If clinicians treating HIV/AIDS patients who can’t stop smoking knew what hidden fungicides those patients were inhaling they could probably do a much better job of treating them.
Here’s The Data
Community Tobacco Control Partners Test Results 12/18
Which tobacco brand above do you think would be most harmful to an HIV/AIDS patient currently undergoing treatment and still smoking?
Which brand above would be least harmful to a patient undergoing the same treatment and still smoking?
How much clinic time and human and financial resources could be conserved, and how many patients’ lives saved, if patients in HIV/AIDS therapy were not being compromised daily by an inhaled fungicide cocktail from smoking that they can’t control?
I propose a simple, inexpensive way to use economic incentive, hard evidence, common sense and an appeal to simple pleasures to change the harmful behavior of smoking during HIV/AIDS therapy.
Merely labeling the behavior harmful and harping at people to quit obviously doesn’t do the job.
The Problem
A very high proportion of people in HIV/AIDS treatment continue to smoke, and they’re driven to cheap tobacco brands by poverty and sometimes choice.
We also know that the pesticides in many tobacco brands like those shown above attack the immune system, so heavy smoking with exposure to these endocrine-disrupting pesticides in addition to the fungicides all go together to make a young LGBTQ person who smokes much more vulnerable to acquiring HIV/AIDS if and when they are exposed.
Existing cessation programs and strategies do not work well, when they work at all.
Patients who continue to smoke disrupt and negate their therapy in ways that their health care providers can clearly see but cannot identify the cause. They know smoking is involved but don’t know how.
What doctor or nurse who is carefully keeping fungicide applications separate from other medications for a patient could know that the patient was dosing themselves with a cocktail of fungicides 40-60 times a day or more through smoking?
Street Math
If a person is paying $6.00 for a pack of cigarettes they are getting 20 cigarettes containing 0.8 grams of “tobacco-like material” at a cost of $0.375/gram, or $10.65/ounce. If they’re paying $8 a pack that’s $0.50/gram and so on
No cigarette smoker ever does that math, but those numbers will get any patient’s attention as part of the onboarding process because everyone on the streets knows how to do drug math. Once a person sees what they’re paying and what they’re getting, and are presented with an attractive option that has compelling economics behind it too – I believe that motivation to participate would not be a problem.
The American Spirit Harm Reduction strategy
You can see the core of the proposed harm reduction strategy in the data above. Tobacco brands differ wildly in their harm potential. It’s that simple. So we find a way to empower the most marginalized among us who must smoke to be able to choose the least harmful way to pursue their need.
I don’t show organic tobacco in the data for an good reason – we tested Organic American Spirit for use as the substrate for the brand tests and it had no detectable pesticide residues.
But if an HIV/AIDS patient is smoking any tobacco brand contaminated with any of the fungicides you see in the data above, getting heavier as the brand gets cheaper, then you can see exactly how harm reduction will work right up front.
The only question is – how can you transition people from the most harmfully contaminated to the least harmfully contaminated kind of tobacco?
I propose that we use the power of economics and the market.
Here’s how it could work – there are a lot of variations.
Program Delivery
First: The clinic locates a lowest-cost source and buys the least-contaminated Roll-Your-Own (RYO) tobacco available, which is probably probably American Spirit Blue.
ASB is not organic but we tested this brand in cigarette form (see the data above) so we know what those pesticide contaminants are from hard data.
A good retail or online cost for a 5 Oz. can of American Spirit RYO will be around $30. 5 ounces of RYO will yield about 135 RYO cigarettes per can, so each cigarette will cost @ $0.22 each to make.
Many clinic clients will already know what American Spirit tobacco is but it’s likely that none can afford it or even find it for sale where they hang out.
It doesn’t have to be American Spirit – there is a much cheaper, down-home approach using whole organic tobacco leaf and a little machine that I’ll describe in another post.
It’s important to stay away from every other kind of RYO tobacco unless you find one clearly labeled “organic” because all the RYO tobacco I’m familiar with is very cheap stuff and is very likely as contaminated as cheap cigarettes themselves.
Next steps: The onboarding procedure can be kept simple.
Participation would be voluntary, just like a clean needles or condoms programs, and the same response to criticism is merited. Of course it would be better if people didn’t use IV drugs but access to clean needles is in everyone’s interests. Same with tobacco products.
There should be an orientation session during which fact-based explanations are offered of why the program is being offered and how it works.
The clinic can set registered clients up with a supervised place and provide the supplies for patients to roll their own using the provided RYO tobacco.
Cigarettes can either be hand-rolled by the patients and staff, maybe in a communal atmosphere like a morning coffee and rolling session. or a very simple $300 hand-turned rolling machine can be used that allows a person to crank out 20 cigarettes in minutes.
The Important step: Paying For The Program
Let’s assume that the program has to pay for itself, or at least partially do so.
Finances can be handled several ways, keeping in mind that the patients are currently paying at least $6 or so a pack, or $0.375 for 0.8 grams.
Plan A:The clinic could recover the full cost at $0.25 per one gram RYO cigarette which is half of what the clients are paying now on the street.
Plan B: Or the clinic can make the proposition irresistible to patients and charge $0.10/cigarette; or you can just charge nothing.
Plan C: Or, we may simply want to ask for a suggested donation of around half of what they’re currently spending on street tobacco rather than charging anything specific – it depends on the clinic’s finances and preferences.
The point is that even if a clinic served 100 patients at 20 cigarettes each a day at no charge that would mean 2000 cigarettes a day at a total cost of $500 a day or $5 a person to transition them away from the massive harm being done to them without anyone’s knowledge.
So a program serving 100 people would entail $15,000 if you were buying the RYO tobacco at retail. But let’s assume that the participants carry the program 100% by paying or donating $0.25 for each of the 20 hand-rolls in their daily allotment.
That would mean that other than administrative costs there would be few other expenses in running the program, and the participants would experience both health and economic benefits and maybe other positive things.
The Economic Impact On Patients
However they pay, or if they don’t pay, people should only be able to roll a limited amount at a time for personal consumption. That could rationally be set at 20 hand-rolled cigarettes a day – one pack.
Even if a patient is paying full price, or donating it, that $0.25 a cigarette is half what they are currently spending, so that’s money in their pocket. If they were paying $6 a pack and are now paying the equivalent of $3, they are way ahead. If they are paying nothing, they are $6 ahead.
However, one economic positive that could come out of the program even though it might not be formally recognized, is that if a person is allowed to roll themselves 20 cigarettes per day’s supply the reality is that they will probably only need ten of those, and will be able to make a little money by selling them on the street, which will add to the money they are saving by not buying commercial cigarettes.
If they are saving $3 a day buying or donating for 20 cigarettes at the clinic, and then also sell 10 of those to other people ( a knock-on tobacco harm reduction effect) at let’s say $0.50 each, then that’s another $5 in their pocket. So this harm reduction program could pay for itself and put at least $8 more a day in patients pockets while salvaging their expensive HIV/AIDS therapy.
I’m not talking about flooding the streets with hand-rolled American Spirit cigarettes, although that might make a wonderful conceptual art piece. I also don’t see too many legal objections to this (although anti-smokers will be venomous) since the tax has already been paid on the tobacco and the patients who sell some of their hand-rolled cigarettes are just adding value with a hand-rolling service for the buyer. If I buy apples and pay the tax and then slice them for people and sell those slices, maybe I need a vendors license technically but in this case … really?
The number of cigarettes involved in a program like this in the context of a city wouldn’t put a dent in the bodega sector’s revenues, but it could make a lot of financial difference for those in the program.
Summary
When you think about the money wasted on smoking prevention and cessation programs that don’t work, here is an idea that is simple and seems to have the potential to solve a very big problem because if it works in one place it can work virtually anywhere. If there are legal or regulatory issues raised, there are workarounds like having a physician prescribe the natural tobacco.
While it’s tempting to focus on positive health outcomes as the greatest potential benefit of this proposal, it’s important to realize that this program would also mean that every patient would immediately have more disposable income. Not big bucks but I personally know that sometimes three bucks is what you need. How people choose to their extra disposable income it is wide open, but getting rid of the cost of a pack of cigarettes a day could make a big difference in many patients’ lives.
Finally, my pretty extensive experience with natural tobacco is that most smokers, especially of cheap brands, will instantly say that it is a lot better smoke. Most smokers of conventional tobacco brands find American Spirit, which is 100% actual Tobacco, stronger and more like “what real tobacco should be”.
Fair Disclosure: This proposed harm reduction approach uses American Spirit Blue RYO tobacco for a specific set of reasons shown in the data and analysis above. I have no relationship of any kind with Santa Fe Natural Tobacco Company, the American Spirit brand, or any other tobacco company or product. I started the company and invented the brand but that was long ago and far away.
