It is difficult to imagine a more devastating scourge on our communities than the long-festering, and now full-blown opiate epidemic. In addition to the heartbreaking loss of life, tracking at about one death per day across the state, thousands of our family, friends and neighbors are battling the physical, mental, emotional, social and economic harms of opiate addiction.

The situation is complex, and there are many contributing factors. Accordingly, there is no one easy solution. Maine lawmakers have struggled to agree upon one and fund a comprehensive path forward.

But sometimes, solutions can hide in plain sight.

Gov. Paul LePage and the Maine Legislature might be surprised to learn that one of the most effective policy interventions for preventing new cases of opiate addiction is sitting right in front of them. It’s called Tobacco 21, and it is part of this story because, behind every opiate addiction, there is almost always nicotine.

Tobacco 21 is the nickname for a bill (LD 1170) that the Legislature passed overwhelmingly a few weeks ago. It would raise the age at which tobacco products can be purchased to 21 years old. The bill’s fate, like the fate of thousands of Maine youth who could potentially be spared a lifetime of addiction, will be decided on Wednesday, Aug. 2. That’s the day we’ll know if the governor has allowed Tobacco 21 to become law, or if the Legislature will be called upon to affirm or override his veto.

What’s the link between nicotine and opiates?

Our nervous systems are wired something like electrical circuits. One of these circuits prompts us to repeat behavior which is reinforcing, or fun. The circuit is driven by a natural chemical signal called dopamine. This system is hugely beneficial, unless it becomes hijacked by an environmental chemical like nicotine.

Nicotine is the highly addictive drug in tobacco products. When nicotine reaches the brain, it causes the release of dopamine, which in turn signals the conscious part of the brain to find more nicotine. And with that, addiction has begun.

Adolescents are particularly vulnerable to addiction because their brains are still developing until about age 25. And because adolescence and young adulthood are critical periods of growth and development, exposure to nicotine and other drugs may have lasting, adverse consequences on brain development.

The parts of the brain most responsible for decision making, impulse control, sensation seeking, and susceptibility to peer pressure continue to develop and change through young adulthood. As a result, nicotine exposure during adolescence may result in impaired attention and memory, problems with learning, reduced self-control and anxiety.

Addicted brains have long-term altered circuits. Dopamine receptors shut down, meaning more of the drug is needed to have the desired effect, which in the case of opiates is just to “feel normal.” Our brains are literally changed with the use of addictive substances like nicotine.

Perhaps most significantly, scientists have affirmed the “gateway” hypothesis – that drug use most often occurs in a sequence, starting with legal drugs like tobacco and alcohol and proceeding to illegal drugs. Research concludes that cigarette smoking is a significant predictor of later drug use. Data from the National Survey on Drug Use and Health shows that cigarette use is significantly associated with subsequent abuse of prescription opioids among 18-25 year olds. Overall, nearly nine in 10 current heroin users are current smokers. Similarly, the majority of cocaine users are smokers.

We know that nearly all smokers (95 percent) start before the age of 21. You can be sure that tobacco companies are experts on addiction, including the particular risk to younger brains. Why are cigarettes the size they are? Because the amount of nicotine in one standard cigarette is just exactly enough to occupy every nicotine receptor in the brain. Why are there 20 cigarettes in a pack? Those receptors reset themselves and put the smoker into withdrawal 20 times a day, requiring another cigarette to prevent withdrawal. Tobacco is the only consumer product which, when used as directed, will make you addicted and kill you.

Although all drugs with the potential to cause addiction make use of the dopamine circuit, nicotine has a special place on the wall of shame. Tobacco is the drug with the highest likelihood of full-blown addiction from a single use. Keeping tobacco products out of the hands of youth and young adults gives them their best shot at living a life free of addiction and the poor health and early death that it almost always leaves in its wake.

Discouraging early tobacco use should obviously be a public policy priority. Increasing the age for purchasing tobacco products serves the purpose of addressing addiction of all types. Maine lawmakers would be wise to take advantage of the opportunity that is before them on Au.t 2 and say “yes” to Tobacco 21.

Arthur Dingley, JD, DO, is physician specializing in psychiatry at Franklin Memorial Hospital and the lead physician at Franklin Health Behavioral Services in Farmington.

It’s called Tobacco 21, and it is part of this story because, behind every opiate addiction, there is almost always nicotine.

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