The goals of tobacco control endgame strategies are
specified in terms of the desired levels of tobacco use
and/or tobacco related health consequences. Yet the
strategies being considered may have other
consequences beyond tobacco use prevalence, forms and
related harms. Most of the proposed strategies threaten
to create large black markets with potential attendant
harms: corruption, high illegal earnings, violence and/or
organised crime. Western societies of course have
considerable experience with these problems in the
context of prohibition of drugs such as cannabis,
cocaine, heroin and methamphetamine. These
experiences suggest that low prevalence has been
achieved only by tough enforcement with damaging
unintended consequences. Tobacco prohibition (total or
partial) may not present the same trade-off but there is
little basis for making a projection of the scale, form and
harms of the attendant black markets. Nonetheless,
these harms should not be ignored in analyses of the
endgame proposals.