Smoking continues to be one of the leading causes of preventable illness and death in Pakistan. Each year, an estimated 160,000 to 170,000 people die from tobacco-related diseases, including lung cancer, heart disease, stroke, and chronic respiratory conditions. Millions more live with long-term disability caused by smoking, creating a heavy burden on families and the nation’s healthcare system. Hospitals across the country regularly treat cancers and cardiac conditions that could have been prevented by quitting tobacco.

Public health experts stress one clear message: quitting smoking is the most effective way to reduce health risks, regardless of age or duration of smoking. Yet, despite widespread awareness of its dangers, many smokers struggle to stop, with high rates of relapse even among those who try repeatedly. Understanding why smoking is so addictive is key to tackling Pakistan’s tobacco crisis.

While nicotine is often blamed for smoking-related disease, the true danger lies in tobacco combustion. Burning cigarettes produces smoke containing hundreds of toxic chemicals, including arsenic, benzene, carbon monoxide, polycyclic aromatic hydrocarbons, and tobacco-specific nitrosamines. These substances damage blood vessels, scar lung tissue, and trigger cancers in multiple organs. It is this mixture of harmful chemicals, not nicotine itself, that makes smoking deadly.

Nicotine’s role is different: it drives addiction. This explains why smokers continue despite knowing the risks. Major health authorities, including the US Food and Drug Administration, confirm that while nicotine fuels dependency, it is the other chemicals in smoke that cause cancer, heart disease, and lung damage.

Large clinical studies support this distinction. The US Lung Health Study, which tracked thousands of participants over more than ten years, found that nicotine replacement therapies such as gum and patches did not increase cancer risk, whereas continued smoking remained strongly linked to illness and death.

However, confusion persists. Research in Pakistan shows that many healthcare professionals still associate nicotine directly with cancer and chronic disease. Misunderstanding the difference between nicotine addiction and smoking-related harm can affect public health messaging, policy decisions, and clinical advice.

Quitting remains critical. Nicotine is addictive, and its use is not risk-free. But separating the roles of addiction and disease helps explain why stopping is difficult and why smoking is lethal. Combustion kills, nicotine hooks. Recognizing this distinction is essential to reducing the devastating toll of smoking in Pakistan.