We tax cigarettes and alcohol, two legal substances with damaging public-health effects. So why not prescription opioids?
A number of states are asking that question as they look for sources of funding to respond to the opioid crisis, which kills an average of 115 people in America every day. Legislation has been introduced in at least 15 states that would tax prescription painkillers like Vicodin and OxyContin, with most of the legislation introduced in the past year, according to the Associated Press. In most cases the revenue—which could amount to tens of millions of dollars for states each year—would be used to pay for addiction prevention and treatment programs. The rationale is that since opioid manufacturers and distributors helped spark widespread addiction by deceptively advertising and aggressively pushing painkillers, they should help pay for the collective damage. “You’re creating the problem. You’re going to fix it,” one Republican state senator in Montana explained.
Though many of the tax bills have some bipartisan support, few have actually gained enough momentum to become law. That may in part be because of strong opposition from pharmaceutical-industry lobbyists, who argue that taxing prescription opioids would unfairly raise costs for patients with a legitimate need for such drugs. But even among those who criticize the drug industry for its role in the addiction crisis, there is some disagreement about how effective the taxes or fees would be.
“I think it’s a good idea,” said Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School for Social Policy and Management, in an e-mail. “Overprescribing is having a devastating impact on individuals, families and communities. With a tax, their price might better reflect their true human and economic cost.”
But Keith Humphreys, a professor of mental-health policy at Stanford University and former drug-policy adviser in the Bush and Obama White Houses, said that the fine print of the legislation matters. Many of the proposals would tax opioids per dose, a strategy that Humphreys doesn’t think would discourage overprescribing, because it wouldn’t affect doctors directly; meanwhile, Medicaid and Medicare (and, effectively, tax payers) could end up paying increased costs. Unlike alcohol and tobacco, opioids do have legitimate, and essential, medical purposes. “Yes, we overprescribe horribly, but that doesn’t mean we want a blanket cut [for] all patients,” Humphreys said.