Smoking. Smoking is a practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have been rolled into a small square of rice paper to create a small, round cylinder called a cigarette. Smoking is primarily practiced as a route of administration for recreational drug use because the combustion of the dried plant leaves vaporizes and delivers active substances into the lungs where they are rapidly absorbed into the bloodstream and reach bodily tissue. In the case of cigarette smoking these substances are contained in a mixture of aerosol particles and gases and include the pharmacologically active alkaloid nicotine; the vaporization creates heated aerosol and gas into a form that allows inhalation and deep penetration into the lungs where absorption into the bloodstream of the active substances occurs. In some cultures, smoking is also carried out as a part of various rituals, where participants use it to help induce trance-like states that, they believe, can lead them to spiritual enlightenment. Smoking generally has negative health effects, because smoke inhalation inherently poses challenges to various physiologic processes such as respiration. Diseases related to tobacco smoking have been shown to kill approximately half of long-term smokers when compared to average mortality rates faced by non-smokers. Smoking caused over five million deaths a year from 1990 to 2015. Smoking is one of the most common forms of recreational drug use. Tobacco smoking is the most popular form, being practiced by over one billion people globally, of whom the majority are in the developing countries. Less common drugs for smoking include cannabis and opium. Some of the substances are classified as hard narcotics, like heroin, but the use of these is very limited as they are usually not commercially available. Cigarettes are primarily industrially manufactured but also can be hand-rolled from loose tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs, and bongs. Smoking can be dated to as early as 5000 BCE, and has been recorded in many different cultures across the world. Early smoking evolved in association with religious ceremonies; as offerings to deities, in cleansing rituals or to allow shamans and priests to alter their minds for purposes of divination or spiritual enlightenment. After the European exploration and conquest of the Americas, the practice of smoking tobacco quickly spread to the rest of the world. In regions like India and Sub-Saharan Africa, it merged with existing practices of smoking. In Europe, it introduced a new type of social activity and a form of drug intake which previously had been unknown. Perception surrounding smoking has varied over time and from one place to another: holy and sinful, sophisticated and vulgar, a panacea and deadly health hazard. In the 20th century, smoking came to be viewed in a decidedly negative light, especially in Western countries. This is due to smoking tobacco being among the leading causes of many diseases such as lung cancer, heart attack, COPD, erectile dysfunction, and birth defects. The health hazards of smoking have caused many countries to institute high taxes on tobacco products, run ads to discourage use, limit ads that promote use, and provide help with quitting for those who do smoke. Main article: History of smoking The history of smoking dates back to as early as 5000 BCE in shamanistic rituals. Many ancient civilizations, such as the Babylonians, Indians and Chinese, burnt incense as a part of religious rituals, as did the Israelites and the later Catholic and Orthodox Christian churches. Smoking in the Americas probably had its origins in the incense-burning ceremonies of shamans but was later adopted for pleasure, or as a social tool. The smoking of tobacco, as well as various hallucinogenic drugs, was used to achieve trances and to come into contact with the spirit world. Substances such as cannabis, clarified butter, fish offal, dried snake skins and various pastes molded around incense sticks dates back at least 2000 years. Fumigation and fire offerings are prescribed in the Ayurveda for medical purposes, and have been practiced for at least 3,000 years while smoking, dhumrapana, has been practiced for at least 2,000 years. Before modern times these substances have been consumed through pipes, with stems of various lengths or chillums.