As New Jersey and other states consider settlements with Purdue Pharma and other pharmaceutical companies for their aggressive and misleading marketing of opioids, how our state handled another crisis provides a cautionary tale — one that we ignore at our own peril.
Just look back to 1998. After years of litigation over the marketing, sale and harmful effects of tobacco, New Jersey and 45 other states, the District of Columbia and five U.S. territories entered into a landmark agreement with the four largest tobacco companies. This agreement, known as the Master Settlement Agreement (MSA), imposed far-reaching restrictions on how tobacco products could be marketed and sold. The settlement required Big Tobacco to pay billions of dollars to the states in perpetuity to offset the costs they incurred as a result of the harmful effects of tobacco products.
The settlement contained well-thought-out provisions designed to eliminate the once prevalent marketing schemes targeted at young people: the use of cartoon characters, advertising outside of tobacco retail stores, and, perhaps most perniciously, offering flavored cigarettes. The MSA also created a tobacco prevention research entity, the Truth Initiative, to focus on preventing teen smoking and encouraging smokers to quit.
Yet here we are 21 years later and New Jersey, along with the rest of the nation, faces an unprecedented rise in youth nicotine addiction. A 2019 report from the National Institute on Drug Abuse called the increase in e-cigarettes, or vaping, the largest ever recorded for any substance in the 44 years the Institute has tracked adolescent drug use. A 2019 American Lung Association report cited a 78% rise in e-cigarette use by high school students from 2017 to 2018. More than 1 million more kids began using e-cigarettes just last year.
This public health crisis seems to have caught public officials and the public in general off guard. But the signs of the emerging crisis were there for all to see. Vaping companies aggressively marketed their “safer” products to young people with candy and mint flavors in campaigns that harken to the early days of Big Tobacco. Many of the tactics used to nurture and grow the vaping market are identical to the ones used to ensnare prior generations of young people into a life of nicotine addition.
How did this happen?
Because we took our eyes off the ball. Despite the promise of billions of tobacco settlement dollars annually — intended to combat smoking, especially in our youth, and to address the effects of smoking-related illness — New Jersey used precious little of this money for these intended purposes. We did not provide effective enforcement and oversight over the marketing of nicotine products by the new Big Tobacco.
Instead, we used this income stream to plug state budget shortfalls. New Jersey was not alone. The Campaign for Tobacco Free Kids says in FY 2019 states will collect $27 billion from the MSA and tobacco taxes; but will spend just 2.4 percent of it on smoking prevention and cessation programs. In fact, just four states follow the U.S. Centers for Disease Control and Prevention recommendation to spend 50 percent of the MSA funds on tobacco control.
To make matters worse, New Jersey securitized — sold off — its future MSA proceeds to gain a short-term cash infusion. As a result, we no longer receive annual payments from the MSA. Of the tobacco taxes that we do receive, which total almost $1 billion each year, New Jersey spends a scant 7% percent on tobacco control efforts.
Before New Jersey enters a global settlement on opiates, what lessons can we take from the Tobacco MSA failure?
First, any opioid settlement must include strong, on-going enforcement mechanisms that provide restrictions on marketing, sales, and distribution of opiates by everyone in the supply chain. Next, we need to make sure that states are bound to use the money to support prevention, as well as the most effective treatment and recovery programs for those suffering from substance use disorder.
Moreover, we need to provide a mechanism to ensure that the settlement funds continue to be directed toward those services year after year to build a sustainable mental health and substance use disorder treatment system. Finally, like the MSA, a settlement should create an independent consumer research and public health entity that is funded from the settlement proceeds and works with numerous constituencies to keep the issue in plain sight and to make sure we don’t take our eye off the ball again
Linda Schwimmer is president and CEO of New Jersey Health Care Quality Institute.