We’re not in an opiate addiction epidemic by accident. The map was drawn decades ago as our nation’s manufacturing jobs began to disappear. At the same time, the independent actions of prescription drug companies, physicians, pain clinics and savvy heroin traffickers aligned on a collision course. Some of the players were completely well-meaning, some malicious and some ambivalent, but the resulting maelstrom created the perfect growing conditions for human suffering and addiction, including the loss of health, hope, community, connectivity and stability.

The complex factors behind the opiate addiction epidemic make simple solutions elusive. We know we need more treatment options for those seeking detoxification and recovery. We know we can and must do more to prevent harm and overdose for those who are currently misusing opiates and not yet in treatment. And we know we can’t arrest our way out of the problem.

But what about prevention? How do we give our young people the tools, resiliency and protections they need to avoid falling into the swamp of addiction? For that, we must take an honest look at the connection between nicotine and opiates, because until we confront the former, we will never conquer the latter.

Like all addictive drugs, nicotine harms the brain. It rewires our responses to pleasure and pain, and because the human brain is not fully developed until about age 26, younger brains are more at risk than older brains. The last part of our brain to fully mature is the frontal cortex, which is the decision-making, stress-handling part of our brains, so this “executive function” can be permanently diminished.

A study published in the April 2014 edition of the New England Journal of Medicine tested the “gateway” hypothesis. This is the theory that drug use most often occurs in a sequence, starting with legal drugs like tobacco and alcohol and proceeding to illegal drugs.

In this journal article, the authors affirm this hypothesis for nicotine. They conclude: “Nicotine acts as a gateway drug on the brain, and this effect is likely to occur whether the exposure is from smoking tobacco, passive tobacco smoke or e-cigarettes.”


Ever wonder why the tobacco companies bother to make cigarettes in candy flavors, like grape and mocha? It’s because 95 percent of smokers start smoking before they turn 21. And the ages of 18 to 21 are a critical period when many smokers move from experimenting to smoking daily.

The evidence is overwhelmingly clear that early use of nicotine leads to brain changes that result in a much higher risk of tobacco addiction as well as misuse of and addiction to other drugs, including opiates.

Even ignoring the risk of multi-drug addiction, tobacco takes a tremendous toll on Maine communities. An estimated 2,400 adults die each year from their own smoking and about 27,000 kids today will ultimately die prematurely from smoking. Of all cancer deaths in Maine, 29 percent are attributable to smoking. Health care costs directly caused by smoking total $811 million every year — a huge weight on our state’s already overburdened health care system.

Knowing all this, the conclusion for policymakers is obvious: We need to do everything we can to delay the age at which young people first experiment with or begin regular use of tobacco. If we can keep cigarettes, cigars, chew and vaping products out of the hands of kids and young adults, we are giving them the best possible chance of avoiding poor health, early death and the financial cost of tobacco addiction.

As we struggle as a state to cope with the opiate addiction epidemic, every day counts because every day, people are dying. This week, the Maine Legislature returns to the State House to finish their work for the session. One of the votes they will be taking is whether to sustain or override the governor’s veto of Tobacco 21 (L.D. 1170, sponsored by Sangerville Republican Sen. Paul Davis), which would raise the age at which tobacco products can be purchased in Maine to 21 years old.

Affirming Tobacco 21 won’t change the underlying factors that created the opiate addiction crisis. And it won’t change Maine’s need for more treatment, less shame and more hope in our communities, but it will give our youth a fighting chance to mature in good health and live productive lives, free from tobacco, opiate or other addictions.

Maine lawmakers should jump at the chance to pass Tobacco 21.

Dylan McKenney, M.D., is a physician specializing in child and adolescent psychiatry at St. Mary’s Hospital in Lewiston and president of the Maine Association of Psychiatric Physicians.

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