New reports on opioid and tobacco use in Indiana say the substances cost the state more than 14,000 lives and $12 billion every year.
The Indianapolis-based Richard M. Fairbanks Foundation released the studies to show the human and economic tolls of opioids and tobacco on Indiana's citizens.
"The number of lives lost is far too high, and everyone needs to take an active role and urgency in tackling both tobacco and opioid addiction," said Claire Fiddian-Green, president and CEO of the Fairbanks Foundation.
"It can't just be the state; it has to be all of us across sectors: policymakers, employers, health care providers, K-12 schools, colleges and universities."
She cited statistics from the reports showing that more than 1,700 Hoosiers died of drug overdoses in 2017, the vast majority from opioids, a 75 percent increase from 2011. And tobacco killed seven times as many Indiana residents last year: 12,500.
"To put that in perspective, that's more than the number of deaths caused by Hurricane Katrina, 9/11 and all motor vehicle accidents in Indiana since 2006 combined," she said.
Indiana has a smoking rate that's about 50 percent higher than the national average, and ranks among the top 10 states for smokers, the research found.
The reports say opioid and tobacco use cost the state $12.6 billion in 2017 in health care expenses and lost productivity.
"People say, 'I shouldn't get involved. It's anyone's choice to smoke or not smoke,' " said Paul Halverson, dean of the Richard M. Fairbanks School of Public Health at IUPUI and one of the reports' authors.
"The truth is those choices are costing all of us as taxpayers a substantial sum."
He estimates that every year tobacco use costs each Indiana household $1,125 in state and federal taxes and the state's Medicaid program $540 million. But he said the state spends just 10 percent of what the U.S. Centers for Disease Control and Prevention recommends to prevent tobacco use and help people stop.
The tobacco report also found that nearly a third of high-schoolers are using e-cigarettes, which Halverson calls "a gateway to traditional smoking."
The studies, which are available at rmff.org, outline solutions.
For the opioid epidemic, those include making sure the overdose-reversal drug naloxone is widely available and expanding access to medication-assisted treatment, which has been found to be the most effective therapy for opioid misuse disorder.
The tobacco report advocates increasing the smoking age to 21, as six states and more than 350 cities have done, and the cigarette tax by $2 a pack. Halverson noted that more than 95 percent of smokers started before age 19. The study asserts that a potential tax hike's impact on cross-border sales, an issue in Northwest Indiana, is overstated.
Abby Naumann, a 15-year-old high-school sophomore from Lake Station, has seen the negative effects of tobacco use firsthand.
She watched her grandmother die of a smoking-related illness, and said most of her family members smoke.
She recently joined a coalition to reduce tobacco use in Lake County, and speaks at anti-smoking events in the state and Region.
She agrees with the report's conclusion that the smoking age needs to be raised.
"I know more people who are 18 than I know that are 21," she said. "If you have to be 21 to drink, you should be 21 to smoke because smoking is just as bad."
But she acknowledged that truly making a dent in the state's rate of tobacco use is going to require talking to peers and loved ones about the dangers of smoking. She said her family, for one, has been supportive of her efforts.
"We have to be able to just sit down and have conversations with people," she said.