During a minor operation, Salim Twagiramungu had to be injected with more dose of morphine because the normal dose could not keep him from feeling  painless throughout the circumcision.

The surgeon demands to know whether Twagiramungu drinks alcohol or even smokes, and true to his expectation, Twagiramungu is a heavy tobacco smoker and also drinks a lot of beer.

"Cigarette smoke contains more than 4,000 chemicals, of which forty-three are known to cause different abnormalities and deviations from normal body function,” Twagiramungu quotes the surgeon as saying. According to the surgeon, alcohol and tobacco decrease the user’s perception of pain and alters his or her reaction to pain.

Immediate effects include cessation of pain, drowsiness, and a feeling of well-being associated with pain reduction. And with consistent use, they build up in the brain and block the production of endorphins; the brain’s natural pain killing chemicals.

Although one initially chooses to use all these for pleasure and fun, there is a compulsive use which results into a chronic illness of the brain called an addiction.

The user must replace the missing endorphins with narcotics in order to feel good and to avoid painful circumstances and with time they become dependent on increasing amounts of the drug and the abuse usually leads to dependence.

That is why Twagiramungu needs an extra doze of marphine to ‘survive’ the operation.

"The effect is even worse if one uses narcotic drugs like marijuana and opium,” says Dr. Edgar Kalimba of King Faisal Hospital, Kigali. He reveals that narcotics behave like endorphins even more and act on or bind to the receptors of the brain to produce their associated effects.

"Narcotics like heroin and opium bind to certain pain killing sites in the brain and the biochemical effects of such narcotic drugs are what make them addictive,” he says.

According to the doctor, such drugs are closely associated with impaired function and interference in the daily life of the user. As he puts it, users often develop serious physical, social, and mental health problems that compromise well-being and affect family and friends.

The body quickly builds a tolerance to narcotics because a state of euphoria or feeling of extreme well being is developed.

Scientists have attempted to develop ways to use the pain-killing properties of narcotics while counteracting their addictive qualities.

Such investigations have led to the discovery of substances known as narcotic antagonists that block the actions of narcotics and are used to reverse the side effects of narcotic abuse.

"Some drugs have been developed so that patients can be relieved of pain without the addictive or other unpleasant side effects associated with narcotics,” reads in part a report on the substantial health hazards associated with smoking.

According to the report, smoking causes about 21 percent of all deaths from heart disease, 86 percent of deaths from lung cancer, and 81 percent of all deaths from chronic lung disease. For these reasons, the importance of smoking cessation extends beyond the health benefit of the smokers themselves.

"Effective interventions include the provision of advice to quit by a health care provider, the provision of behavioral counseling, and medications,” Agatha Kaitesi, a Kigali based councilor said.

A broader public health approach increases quitting by changing societal norms around tobacco use and increasing the motivation and support for people to attempt to quit.

"Every person who uses tobacco should be offered at least brief advice to quit smoking because failure to do so becomes a reason for smokers to assume justification,” said Kaitesi.

According to Kaitesi, more intensive counseling like individual, group, and telephone counseling are even more effective and should be provided to all tobacco users.

"A pregnant woman who is a heavy smoker and unable to quit should consult her physician about the possible use of medication,” Kaitesi recommends.

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