DV Journal

Gambling generates big bucks in Pennsylvania, and Gov. Josh Shapiro’s budget proposal counts on it generating even more.

Gamblers spent a record $6.1 billion in Pennsylvania last year, creating $2.7 billion in state revenue.

Another thing easy access to gaming creates? Addiction.

Pennsylvania has the fourth-highest gambling addiction problem, according to a new study from WalletHub. As might be expected, Nevada, home of gambling Mecca Las Vegas, takes first place, followed by South Dakota and Montana. Mississippi ranks fifth.

Gambling disorder or compulsive gambling affects between 1-3 percent of all U.S. adults. “Gambling can stimulate the brain’s reward system much like drugs such as alcohol can, leading to addiction,” according to the Mayo Clinic.

In 2024, Americans lost approximately $172 billion through legal gambling, according to industry estimates. That figure includes losses from casinos, sports betting, online gaming, and lotteries. America’s commercial gambling industry generated $71.92 billion in revenue,

Philadelphia psychologist Julian Katz sees a lot of people who are addicted to gambling. He believes the ease of online gambling drives his patients’ addiction.

“What causes it is the accessibility,” he said. “You can take your phone and access it 24/7. It’s a growing problem.”

Katz added, “It can destroy lives,  not just the life of the gambler but everyone in their circle,” including spouses, children and friends.” He’s seen gamblers who write bad checks or sell their family heirlooms to get money to continue. Gambling addiction can lead to divorce, or losing a house and car. The effect on the gambler’s family is “heinous,” he said.

The good news is that talk therapy can help, along with groups like Gamblers Anonymous, he said.

Pennsylvania’s Compulsive and Problem Gambling Treatment Fund receives .002 percent from the combined revenue of casino, iGaming, sports wagering and fantasy sports, or $2 million, whichever is greater, according to Doug Harbach, communications director for the state Gaming Control Board. Another $3 million goes to the Department of Drug and Alcohol Programs, which helps with compulsive gambling, along with drug and alcohol addiction.

His department does not oversee the state lottery, a separate agency. The lottery saw $1.22 billion in profits for fiscal year 23-24, the 13th consecutive year that profits exceeded $1 billion. Proceeds from the lottery go to programs to help senior citizens. Looking for more revenue, Shapiro and the state legislature are eying taxes on games of skill, which have been installed in bars, restaurants, and gas stations.

Debra Cohen, a spokesperson for the American Gaming Association (AGA), declined to comment on WalletHub’s findings.

A 2024 Connecticut study found problem gambling for adults remained at 1.4 to 1.8 percent even after the state launched legal sports betting and iGaming. A 2022 Indiana study found 1.3 percent to 2.3 percent of that state’s residents met the clinical threshold for gambling disorder.

Chip Lupo, a WalletHub analyst, said, “Gambling addictions can destroy lives the same way that alcohol and drug addictions can. While some people may be able to enjoy casual gambling from time to time, others need to avoid temptation altogether. People with a gambling addiction may find it helpful to live in states where places to gamble are less prevalent and laws against betting are stricter.”

Katz believes the problem is only getting worse.

“I don’t think we’re anywhere near where this is cured or fixed,” Katz said. A problem gambler’s best chance of recovery is “self-exclusion” to make sure they can’t go to their favorite gambling apps or casinos, he said.

The Problem Gambling Helpline is: 1 (800) GAMBLER or (1(800) 426-2537.

The Biden administration’s 11th-hour proposal to force tobacco manufacturers to slash nicotine levels — made just days before President Biden’s exit — was viewed as a political stunt by many public health officials.

Meanwhile, tobacco reduction experts like Jed Rose, the head of the Rose Research Center, say the opportunity for real progress in the fight to get more Americans to stop smoking is on the horizon. More science is needed and more accurate information provided to the public.

It starts with understanding why people smoke.

“Smokers don’t just value the nicotine in their bloodstream,” Rose said, referring to the chemical behind the addiction. “There are sensory cues that become pleasurable to smokers. People who get IV feedings do not feel their hunger satisfied. Likewise, a smoker wants to smoke a cigarette to feel satisfied.”

Rose knows what he’s talking about. More than 40 years ago, he fell into a career working on smoking cessation by accident when he took a temporary job while awaiting a fellowship connected to his doctorate in learning processes underlying anxiety.

In the 1980s, he was named the lead inventor of the nicotine skin patch, along with his physician brother Daniel and the late Murray Jarvik. Rose says he’s studied the most effective strategies for smokers who want to quit.

(Spoiler alert: cold turkey is not one of them, Rose says.)

It turns out, Rose says, the old saw about quitting smoking cigarettes being harder than quitting hard drugs isn’t too far off the mark.

“It’s a really difficult question: Why it’s so much harder to quit smoking,” Rose said. “On a behavioral level, smoking actually helps people to behave more normally. It helps you concentrate better on tasks, helps thinking, reduces anxiety under stress. It enables people to feel they can cope more normally in life. That is harder to give up than ‘feeling high’ such as you get with cocaine.”

Rose was involved in the development of the medicine varenicline, commercially known as  Chantix, which the National Institutes of Health indicates has an effective rate of 40 percent to 60 percent in helping people quit smoking.

Throughout the years, Rose’s research has focused primarily on developing practical tools to help people quit smoking. Giving smokers nicotine replacement methods to wean themselves away from nicotine in cigarettes is only part of the equation. It is essential to replace the sensory and behavioral aspects of smoking with less harmful substitutes.

That’s why it’s so confounding that health regulators keep throwing up roadblocks against electronic delivery devices that research shows improve the likelihood that a person will quit smoking traditional cigarettes.

“It takes more than nicotine to address the addiction,” Rose said. “It’s the feeling of inhaling something. There’s a holistic approach. It’s not just substituting nicotine or another drug but also the behavioral substitution.”

The Food and Drug Administration has approved several pharmaceutical products for nicotine replacement therapy, such as skin patches, chewing gum and lozenges. There are also nicotine sprays and inhalers.

FDA’s population modeling shows that stopping smoking by reducing nicotine in cigarettes is predicated on a 67 percent increase in the use of non-combusted nicotine products as off-ramps from cigarettes.

The day after publishing the cigarette nicotine reduction standard, the FDA authorized 10 flavors of a nicotine pouch product as a less harmful alternative for adults who smoke.

For those looking for a non-drug approach, the FDA has blessed companies to market transcranial magnetic stimulation (TMS) in which a magnetic coil held over one’s head delivers magnetic pulses to the brain. TMS can be used to treat obsessive-compulsive disorders, depression and addictions such as smoking.

However, the agency has authorized marketing only for a limited number of heat-not-burn devices or other electronic delivery systems such as e-cigarette cessation — despite evidence from Rose and other researchers showing they can get smokers to quit.

In February 2024, Nancy Rigotti published an editorial in the New England Journal of Medicine calling on U.S. public health agencies and the medical community to recognize the value of electronic cigarettes. She based her opinion on comments on research done in Switzerland, which found that study participants who had access to e-cigarettes were more likely to abstain from traditional cigarettes than those who received just smoking-cessation counseling. A recent independent review of the evidence by the Cochrane Library concluded that e-cigarettes were more effective than traditional nicotine replacement methods such as the nicotine patch or gum.

“It is now time for the medical community to acknowledge this progress and add e-cigarettes to the smoking-cessation toolkit,” Rigotti wrote. “U.S. public health agencies and professional medical societies should reconsider their cautious positions on e-cigarettes for smoking cessation. The evidence has brought e-cigarettes to a tipping point. The burden of tobacco-related disease is too big for potential solutions such as e-cigarettes to be ignored.”

However, unintentional and intentional misperceptions about e-cigarettes are rampant, and Rose said the FDA, which regulates such products, is doing little to correct the record. The results are devastating: Surveys show that 80 percent of smokers mistakenly believe that e-cigarettes are just as harmful or even worse than traditional cigarettes.

“Many smokers will not avail themselves of products that can save their lives because nobody is correcting their misperceptions of e-cigarettes,” he said. “It’s costing lives.”

A lawsuit filed recently in Philadelphia reads like it was ripped from the headlines about President-elect Donald Trump’s secretary for health and human services nominee, Robert F. Kennedy Jr., who has long warned about America’s unhealthy eating habits.

The suit, filed by Morgan and Morgan on behalf of Bucks County resident Bryce Martinez, holds a long list of prominent American food suppliers responsible for his health conditions. Martinez suffers from fatty liver disease and Type 2 diabetes, and he says Kraft Heinz, General Mills, and Post, among others, are responsible for his poor dietary decisions.

The lawsuit blames the companies for selling “ultra-processed foods (UPF)” that are “chemically modified, combined with additives, and then reassembled using industrial techniques.”

These UPFs “are alien to human experience” and “have come to dominate the American food environment and the American diet,” the suit claims. Compared to less processed foods, UPF are addictive and linked to many diseases.

“The story of ultra-processed foods is an egregious example of companies’ prioritizing profits over the health and safety of the people who buy their products,” said Morgan and Morgan partner Mike Morgan. “The consequences of these companies’ alleged actions have allegedly harmed thousands of children and families. Executives at the defendant companies have allegedly known for at least a quarter-century that ultra-processed foods would contribute to illnesses in children, but these companies allegedly ignored the public health risks in pursuit of profits.”

Attorney Renee Rocha said, “The defendants allegedly maximized their profits at the expense of the health of American children. These companies allegedly use the tobacco industry’s playbook to target children, especially Black and Hispanic children, with integrated marketing tie-ins with cartoons, toys and games, along with social media advertising. Our goal is to hold these companies responsible for their alleged efforts to make ultra-processed foods as addictive as possible and get them into the hands of children.”

Since the consumption of UPFs has risen since the 1980s, there’s been “an explosion in obesity, diabetes, and other life-changing chronic illnesses,” the suit said.  Diseases formerly found in “elderly alcoholics” like Type II Diabetes and Fatty Liver Disease are now found in children, the suit said.

The suit accuses Big Tobacco of taking over the food industry and using its “cigarette playbook” to deploy “the same kind of brain research on sensory perceptions, physiological psychology and chemical senses that were used to increase the addictiveness of cigarettes.”

The food and beverage industry disputes those allegations.

“Food safety and protecting the integrity of the food supply is priority number one for food and beverage manufacturers. Companies adhere to the rigorous evidence-based safety standards established by the FDA to deliver safe, affordable and convenient products that consumers depend on every day. Americans deserve facts based on sound science in order to make the best choices for their health,” said Sarah Gallo, senior vice president of product policy for the Consumer Brands Association.

“There is currently no agreed-upon scientific definition of ultra-processed foods. Attempting to classify foods as unhealthy simply because they are processed or demonizing food by ignoring its full nutrient content misleads consumers and exacerbates health disparities. We fully support providing consumers the dignity of choice when making decisions about healthy dietary patterns, and the makers of America’s household brands are continuously innovating to meet the health and lifestyle needs of their customers,” she said.

According to the lawsuit, however, consumers only think they have choices when they shop. In fact, they are victims of a conspiracy among sugary snack makers.

“In April 1999, the CEOs of America’s largest UPF companies attended a secret meeting in Minneapolis to discuss the devastating public health consequences of UPF and their conduct. At that meeting, a Kraft executive told the other CEOs in attendance that obesity was reaching epidemic proportions, especially among children, who were at a higher risk of developing chronic diseases such as diabetes, heart disease, hypertension and cancer.’ This same executive informed the others that their companies were collectively driving this, costing the U.S. upwards of $100 billion a year, and inflicting a toll on public health rivaling that of tobacco,” the suit said.

Martinez “is one of many casualties,” the suit said. He “frequently and chronically ingested their UPF, which caused him to contract Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease at the age of 16,” the suit said. And he continues to suffer from these diseases.

Consuming UPF has been linked to increases in various cancers, cardiovascular disease, cerebrovascular disease, irritable bowel disease, chronic kidney disease, Crohn’s disease, dementia, Alzheimer’s disease, metabolic syndrome, Type 2 Diabetes, non-alcoholic fatty liver disease, depression , anxiety and frailty, according to the suit.

For an alternate point of view, see: COUNTERPOINT: PA Should Join Neighboring States to Legalize Marijuana 

When I was in high school 20 years ago, marijuana use was generally confined to buying dime bags of dry flower that had a THC potency in the single digits (THC is the psychoactive component of marijuana that gives the high). No one was vaping marijuana because vaping wasn’t around yet.

Today, not only has marijuana flower been industrialized to produce upwards of 30 percent THC and more, but you have a host of new delivery mechanisms – including vapes that come in a kids’ menu of flavors like Blueberry Cookies and Orange Crush – that can range between 80-90 percent THC and higher.

No longer are teachers and educators just finding a few students smoking weed under the football field bleachers but are now confronting students vaping marijuana in school, not only in bathrooms but right in the classroom as well, with devices disguised as USB drives and even yellow highlighters.

We have never experienced a time in history when the potency strength of manufactured marijuana is as high and in such a diverse set of products as it is today, and children and young adults are using today’s marijuana at record rates. Both facts are colliding, and the impact of this wreckage is made significantly worse by a state government that encourages its recreational use through legalization.

Earlier this year, researchers at Temple University released a study finding that more children and young adults use marijuana because of states legalizing its recreational use, particularly due to the lowering of perceived harm by making it legal. It is a logical conclusion: if you increase access, you increase use.

We know that using today’s industrialized marijuana with upwards of 99 percent THC can have damaging health consequences, including marijuana use disorder (MUD), the medical term for addiction; risks that increase exponentially for those using in their mid-20’s or earlier as it impacts their developing brain.

“The risk of developing marijuana use disorder is stronger in people who start using marijuana during youth or adolescence,” states the CDC. And according to the Substance Abuse and Mental Health Services Administration (SAMHSA), addiction rates nearly double when you start using before age 18.

Addiction to marijuana? Yes, science has proven today’s marijuana can absolutely be addictive, and rates are steadily increasing. Yet there are some Pennsylvania state lawmakers who dismiss the addictive traits of marijuana. State Representative Jordan Harris (D-Philadelphia) has gone so far as to claim not only that marijuana is not dangerous or addictive but that the only thing at risk with legalizing marijuana for recreational use is potato chips and Fritos – alluding to getting “the munchies” after use.

Not only is this joke insulting to families who have been directly impacted by the harms of marijuana use, but it denies the existing science and evidence that are contrary to those archaic claims. There’s a reason why every major medical association is opposed to legalizing recreational use.

We know that there has been a significant change in potency strength in the last decade. In 2014, Washington State’s total market of manufactured marijuana extracts was 9 percent. Today, extracts are now 35 percent of the market. This growth has led to calls for potency caps.

“Twenty years ago, prescription opioids were seen as a breakthrough in pain relief,” writes The Seattle Times Editorial Board. “We understand now the human costs of addiction and dysfunction. This state should not make the same mistake with high-potency marijuana.”

We also know that, in states like Colorado, the commercialized sale of marijuana – backed by Big Tobacco and their predatory history of targeting teens for addiction – has led to more marijuana shops than McDonalds and Starbucks combined. This market proliferation is also reflective in the use of social media and billboards advertising these harmful products.

Additional harms caused by marijuana legalization include an increase in DUIs and drugged driving fatalities. Evidence from the two states who started experimenting with marijuana legalization for recreational use, Colorado and Washington State, both witnessed an increase in motor vehicle accidents and fatalities.

A 19-year old woman from Pennsylvania was recently charged with involuntary manslaughter and DUI after having marijuana in her system when she was driving and killed a motorcyclist and father of three. If we don’t want an increase in these types of scenarios, then we should listen to law enforcement and safety associations like AAA and oppose marijuana legalization for recreational use.

When voters are given options of marijuana policy that are not just a one-size-fits-all model for recreational use, options that include ways to address the criminal justice system, voters often do not favor full recreational sales.

Here in Pennsylvania, there are options available to our state lawmakers to improve our medical marijuana program. The question is who do we help: an addiction-for-profit industry or our children? Will we protect public health and safety or subject communities to the harms caused by commercializing manufactured marijuana?

I know my choice.

Leave it to Washington to make a federal project out of something that can be safely and easily thrown in the trash or handled in other ways.

At issue are billions of unused, no longer medically needed prescription opioid pills, which remain susceptible to misuse.

More than 1 million Americans have died of a drug overdose since 1999, including 80,411 from opioids alone in 2021. The over-availability of opioids has been integral to this crisis.

When a patient no longer needs prescribed opioids for severe pain relief, the unused pills are a lurking danger that can lead to drug abuse by the patient or, worse, children and others in the home.

To help save lives and prevent addictions, it is crucial to destroy and dispose of unused, no-longer-needed opioids immediately.

Fortunately, in the last five years, numerous programs have facilitated this.

These include widespread take-back programs at pharmacies, police stations and other venues. Another option is commercially available in-home disposal kits that are inexpensive and easy to use.

Many government agencies offer clear and simple instructions so that opioids can easily be turned into junk at home by combining them with kitty litter, coffee grinds and other unpalatable pollutants and then thrown into the trash. Opioids, though, should not be crushed.

According to the Centers for Disease Control and Prevention, there were 142 million prescriptions for opioids dispensed in 2020. On September 12, during a court trial, the Associated Press reported that the Drug and Enforcement Administration disclosed “that in 2019, 8.8 billion dosage units — pills, patches and lollipops — were shipped for 12 common opioids.”

Even today, there are a lot of excess pills prescribed. On June 26, after an assessment of numerous studies, the Food and Drug Administration said “most studies reported that 50 to 70 percent of tablets went unused.”

Yet, federal health officials, particularly the FDA, have squandered mainly an opportunity to aggressively promote a public health campaign about the continued dangers of unused opioids and the many ways to get rid of them safely and quickly. Fortunately, communities and others picked up the slack.

The FDA has also become primarily focused on a new way to dispose of these narcotics: through the U.S. mail. Yes, the U.S. mail, the theft of which is today at unprecedented heights.

Since April 2022, the FDA has been fielding comments and developing a program by which the U.S. Postal Service is envisioned to be widely used for patients to mail unused opioids back to drug manufacturers. This would be the case even though many of the same pharmacies providing a pre-paid envelope also have take-back programs.

The FDA’s strong emphasis on promoting a mail-back program since 2022, which it aims to start in 2024, may already have the unintended consequence of cannibalizing other successful disposal efforts and stymying their growth.

Fourteen attorneys general expressed strong concerns about this in a June 21 letter to the FDA.

“It is critical the FDA reconsider its unproven one-size-fits-all mail-back proposal and instead choose to promote and educate Americans on all available in-home disposal options,” they said.

The other concerns raised were “the insecurity of mailboxes and inconvenience for many rural Americans. A critical component of providing any in-home disposal option is providing a solution that will immediately rid the home of the medication in question.”

Against this backdrop, there appears to be hopeful news: significantly more Americans are responsibly disposing of unused opioids now than five years ago when such programs started.

In 2022, a study in the medical journal Cureus found that 94 percent of patients receiving opioid prescriptions reported having leftover, unused opioids. Sixty-nine percent claimed to dispose of their prescription opioids, while 31 percent did not.

Whatever course the FDA decides, communities, state governments, pharmacies and others should continue and accelerate their take-back and public education destruction programs.

And if you have unused opioids at home, plan to get rid of them — within the next 24 hours.

Several friends were milling about talking over sports and such when our conversation abruptly took a serious turn.

The catalyst for the change was the death certificate in my hand. The deceased was a friend’s 35-year-old former husband and the father of their 7-year-old daughter.

The document told his story: Time of death “Approx-0705,” Immediate Cause of Death “Adverse effect of drugs, ” Interval Between Onset and Death “A few minutes, ” Manner of Death “Accident.”

Odds are marijuana was the gateway drug to his 20-year addiction. Of the many addicts I have known, the majority will attest that marijuana was their first drug of choice.

To quote one young man about his first high, “ The feeling was incredible. All my social anxiety instantly went away.” His descent into addiction was driven by his pursuit of that first sensation.

The conversation then turned to the incongruity between the push to legalize marijuana and the so-called “ War on Drugs.”

It beggars belief that anyone the least bit acquainted with the insidious progression of drug addiction would ever call for the legalization of marijuana, the gateway drug to every more powerful and deadly drug on the market.

What sticks in my craw most is the unconscionable duplicity among certain politicians who attempt to have it both ways: Legalize marijuana for the tax revenue it offers while covering their tail by pouring millions of dollars into the largely symbolic (“We’re doing something!”) and astonishingly unproductive (no measures of efficacy) “War on Drugs.”

In his Feb. 16 Wall Street Journal column, “Super Bowl of Sin Taxes,” Daniel Henninger strikes a similar note.

His topic was sin taxes, specifically legalized gambling and legalized marijuana, and the windfall in tax revenues they generate to state and federal coffers. New Jersey, the U. S. sports-bet capital, took in $200 million in gambling tax revenue last year.

Sixty percent of Americans favor medical and recreational marijuana use. Recreational marijuana is now legal in 18 states and Washington D. C.

New York’s Sen. Chuck Schumer plans to introduce a federal legalization bill in April. It has a cannabis tax that starts at 10 percent and rises eventually to 25 percent.

Henninger writes that sin and sin taxes are now passé. Consequently, much of contemporary American government is now amoral.

“After decades of pretense from government about its good intentions, government doesn’t much care one way or the other anymore.”

“Any previous pro-social purpose, “he writes, “has been overwhelmed by the crude need to maximize revenue no matter the source, especially in open-spigot states such as New York, New Jersey, and Illinois.”

Echoing my annoyance he writes, “We are legalizing marijuana just as opioid addiction and overdoses from ‘recreational’ fentanyl skyrocket.

“In virtually all the legalizations of marijuana or gambling,” he continues, “the politicians include language about creating programs for prevention and rehabilitation. It’s boilerplate, a pro forma caveat that rarely delivers.”

Politicians don’t care that a 7-year-old girl lost her father to drug addiction so long as they get the one thing they want—a steady stream of tax revenue from both users and the commercial cannabis interests.

Deaths are simply an acceptable cost of doing business.

Henninger concludes, “When more people understand that the goal of governments today is to take rather than help, as they piously claim, perhaps we can have a sensible discussion about whom to tax and for what purposes.”

A discussion long past due.

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