According to CDC data 480,000 U.S. people died due to tobacco use last year, including 41,000 due to second-hand smoke. If the Feds and the states can’t reduce those numbers, maybe towns can!
The town of Brookline, MA on July 19, 2021 became the first U.S. town to ban the selling of all nicotine products to anyone born after January 1, 2000 in hopes of producing the first tobacco-free generation (TFG). (1) This “birth-date phaseout law” leaves those who are already addicted (or nicotine-dependent, if you prefer) free to continue their flirt with premature disease and death. Advocates of the ban call it a “generational firebreak”. The Brookline ban includes e-cigarettes (vapes) which often contain nicotine and are known to entice young users into smoking cigarettes. The adjacent towns of Melrose, Stoneham, and Wakefield are considering doing it as well. New Zealand and UK have passed such bans, BUT only on combustible nicotine products; vapes and chews are still available there.
In 1964 the U.S. Surgeon General, Dr. C. Everett Koop (remember that very tall guy in a uniform with a tidy, trimmed beard?), successfully promulgated that smoking cigarettes was dangerous to your health. In 1992 U.S. Congress banned sale of cigarettes to anyone under 18 yrs. Tobacco use costs the U.S. more than $300 billion annually in health care costs and lost productivity.Several states have successfully sued tobacco companies for compensation of their taxpayers’ money spent on health care for people who smoke. In 2021 Congress raised the cigarette selling ban age to 21 yrs. In 2024 we have the first towns passing TFG laws.
The legal challenges by tobacco retailers in Massachusetts stating that the ban illegally pre-empted the federal law limiting sales of tobacco to those over 21 yrs., and also that the ban was discriminatory under the “equal protection of the the law clause” in the state constitution, was dismissed by the Massachusetts Supreme Judicial Court in October 2022. “This is an important day for myself, my family, my neighbors, and my state,” said Katharine Silbaugh, a Brookline resident, a co-sponsor of the law, and a professor of law at Boston University, “This decision secures the right of Massachusetts towns to protect their residents’ health by phasing out the sale of tobacco.”.
In the meantime, treatment for nicotine addiction continues; most successfully through combinations of medical Nicotine Replacement Therapy (NRT), cognitive behavioral therapy (CBT), and support groups. NRT can include prescribed tablets of Bupropion (Wellbutrin) or Varenicline (Chantix) , OTC nicotine skin patches, nicotine gum. lozenges, or even an inhaler or nasal spray. About 75% of people who try to cease smoking without some medical help (NRT) stop trying after about a week because of withdrawal symptoms..
Future prevention and treatment modalities may include “nicotine vaccines” that cause the development of antibodies that block the nicotine from reaching the receptors in the brain that release the very pleasing dopamine molecules which is the basis of the nicotine dependency. RJK, Jr. need not worry currently about adding this to his anti-vaccine band wagon because I couldn’t find any journal articles after 2013.
TMS, Transcranial Magnetic Stimulation, has received FDA “market clearance” as safe, but is not yet approved as effective, for the treatment of resistant depression. TMS is just beginning to be studied in treating addictions. However, the treatment involves multiple weekly visits to a physician’s office for treatment time of “wearing a tinfoil hat”.
Massachusetts is a bit unique (for a variety of reasons) but one of them is that Massachusetts did not past new laws during the pandemic, like some states did, which limited the authority of town Departments of Health to regulate mask use, quarantines, closures, etc. during the pandemic. In those states that did pass those laws, towns may not have the authority to pass TFG regulations like in Massachusetts. Until the federal government and state governments do for nicotine use and gun safety what they have accomplished for automobile safety, maybe we should be looking more to our towns for the action needed to advance our public health regarding nicotine use.
1. Silbaugh, et.al. Toward a Tobacco-free Generation – A Birth Date-Based Phaseout Approach. NEJM 390:20 May 30, 2024, pg. 1837-9.
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