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June 20, 2017

Tobacco, 20 Years Later: What leadership can do for public health

by: Joseph F. Rice

Twenty years ago today, June 20, 1997, the announcement of the historic Master Settlement Agreement reached between more than two dozen State Attorneys General and the nation’s four largest tobacco producers was announced in Washington, D.C. Death and disease by tobacco was running rapidly out of control in our country in the 1990s, impacting millions. It was considered to be the largest public health issue of that time.

A small band of courageous Attorneys General sought to make a difference and raise awareness on tobacco’s effect on the American people. Attempts to pass legislation addressing the issue had not been successful, so these public officials sought instead to enforce applicable laws already on the books in our country. I had the privilege of working with these Attorneys General, led by Mike Moore of Mississippi, Christine Gregoire of Washington, Robert Butterworth of Florida, Richard Ieyoub of Louisiana, Scott Harshbarger of Massachusetts, Heidi Heitkamp of North Dakota, among others. Their efforts made an immeasurable difference in the public health of this country and undoubtedly saved lives. For that, we all owe them a debt of gratitude. 

Prior to the Master Settlement Agreement, the smoking rate among American high schoolers was estimated to have exceeded 36 percent. Today, that number is reported to be less than 8 percent and dropping. The litigation aimed to prove that tobacco was an addictive drug, and those who started smoking at a young age were often hooked for life. By combatting targeted ad campaigns aimed at marketing tobacco to children, this litigation helped prevent children from picking up the habit and the addiction. Our nation’s public health related to tobacco diseases is the better for it.

The collective progress we’ve made to reduce tobacco use among youth was thought unattainable and unimaginable at the time. Unfortunately, a significant part of our population has been left behind. The less educated, underemployed, uninsured, underinsured, and rural communities largely have not benefitted as widely from these control measures credited with stemming the tobacco problem. While more work needs to be done, it was the courage of these Attorneys General to get out front and make a difference and start addressing a large social problem that spearheaded the vast improvements we have made.

Confronting the Opioid Crisis Today

Today, we face a new crisis that is arguably the worst health crisis since tobacco as drug overdose deaths in the U.S. are at an all-time high. The numbers are staggering. As many as 65,000 people died from drug overdoses in the U.S. in 2016, an estimated 19 percent increase compared to the 2015 death toll, the New York Times reported. The rise is largely attributed to the rampant use of highly addictive opioid prescription painkillers. More than two million Americans are estimated to be dependent on the drugs, with an additional 95 million having reported using the painkillers in the past year, according to the New York Times report. Compare that to the roughly 36.5 million people the CDC reported were current cigarette smokers in 2015.

The need for action to limit the destruction caused by opioid addiction grows more pressing by the day. Looking back, it’s clear to me that the tobacco litigation offers some insights into the fight in front of us, the first being that our public officials can hold great power to battle such a massive issue.

Though similarly driven by addiction, opioid use may begin with a prescription for a painkiller but then can lead to a deadly descent into addiction and abuse of illegal drugs, including heroin. The issue touches all demographics, so much so that you can’t pick up any newspaper or magazine today without reading about death as a result of opioid addiction and its consequences.

That said, despite the desire to compare the two crises, tobacco and opioid are also very different, and particularly in that tobacco is a legal drug and the opioid crisis started with one but has exponentially expanded beyond that.  

While tobacco-related deaths have declined, opioid related deaths are drastically on the rise. Unless something is done very soon, deaths and addiction will only continue to rise.

A Lesson Learned

As we learned in the tobacco litigation, we need a unified plan of action if we are going to address the opioid problem. The battle has started, led by the county of Santa Clara and the City of Chicago who first filed litigation in 2014 working with our now firm partner and former AG of the District of Columbia, Linda Singer.

Today it is encouraging to recently see more states, counties, cities and other entities stepping forward to play a significant role against this epidemic affecting our country. But on their own, they can only address their specific areas. In order to effect change across the board, we need courageous leaders nationwide who are willing to join together to make a concerted effort and affirmative steps to ensure that this problem is brought under control very soon. It must include leaders from all areas, particularly including government and elected officials, but also including the manufacturers, physicians, pharmacies, addiction experts, treatment centers, and many many others.

I hope to be able to write a blog in not so many years that talks about the drastic decline in the abuse and deaths related to opioid drugs. That will only be possible if those in power and those with authority take action. Working together with our clients, we at Motley Rice intend to do everything we can within the civil justice system to help find, fund and implement a solution to this public health crisis.