arguments on lies or sensationalism, it will do nothing but undermine our credibility in the long run. I do not believe arguments against the use of drugs need to be embellished to be effective. Lets learn from the mistakes of the past and avoid them for a better future.