When the medical community makes mistakes, it’s like shooting down a few hundred airplanes every year. That’s a dramatic metaphor that has stuck in my mind since I first heard it from a doctor, and an apt way to describe a pathological marketing system that allows companies to push dangerously addictive drugs to the public, and to doctors. It could describe both the mistakes of opioid makers and the emerging problem of nicotine addiction through vaping.

Starting in the 1990s, drugmakers encouraged the term “opioids” to replace the scarier term “narcotics,” as they began aggressively marketing a new set of painkillers. Opioids were once reserved for people with terminal conditions, such as cancer, but an influential 1986 paper started a trend toward opioid use as a “humane” way to treat other painful conditions. By 2014, U.S. doctors wrote a staggering 245 million prescriptions for opioids. Meanwhile, while teen smoking rates have plummeted, vaping among teens is soaring: 20.9 percent of high school students surveyed in 2018 admitted to vaping, up from 11 percent in 2017.

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