180,000 – that is the number of people who already have died in 2018 from tobacco-related causes. Opioid overdose deaths – 64,000 in 2017 – understandably continue to be a focus of public concern about substance use disorders. What continues to amaze me, however, is how comparatively little focus there is on the continuing toll taken by what is by far the deadliest addiction – tobacco. Data from the Center for Disease Control about tobacco deaths is staggering:
- 480,000 deaths per year – 1,300 deaths every day – in the United States
- For every person who dies because of smoking, at least 30 people live with a serious smoking-related illness
- Worldwide, tobacco use causes nearly 6 million deaths per year
I was recently reminded of this discrepancy while giving a presentation at the 2018 Maryland Tobacco Control Conference. My presentation, given at one of the breakout sessions, was the only one at the conference that addressed tobacco as an addiction rather than a public health behavior problem. Conversely, when I go to addiction conferences, sessions that focus on tobacco are rare. Professional groups that focus on tobacco or substance use disorders are not the only groups where tobacco as an addiction gets little attention.
The most stunning “looking away” from tobacco deaths is found in the recovery support community. Untreated tobacco addiction is one of the causes of the shortened lifespan of recovering alcoholics. And yet, my patients regularly find support for their disinclination to stop their tobacco use from members of the recovery community who warn them – without evidence to support their claim – that such a step could undermine their recovery from their “drug of choice.”
Outpatient rehabilitation treatment, assisted by medication, would benefit patients with tobacco use disorder. Insurance companies, however, refuse to pay for any treatment other than medication. At the same time, however, they freely spend on the medical consequences of tobacco addiction a multiple of what rehabilitation would cost. This mirrors the pre-1970’s policy toward alcohol addiction. If we ever see a similar shift for tobacco, many lives would be improved, and the insurance companies would see an economic benefit.