0 Committee on Substance Abuse

Hazards of Clove Cigarettes

In recent years, the development of a dangerous of eugenol in the body, and the short- and long- fad in which young people use clove cigarettes as term health consequences of eugenol generally are an alternative to conventional cigarettes has oc- unknown at this time. Furthermore, the common curred in several areas of the United States and smoking technique of “toking” (deep inhalation and Canada. Many users have the mistaken belief that prolonged retention of the smoke in the respiratory clove cigarettes are an herbal, “natural,” nonto- tract) may allow for more contact and absorption bacco alternative. Others are attracted to their use of all of the ingredients of the clove cigarette.3’4 because of the association of clove cigarettes with In 1984 and 1985, the US Centers for Disease the image of surfing, New Wave music, and the Control received 11 case reports of acute respiratory search for “exotic” and unusual experiences. system injury in adolescents and young adults, in- More than 170 million clove cigarettes were sold cluding two deaths that occurred in close temporal at the height of their popularity in 1984, and sales association with smoking clove cigarettes. The were still averaging more than 40 million per year acute pulmonary effects included hemoptysis, bron- in 1985, 1986, and i987.’ This is even more chospasm, hemorrhagic and nonhemorrhagic pul- remarkable when one considers that a significant monary edema, pleural effusion, respiratory insuf- portion of the consumers are under the legal age of ficiency, respiratory infection, and aspiration of purchase and that these sales have been achieved foreign material.3 0 without the assistance of overt advertising. Indeed, The precise role of the eugenol versus the potent a recent report of California youth in the 10th grade effects of tobacco is unknown. However, the re- showed that 23% had tried clove cigarettes at least ported cases may represent only those who are most once. Furthermore, one third of those, approxi- sensitive to clove cigarette constituents. Many mately 8.5%, had used them at least once per other young people report similar but less signifi- month.2 cant symptoms.35 Clove cigarettes are imported from Southeast The hazards of chronic long-term use of clove Asia, principally from Indonesia, and are composed cigarettes are unknown because they have not been of approximately one third shredded cloves and two studied systematically during a long period of time. thirds tobacco. The type of tobacco in a clove However, it is reasonable and prudent to assume cigarette delivers approximately twice as much tars, that they are, at the very least, just as dangerous nicotine, and carbon monoxide as does tobacco in and harmful as unfiltered tobacco cigarettes. In ordinary American cigarettes.1 addition, the long-term dangers from the inhalation In addition, substantial amounts of eugenol, an of eugenol and other chemicals in the cloves are anesthetic agent, are found in cloves and in the simply not known, but they do represent a potential smoke of clove cigarettes. The typical clove ciga- further risk. rette smoker inhales approximately 7 mg of eugenol Another area of concern is the possible associa- per clove cigarette. The extent of the body’s ab- tion of clove cigarette smoking and subsequent sorption of eugenol into the lungs, the distribution marijuana use.3’4’7 Clove cigarettes should be sus- pected as a gateway drug because of their properties

This statement has been approved by the Council on Child and and the manner in which they are smoked. Because Adolescent Health. the eugenol in the clove cigarette acts as a topical The recommendations in this publication do not indicate an anesthetic to the posterior oropharynx, it reduces exclusive course of treatment or serve as a standard of medical the noxious elements of smoking. Thus, it may care. Variations, taking into account individual circumstances, facilitate the learning of smoking techniques, both may be appropriate. 0 PEDIATRICS (ISSN 0031 4005). Copyright © 1991 by the regular inhalation and the deep inhalation toking American Academy of Pediatrics. technique used in marijuana smoking. In addition,

Downloaded from www.aappublications.org/newsPEDIATRICS by guest on September Vol. 88 27, No. 2021 2 August 1 991 395 the aroma and mystique of the use of clove ciga- Manuel Schydlower, MD rettes have made them very popular among those Benjamin 0. Stands, MD nondrug-using adolescents who are seeking to be Jonathan M. Sutton, MD accepted by and participate in the experiences of a Milton Tenenbein, MD 0 drug-using peer group.3’4 Liaison Representative Dorynne Czechowicz, MD, Na- CONCLUSIONS AND RECOMMENDATIONS tional Institute on Drug Abuse 1. The American Academy of Pediatrics (AAP) Section Liaison alerts pediatricians to the possible use of clove Conrad Andringa, MD, Section cigarettes by young people in their practices and on School Health to the health consequences of such use. 2. Clove cigarettes are tobacco products and have REFERENCES the same potential for producing all of the path- ologic effects associated with tobacco smoking. 1. US Department of Commerce, Bureau of the Census, Trade Information Section. Health Hazards of Cloves Cigarettes 3. Clove cigarettes are without health benefits, and (Tariff Schedule Number 1706300). Report to the California the health risks of smoking them, in addition to Legislature prepared by the Office of Environmental Health those caused by tobacco, include lung injury in Assessment, California Department of Health Devises, Oc- tober 1988 susceptible individuals, bronchospasm in those 2. Robinson TN, Killen JD, Taylor CB, et al. Perspectives on with a history of asthma or other respiratory adolescent substance use. A defined population study. diseases, hemoptysis, and the potential for pul- JAMA. 1987;258:2072-2076 3. Guidotti TL, Binder 5, Stratton JW, Schechter FG, Jenkins monary aspiration. RA. Clove cigarettes: development of the fad and evidence 4. In keeping with the goal of a tobacco-free society for health effects. In: Hollinger MA, ed. Current Topics in by the year 2000, the AAP urges its members to Pulmonary Pharmacology and Toxicology. New York, NY: Elsevier; 1987;2:1-23 maintain awareness and to educate their pa- 4. Guidotti TL, Laing L, Prakash UB. Clove cigarettes: the tients and their families about the hazards of basis for concern regarding health effects. West J Med. clove cigarettes. 1989;151:220-228 5. Centers for Disease Control. Illnesses possibly associated with smoking clove cigarettes. MMWR. 1985;34:297-299 COMMIrFEE ON SUBSTANCE 6. Council on Scientific Affairs. Evaluation of the health haz- ABUSE, 1990 to 1991 ard of clove cigarettes. JAMA. 1988;260:3641-3644 7. Dupont RL. Getting Tough on Gateway Drugs: A Guide for Albert W. Pruitt, MD, Chairman the Family. Washington, DC: American Psychiatric Press; Edward A. Jacobs, MD 1985

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Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 1991 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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