Both cigarettes and opioids have a high potential for addiction and death. Profiteering companies sell both substances based on science that has been skewed by spin or outright lies.
Both have been challenged for multibillion-dollar sums of money.
Opioids, on the other hand, are not like cigarettes.
And, as the opioid settlements near the conclusion, it’s critical not to apply tobacco-related lessons incorrectly.
Fundamentally, this involves acknowledging that, unlike cigarettes, opiates have legitimate purposes in pain and addiction treatment.
But, so far, we’ve been doing the exact opposite.
Rather than acknowledging that opioids help certain people with intractable pain, we continue to restrict access— often without providing affordable and effective alternatives.
We routinely abandon patients in withdrawal rather than understanding that eliminating “pill mills” and detecting “doctor shoppers” leads them to deadly street drugs rather than recovery.
Instead of accepting that prescription opioids (usually buprenorphine or methadone, but some nations use heroin) are the best therapy for opioid addiction—the only one proven to reduce death rates by 50% or more—we predominantly promote abstinence-based treatment.
Understanding where the parallel between painkillers and cigarettes makes sense—and where it doesn’t—can help policymakers make smarter decisions.
First, unlike cigarettes, cutting off the supply of opioids can kill rather than cure.
In a recent study published in JAMA, researchers looked at dose decreases in persons who had been using opioids for at least a year.
These reductions were believed to reduce the danger of overdosing.
Opioid decrease, regardless of how rapidly or slowly medicines were weaned, almost increased the risk of patients overdosing.
These individuals had more than twice the chance of hospitalization for psychiatric issues, including suicide attempts, when compared to those whose dosages were stable.
These findings are backed up by previous studies.
Patients who had their doses abruptly reduced were nearly four times more likely to commit suicide, according to one study.
Another research of veterans found that abruptly stopping opioids increased the chance of suicide by a factor of seven for those who had been using them for a long time.
Because five to eight million Americans use opioids for chronic pain, these figures suggest that many of today’s overdoses and suicides may be the result of our efforts to address the epidemic.
Quitting smoking, on the other hand, increases life expectancy (though it can sometimes increase depression in vulnerable populations).
Despite this, our anti-Big Tobacco policies have not included making cigarettes illegally inaccessible to current smokers.
Indeed, regulators recognized that outright banning cigarettes—or making them available only through increasingly difficult-to-obtain prescriptions—would create a massive and dangerous underground market.
Opioids were not treated with the same caution. Prescriptions have decreased by at least 60% since 2011, owing to increased prescription-monitoring databases and prosecution of “pill mill” doctors.
Even genuine doctors were terrified to drop chronic pain patients, as well as anyone else who might be hooked, as a result of the crackdown.
This, predictably, resulted in a windfall for dealers, whose wares, unlike legal pharmaceuticals, are unregulated and vary greatly in dosage and quality.
As a result of the decrease in prescriptions, overdose deaths more than doubled, hitting a new high of more than 93,000 in 2020.
Anti-opioid crusaders, on the other hand, have dug in their heels, continuing to draw incorrect conclusions from tobacco’s history.
Just like Big Tobacco lied about cigarettes, Big Pharma misled opioid advantages.
As a result, they argued, any favorable statements about opioids should be quashed, and the medical supply should be reduced even more.
This method obscures important information about addiction that is important for prevention and therapy.
For starters, most opioid addictions do not begin with medical treatment.
Eighty percent of persons who start misusing prescription opioids receive them from friends, relatives, or other unlawful sources rather than from doctors, and nearly all of those who become hooked had already used cocaine or methamphetamine.
Furthermore, most addictions begin in adolescence or early adulthood, with 90 percent of cases beginning as experimentation.
Chronic pain, on the other hand, is more likely to strike in the middle or later life.
According to a review co-authored by the head of the National Institute on Drug Abuse, fewer than 8% of persons who take opioids long-term for pain develop new addictions.
In contrast, the age group that receives the most opioid prescriptions—those over 65—has the lowest prevalence of addiction and overdose. (And no, Big Pharma did not sponsor this research, even though they exploited part of it dishonestly.)
It’s tough to deter drug-seeking teenagers by inflicting pain on Grandma.
Policies focused on reducing the number of remaining tablets provided for acute pain, as well as enabling secure storage for needed medications, make sense.
However, our current method of lowering chronic pain prescriptions has failed.
While caution is advised when extrapolating tobacco policy to opioid policy, the settlements do provide one apparent warning lesson: make good use of the money.
Cigarette companies have already paid out $246 billion, but nearly all of it goes to state general funds.
In the fiscal year 2021, for example, less than 3% of the $27 billion budget is dedicated to smoking cessation and prevention.
To improve, we must specifically target opioid money and use them wisely.
This entails shifting away from cutting supplies and toward assisting.
First, doctors must be able to continue prescribing opioids to people who are already on them without fear of losing their license or their freedom if they do it responsibly.
Millions of “legacy patients,” as well as future patients who have exhausted all other alternatives, require a legal safe refuge to avoid being killed by dose decreases intended to save them.
Second, persons suffering from addiction require better treatment: arrest or removal from medical practices on suspicion of drug abuse is not treatment.
Instead of sending people to restrictive clinics, doctors should be authorized to lawfully prescribe methadone or buprenorphine on the spot when they detect opiate addiction.
Furthermore, no government or insurance-funded rehab should refuse to provide drugs or degrade them.
To summarise, settlement cash should be spent on proven, effective care rather than prescription monitoring and enforcement.
Despite their risks, there is now no alternative to these medications. While a world without smoking is great, a world without opioids is a world in which people suffer.
THE AUTHOR IS : Maia Szalavitz is a journalist and author or co-author of seven books. Her latest, New York Times best seller Unbroken Brain: A Revolutionary New Way of Understanding Addiction, was published in April 2016 by St. Martin’s Press.