The most fatal, addictive drugs in the world are nicotine and tobacco. Worldwide, nicotine deaths are double the totals from alcohol and illicit drugs combined. In Massachusetts, more than 9,300 people die annually from nicotine use, plus an additional 1,000 from secondhand smoke.

Every day, more than 250 of Massachusetts’ residents turn 21. If these grim statistics do not change, 28 of them will eventually die of nicotine, well before their time. We need a way to end this curse. Nicotine-Free Generation (NFG) is an endgame strategy that can overcome enormous political opposition to efforts to eliminate this menace.

The NFG policy uses a birth date to set a limit on retailers’ ability to sell nicotine products. NFG prevents the creation of future demand for nicotine by preventing sales to anyone born after the designated birth date. Users who currently are legally sold nicotine are not affected.

Twenty-six Massachusetts cities and towns have shown the political will to enact Nicotine-Free Generation. These communities have a combined population of nearly 700,000, larger than Washington, D.C., and two states. After public input, most of which is favorable, local boards of health choose a birth date (typically 21 years ago) and a future implementation date (often the next Jan. 1). Health officials provide licensed nicotine dealers with appropriate signage and repeated education. Overall, compliance has been very good.

The NFG policy is endorsed by the 23,000-member Massachusetts Medical Society and nationally by the American Medical Association.

The state’s highest court has allowed localities to enact NFG. Some other states allow local governments to set stricter guidelines for sales of dangerous drugs; other states prohibit local options.

There are other benefits to a Nicotine-Free Generation besides saving thousands of lives, if that is not enough.

State budgets are bursting with ever-increasing healthcare costs, which account for a substantial share of Massachusetts’ budget. Reducing disease and deaths from nicotine addiction will contain some of those costs year after year.

This is why cigarette taxes are important. In Massachusetts, a pack of Marlboro averages $14.86. In 365 days, a one-pack-a-day smoker spends $5,423.90.

This money could help young people pay for education, recreation and all kinds of necessities. Some kids become addicted as early as middle school, and many others in high school before age 18. However, peer pressure from older nicotine users encourages the juvenile brain to ignore health warnings.

Of course, the tobacco industry has its defenders.

In public hearings, convenience store lobbyists insist their clients deserve to profit from nicotine sales, in preference to all other vendors. Their sense of entitlement over other local merchants is disturbing. Most do not think about the fatalities their sales cause.

Some people claim that there is “a right to smoke.” However, drug addiction is the opposite of free choice. The Massachusetts court rejected arguments that young people have a right to choose to get addicted.

Though cigarette use is down overall, that ignores the continued use of vapes, pouches and other nicotine products among young people.

Lobbyists can be creative in inventing falsehoods. NFG never burdens police officers or other law enforcement. Only boards of health enforce tobacco regulations, and this is strictly a civil matter. Sales violations might be subject to a fine and a possible short license suspension. Vendors are part of our communities, and we want their businesses to keep thriving by selling safe products.

Regarding enforcement: Purchasing, using or possessing nicotine products is not a violation of these municipal policies. This was important in crafting the language so that NFG could never be confused with alcohol prohibition in the 1920s.

Massachusetts led the way in banning flavored tobacco sales and in raising the age of sales from 18 to 21. A Democratic legislature passed bipartisan legislation, and a Republican governor signed it. Soon after, a bipartisan Congress also passed legislation raising the age to 21, and President Trump signed it.

Though cocaine and heroin were effectively banned in America more than a century ago, addictive nicotine remains legally available almost everywhere. The Nicotine-Free Generation policy offers an effective, if gradual, endgame strategy that will save thousands of lives yearly.

_____

ABOUT THE WRITERS

Ken Elstein is serving his seventh year on the Belchertown (Mass.) Board of Health as vice chair. Belchertown was an early adopter of Nicotine-Free Generation. He wrote this for InsideSources.com.

Richard Lopez is a retired primary care physician and is serving his sixth year as the chair of the Reading (Mass.) Board of Health. Reading was an early adopter of Nicotine-Free Generation. He wrote this for InsideSources.com.

_____

©2026 Tribune Content Agency, LLC