tocacco plant Native American Tobaccoo flower, leaves, and buds

tocacco Tobacco is an annual or bi-annual growing 1-3 meters tall with large sticky leaves that contain nicotine. Native to the Americas, tobacco has a long history of use as a shamanic inebriant and stimulant. It is extremely popular and well-known for its addictive potential.

tocacco nicotina Nicotiana tabacum

tocacco Nicotiana rustica leaves. Nicotiana rustica leaves have a nicotine content as high as 9%, whereas Nicotiana tabacum (common tobacco) leaves contain about 1 to 3%

tocacco cigar A cigar is a tightly rolled bundle of dried and fermented tobacco which is ignited so that its smoke may be drawn into the mouth. Cigar tobacco is grown in significant quantities in Brazil, Cameroon, Cuba, Dominican Republic, Honduras, Indonesia, Mexico, Nicaragua, Sumatra, Philippines, and the Eastern United States.

tocacco Tobacco is an agricultural product processed from the fresh leaves of plants in the genus Nicotiana. It can be consumed, used as an organic pesticide, and in the form of nicotine tartrate it is used in some medicines. In consumption it may be in the form of smoking, snuffing, chewing, dipping tobacco, or snus.


Tobacco bans spark anger

From Wednesday, April 1, the organisation — which serves nearly one million residents of the city’s north and west and provides a range of specialist services to all Victorians, including but not limited to mental health — will introduce a smoking ban across all indoor and outdoor areas at its premises.

These include Orygen Youth Health, one of the country’s leading mental health services for young people. From Wednesday the high proportion of Orygen’s patients who smoke will no longer be able to light up outside its doors, as they have been accustomed to doing, using a courtyard. they will have to go outside the gates. For involuntary patients, detained without their consent for the treatment of a significant mental health problem, this won’t be an option.

While smoking bans in public places, particularly hospitals and other health facilities, have been sweeping the globe in recent years, preventing mental health patients from smoking is controversial.

This was dramatically illustrated last week after The Sydney Morning Herald reported NSW Health was moving ahead with a ban in all its psychiatric centres, despite vehement objections from some front-line mental health workers.

Over the next few days a patient wrote to the paper to say smoking areas were the happiest places in the hospital and the plan “shows ignorance of the reality of survival in a psychiatric ward”. “The road to recovery from mental illness is hellish enough without the burden of giving up a smoking addiction,” the patient wrote.

A doctor wrote to denounce the plan as “deplorable”, adding that smoking was the main means for such patients to ease anxiety and it was “clearly not the time in their lives to introduce intransigent non-smoking rules that only escalate their agitation”.

According to NSW Health, the newspaper got it wrong: no blanket smoking ban is being introduced. Instead, the department is providing guidelines to health services on how they should go about preparing for and implementing a ban, should they choose to do so.

A similar approach is being taken in Victoria, where Melbourne Health is exercising its discretion to introduce a ban. Other health services in the state are free to allow smoking in non-enclosed spaces..

But it’s nevertheless true that even the whisper of a smoking ban in mental health centres puts the cat among the pigeons. Other states have been watching the NSW ruckus with interest; South Australia says it has no plans to introduce a ban, and in Western Australia, where smoking bans have been in place in all state-run hospitals and health services since January 2008, the new Health Minister has promised to review the measure in relation to mental health facilities, in the light of concerns raised by some workers.

In Queensland, smoking has been banned at state-run health facilities except in nominated smoking sites, with one such site permitted at each facility, provided they are outdoors, at least 4m away from the doors and out of public view, among various other requirements.

Health experts acknowledge the issue is fraught with ethical dilemmas, but most come down in support of smoking bans — provided they are introduced with sufficient planning and support is provided to smokers to enable them to cope.

Mike Daube, a former director-general of WA Health and an international tobacco control expert, says the main claims by those who oppose smoking bans are that they can foster aggression, add unnecessary stress at an already difficult time in a patient’s life and needlessly deny them what is sometimes a rare source of pleasure.

“The response is that you don’t ban everything overnight,” says Daube, now a professor of health policy at Curtin University.

“You phase it in — you provide all the supports that people with mental health problems want in quitting. There’s good evidence that they want to quit.”

Part of the opposition, Daube says, comes from the fact that staff in mental health facilities are themselves more likely to smoke. Besides, some of them use cigarettes to reward good patient behaviour.

He says it’s telling that the mental health charity SANE Australia is “campaigning passionately” for smoking to be banned in mental health centres, on the grounds that it’s good for smokers’ health and, besides, the rights of non-smokers not to be assailed by fumes should be respected.

Dan Lubman, associate professor of addiction psychiatry at the University of Melbourne and Orygen Youth Health, says it’s important to remember that out of about 4000 chemicals in tobacco smoke, at least 43 are known to be carcinogenic, and “smoking causes a lot of harm”.

People with mental problems are two to three times more likely to smoke than the general population, and among people with more serious disorders such as schizophrenia, smoking rates can be between 70 and 90 per cent, he says.

“Tobacco smoking has been an area of neglect within mental health, because despite these high rates, we know most of the excess mortality associated with schizophrenia, excluding suicides and accidents, relates to cigarette smoking and the consequences of that. People with schizophrenia have twice the rate of lung cancer as the general population, and as a group, people with major mental disorders die at a greater rate than the general population, and at a much younger age — many from illnesses for which smoking is a major risk factor.

“The evidence is that when people with mental health problems are asked, they do want to stop smoking — but they are often not given the opportunity, or support.”

On the other side of the argument, he says it has been suggested that smoking can improve cognitive function in people with schizophrenia and that it may also combat depression by blocking an enzyme called monoamine oxydase B, involved in the breakdown of chemicals that regulate mood.

However, most, including Lubman, feel that is too slender a counterweight to the push to wean patients off tobacco.

Patrick McGorry, executive director of the Orygen Research Centre, says the physical health problems of people with mental health issues are “massive” and banning tobacco is “an excellent idea”.

“But it’s got to be presented to people in the context of looking after their holistic health,” McGorry says. “Obviously it has to be done in a humane way; there has to be support for their withdrawal symptoms.”

He says this is easily done with nicotine-replacement therapy, such as patches.

Orygen has been preparing for the April 1 ban for some time. Staff in the intensive care ward have been trained in nicotine replacement therapy, and there have been talks by experts from the local Quit program.

And despite fears of an increase in violent incidents, Orygen staff say experience from other places where smoking bans have already been introduced — such as the Alfred Hospital — suggest this will not happen. In fact, there may even be a drop in such incidents. Once smoking is banned, smokers are no longer trying to wheedle cigarettes from each other, and — provided replacement therapy is provided — are not worrying about where the next nicotine hit is coming from.

SANE’s Barbara Hocking says she can “understand the concerns” from those opposed to a ban, but people with mental health problems should have the same rights as other Australians, including the right of non-smokers to a smoke-free environment.

“I think the key thing is, if any change is to be made it has to be made in a very planned and thoughtful way, because there’s a lot of fear about.”


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