Anxiety, withdrawal, the illegal market - smokers tell their stories, and psychiatrist warns against ban

Dr Mike West, a psychiatrist from Cape Town, warned against the decision

01 May 2020 - 14:05 By Unathi Nkanjeni
Not allowing cigarettes to be sold legally during the lockdown could result in disastrous consequences of acute, forced and involuntary nicotine withdrawal for smokers.
Not allowing cigarettes to be sold legally during the lockdown could result in disastrous consequences of acute, forced and involuntary nicotine withdrawal for smokers.
Image: 123rf.com/marcbruxelle

The government's u-turn on cigarette sales could result in disastrous consequences of acute, forced, involuntary nicotine withdrawal, warns psychiatrist Dr Mike West.

On Wednesday, cooperative governance and traditional affairs minister Nkosazana Dlamini-Zuma prohibited the sale of cigarettes during the nationwide lockdown.

The announcement came less than two days before the initial ban on tobacco was supposed to be lifted during SA’s level 4 lockdown on Friday.

Dlamini-Zuma backtracked on the initial announcement made by President Cyril Ramaphosa, citing several reasons, including health issues.

Capetonians spoke out about the ban on cigarettes announced by minister of co-operative governance & traditional affairs Nkosazana Dlamini-Zuma on April 29 2020. This comes less than a week after president Cyril Ramaphosa announced that cigarettes would be back on shelves across the country when the Covid-19 lockdown level is eased to level 4 on May 1 2020.

Severe withdrawal consequences

West, who is a  psychiatrist based in Cape Town, warned about nicotine withdrawal, saying it can lead to physical, mental and emotional symptoms.

“These include coughing, headaches, fatigue, insomnia and constipation. These usually resolve in a week but are followed by other symptoms including depression, anxiety, irritability and cognitive impairment, which gradually diminish over several weeks,” he told TimesLIVE.

He said if tobacco abstinence is forced on people without their buy-in, smokers will stop smoking but will almost always restart smoking when they have access to cigarettes again.

“It is worth mentioning that reducing the supply of a drug, or banning the sale or possession thereof, has never and will never help people quit. It hasn’t worked in 100 years and it won’t work in another 1,000 years.

“Even worse is that people were not given time to prepare themselves, and there have been mixed messages and inconsistencies about whether or not cigarettes are permitted to be sold.”

West said while smokers are always more at risk of negative health outcomes for any respiratory disease, there was no evidence that a history of smoking increased a person’s likelihood of contracting Covid-19.

“The data is not yet sufficient. Smokers may touch their mouths more often, but that emphasises the need to wash hands.

"There is also no evidence to connect e-cigarette use and Covid-19, and this is an actively researched area. If you are going to ban cigarettes, you should at least provide smokers with an alternative,” said West.

'I mistrust government' - Melinda Ferguson

Speaking to TimesLIVE, five smokers, including author and publisher Melinda Ferguson, explained what effects the ban had on them.

Ferguson, a recovered drug addict  who started smoking again after 10 years, said she mistrusts government, and the u-turn “makes me wonder how many more promises will be broken”.

"For me the issue here is the government breaking its word,” she said.

“The president announced that tobacco would be available in level 4, but this was withdrawn on the basis of 2,000 people being against the decision while close to a million people signed petitions to have tobacco unbanned.”

The petition, started by Bev Maclean, was started when smokers were given one day's notice of the ban ahead of the lockdown on March 27.

By noon on Friday, it had garnered more than 452,000 signatures, with the number increasing by the minute.

“This makes me question who the government is listening," said Ferguson.

“I am a recovering addict so I know about withdrawals. I am also someone who stopped smoking for 10 years and then started again.

“For me, the psychological withdrawals are much worse right now. We have so few crutches at the moment, and I battle to understand why the government is being so punitive .”

Four other smokers, who spoke to TimesLIVE on condition of anonymity, also weighed in on the issue.

'I suffer from anxiety and smoking helps that' 

A 58-year-old, who is an admin manager, said she started smoking at the age of 34 while divorcing her abusive, alcoholic husband.

“I smoke Peter Stuyvesant. I suffer from anxiety and this law is affecting my mental health. I can't concentrate. I am worried about not being able to purchase cigarettes so my anxiety is just getting worse,” she said.

She said Dlamini-Zuma's reasoning was not substantial, and she has since turned to the black market for cigarettes.

“I don't believe it is because of the spread of Covid-19. I have now turned to the illegal cigarette market because I need something,” she said.

'I am buying smokes illegally' 

A 62-year-old, who also buys cigarettes illegally, said: “Smoking is the only thing keeping me sane.

“I don't go out and I don't share cigarettes. I am buying tobacco products illegally now because I need my fix. I am already on edge and I can't imagine how I will control my emotions if I don't have this.”

'It has tested whether or not I'm addicted'

Another smoker, a 27-year-old radiologist, questioned the worthiness of  buying cigarettes now.

“Since the announcement of lifting the cigarettes ban, I honestly felt relief because I didn’t have to find out whether or not I was really addicted to smoking.

“For the past few weeks, I’ve been getting them at very high prices in back doors, but now with the ban in place again, I wonder if buying them at such a ridiculous price is worth it. What is more scary is finding out if I’ll crave them once they are not available.”

'Coping mechanism'

A 25-year-old content creator, who has been smoking for eight years, said she was not against the ban but as a smoker, it was “taking a toll” on her due to the cravings.

“I use smoking as a coping mechanism to deal with my anxieties. Now I have to find a new coping mechanism that can help me.

“I do buy cigarettes from the black market even though they are not what I usually smoke. I was looking forward to buying cigarettes, legally, on Friday but that's no longer happening.”


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