Opioid and tobacco deaths

Why are people all upset about opioid deaths but relatively quiet about tobacco deaths. From Wiki, I get that the latter outnumber the former by a factor of 8 (about 480,000 a year to 60,000). I grant that tobacco generally kills mostly older people, but even so this attitude seems odd. Incidentally, I was astonished when I read those numbers, both of them.

It is because tobacco kills mainly at an old age, plus tobacco overdoses are virtually non-existent. People using tobacco don’t end up deteriorating until they can’t hold job or take care of themselves (not this happens to all opioid addicts), and they primarily purchase their tobacco legally without contributing to greater criminal activity involved in the distribution (although there is some crime involved with tobacco to avoid taxes). Smokers may get cranky when they don’t have cigarettes but they don’t turn to more addicting and dangerous drugs to deal with it.

So there may be arguments for legalizing opioids in the comparison to tobacco, but the situation regarding deaths from the two substances are nowhere near alike.

In what world are people (relatively or otherwise) quiet about tobacco deaths?

Despite the significant harms and blantant duplicity of the tobacco industry, nobody is calling for an outright ban on tobacco products. It has just recently (in the last fifteen years) become politically feasible to restrict their use in public facilities in industrialized nations. While the Master Settlement Agreement of 1998 significantly limited the ability of tobacco companies to advertise and market their products in domestic markets and forced them to open up decades of archives of fraudulent marketing and scientific research, the only real impact was to cause them to shift their market focus to the developing world where they promote their products as openly today as they did in the 1950s here in the US to a population that is largely uneducated about the harms. And the global tobacco-related health crisis looms: see the [URKL=http://www.who.int/tobacco/mpower/mpower_report_tobacco_crisis_2008.pdf]World Health Organization 2008 Report on the global health crisis of tobacco and yet, there is no organized drive to restrict or phase out tobacco sales.

In addition to tobacco largely impacting people in later middle age to old age (and some not at all), opioid misuse can rapidly affect people at any age and devastate entire communities. However, unlike tobacco, opioids have genuine medical uses and the backlash against prescribing opioids for chronic pain conditions has had attendant impacts. Pharmaceutical companies get blamed for promoting opioid prescriptions for profit, which is probably somewhat justified, but the attempt to set restrictive guidelines that are nonetheless ambiguous, and penalties to physicians whose patients misuse or overdoes on opioids have been severe even when the physician had good reason to prescribe the medication. Nonetheless, production and distribution of opioids by legitimate sources remains high.

The real point, however, is that while the tobacco epidemic was precipitated by marketing, the opioid epidemic appears to be linked to socioeconomic crises, striking economically depressed states in which mining and manufacturing industries are faltering. Unlike crystal methamphetamines and crack cocaine, it didn’t start with or largely confine within previously depressed socioeconomic groups, and the conventional methods of drug abatement (e.g. attacking criminal distribution networks, interdiction methods, long mandatory sentences for distributors, confiscation of properties through asset forfeiture) is even more unlikely to make a serious impact than it has on previous drug epidemics. So it appears to be a dramatic, and quickly developing problem in previously stable communities (which no doubt included the general distribution of tobacco users).

The lack of proportionality is akin to how Islamic terrorism is seen as a vast threat worthy of going trillions of dollars into debt to fight, even though the greatest immediate and largely preventable hazards to American citizens are coronary and respiratory disease, accidental deaths (automobile, household and vocational), diabetes, firearm-related homicides, and suicides, and yet, we spend a tiny fraction of our GDP addressing the causes of all of these combined while the number of people killed by acts of terrorism this century is essentially a rounding error of preventable deaths.


Having worked in the drug rehab industry this boils down to two main reasons:

  1. Opiod abuse is spiking way, way up, whereas tobacco use is trending way, way down.

  2. Opiod abuse leads to quick addiction and a quick death…with a lot of pain and torture in-between. Tobacco abuse is a much longer process to the eventual death, and the pain in-between doses is much less.

How come?

OP’s question: A large part of it is familiarity and people being irrationally afraid of what’s unknown to them. Think of the different reactions someone who unwinds after work with beer would get vs someone who drinks shroom tea.

Tobacco kills people in their 70s but opioids kill people in their teens, 20s and 30s.

Another reason is that a person addicted to tobacco can still function in society and hold on to a job (almost always).
Opioids not only destroy the addict’s ability to function in society, but it is a showstopper for holding many jobs. The consequences for opioid are, as other posters have mentioned, more immediate and severe in the short term.

All the answers are reasonable, but it still bothers me. An even more striking example of people’s inability to reason about risk is that the chances of dying in a terrorist attack are nearly infinitesimal, while the chances of dying in an auto accident are not. I believe that even in the month of Sept., 2001, nearly as many people were killed in auto accidents than in the terrorist attack.

It is incorrect to say that smoking became popular through marketing. Smoking has been popular for centuries in the Americas and exploded into Europe in the 16th century via the Spanish. The tobacco companies took an already popular habit and ramped it up via additives.

The reasoning is that auto accidents are just that, accidents. Those killed on 9-11 were intentionally killed. People as a group can accept that life has risks and that we take them every day, but somehow we think we can stop deliberate acts of murder.

There’s just so much money involved with opioids now, we should all be screaming louder. Our taxes pay for a lot of the opioids that are handed out like candy then our taxes pay for the medical staff and EMTs to deal with all those overdoses. Now, the senate wants to spend $54 BILLION dollars on the problem. A lot of people are already making a lot of money manufacturing and selling the opioids. Now a lot of people are going to make a whole lot of money with vague treatments that barely meet the letter of some Federal guideline.