for which a solution needs to be found, as nicotine is an
effective treatment in helping smokers to stop smoking
and is recognized as an essential medicine by WHO .
There is growing objective evidence that recreational
nicotine use, separated from smoking, is likely to be less,
not more, harmful than cannabis . In the United
Kingdom and the United States there is evidence that
nicotine delivery through electronic cigarettes is proving
acceptable and effective at population-level in helping
smokers to quit [14,15]. However, the traditional tobacco
advocates’ support for an abstention agenda, at its extreme,
is opposed not only to recreational use of nicotine but even
to its short-term use as a medicine to help smokers quit
, and continues to hold considerable sway, ignoring
the needs of the millions of smokers unable or unwilling
to quit their nicotine use.
Hall & Kozlowski conclude that it would be helpful for
advocates in both areas to talk to each other, and this is
certainly true. Public health advocates working on tobacco
are rightly concerned about the impacts of cannabis
legalization and the need to be cognizant of the public
health risks of creating a for proﬁt cannabis industry .
There are lessons to be learned from the experience of
tobacco about how to regulate cannabis effectively using
both supply and demand measures, as set out in the
international tobacco treaty and its guidelines .
However, the prohibitionist stance to nicotine taken by
many tobacco advocates makes it unlikely these lessons will
be heeded by those advocating the legalization of cannabis.
Declaration of interests
ASH receives funding for its programme of work from the
British Heart Foundation and Cancer Research UK.
Keywords Cannabis, legalization, nicotine, prohibition,
public opinion, regulation, smoking.
Action on Smoking and Health, London, UK
Submitted 21 July 2017; ﬁnal version accepted 22 August 2017
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THE DIFFERENT OUTCOMES OF LEGISLATIVE-
VERSUS ADVOCACY-LED DEVELOPMENT OF
While tobacco control and cannabis reform may appear to
be divergent phenomena, in many cases thinking is
converging around similar regulatory models which seek
to minimize social and health harms. The origins of
policymaking processes for cannabis reforms in the
United States can inﬂuence outcomes, with government-
led processes more likely to prioritize public health than
activist and industry-led ballot initiatives.
It is certainly the case that the groupings driving the two
policy positions identiﬁed by Hall & Kozlowski , cannabis
legalization and nicotine prohibition, have different sets of
priorities. The nicotine prohibitionists overwhelmingly pri-
oritize public health while, among US cannabis reformers,
© 2018 Society for the Study of Addiction Addiction, 113,602–609