The Opioids Crisis: Don’t Punish Pain Patients To Treat Opioid Addiction

Why a sin tax on opioids is not like a sin tax on sugary drinks.

The U.S. is suffering not one epidemic, but two: The opioid crisis continues to rage through the Covid-19 pandemic. In 2020, opioid deaths surged 30 percent to 93,000, the Centers for Disease Control (CDC) just announced, due largely to fentanyl, a potent synthetic opioid trafficked from Mexico and China. Federal action to help Americans combat substance abuse is urgently needed.

But a sin tax imposed in a new bipartisan Senate bill, The Life Budgeting for Opioid Addiction Treatment (LifeBOAT) Act, is sorely misguided, robbing pain patient Peter to treat addiction patient Paul.

Introduced by Senator Joe Manchin (D-West Virginia), along with ten co-sponsors including Senators Mitt Romney (R-Utah), Elizabeth Warren (D-Mass.), and Amy Klobuchar (D-Minn.), the bill would establish a tax on sales of opioids (“stewardship fee”) of one cent per milligram. The revenue would be earmarked to fund drug treatment.

New York State tried an opioid sin tax; the results were not encouraging. In 2019, it imposed taxes and fees on opioid manufacturers and pharmaceutical distributors that deliver opioids to pharmacies and hospitals.  According to Kaiser Health News, “scores of manufacturers and wholesalers stopped selling opioids in New York,” among them Epic Pharma, a manufacturer, and Independent Pharmacy Cooperative, a wholesaler. AvKARE and Lupin Pharmaceuticals no longer ship to New York.

Unable to recover their higher costs from insurers, some pharmacies raised prices, while others ceased carrying the medication altogether. Pain patients who relied on these medications struggled to fill their prescriptions.

A tax of one cent per milligram might not seem prohibitive, but the tax will cost many patients hundreds if not thousands of dollars per year. Roughly one-third of people receiving opioids in the U.S. take a daily dose of 90 mg or higher, according to data from IQVIA. With 5.4 percent of all adults taking opioids for long-term pain, millions of people will pay a surcharge for their care.

Such fees have proved much more effective at reducing access to pain medications than at raising revenue for drug treatment. New York’s anticipated $100 million fell short by seventy percent in 2020. A similar tax imposed by Delaware in 2019 generated $1 million in one year, a slow start to the $8 million projected by 2022.

A sin tax on opioids is different from, say, a sin tax on sugary drinks to subsidize insulin costs for people with diabetes. Ginger ale is not a medical product; Percocet, Vicodin, and morphine are.

Taxing opioids would compound pre-existing barriers that legitimate medical users must surmount to get pain relief. Guidelines issued in 2016 by the CDC were widely misinterpreted by physicians as a federal mandate to reduce opioid medication or cut patients off altogether, as the agency itself has acknowledged. One survey found that 71 percent of patients with chronic pain were getting a lower dose or were cut off completely. Eight out of ten said their pain and quality of life were worse.

The barriers imposed on pain patients have been called a “humanitarian crisis” by Human Rights Watch. The American Medical Association has also raised alarm about the harm to patients who require opioids.

Opioid taxes might even undermine the bill’s goal of fighting addiction by pushing users into the cheaper black market. In a 2021 online survey of nearly 4,000 pain patients, nine percent reported seeking opioids illegally when they were unable to obtain their medication through normal medical channels – risking addiction in the process.

No one can dispute that the aggressive marketing conducted by OxyContin-maker Purdue Pharma did the country significant damage. Nor the harm done when providers routinely prescribed an entire month’s supply of pills for short-term pain. But excessive prescribing declined 60 percent between 2011 and 2020. That didn’t keep the overdose death rate doubling over the same period, driven overwhelmingly by illegally-produced fentanyl. Politicians seem to have conflated the corporate misbehavior of Big Pharma with the problem of pain itself, which afflicts 50 million Americans and disables nearly 20 million.

Some patients who use prescribed opioids might benefit from other forms of pain management, but many alternatives are not widely available and are poorly covered by insurers. Doctors treat patients with the tools they have, not those they wish they had.

Drug treatment for opioid addiction is needed urgently, but Congress can and should fund it from other revenue sources. On July 29, the House passed a 2022 appropriations bill (awaiting Senate action) that would increase by more than 50 percent funding for the Substance Abuse Prevention, Treatment and Recovery Block Grant, and boost funding for other treatment programs. That’s a much better approach. People battling addiction need our help, but pain patients need it, too. The lifeboat is big enough for both.

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Kate M. Nicholson

is a civil rights and disability rights attorney and president and founder of the National Pain Advocacy Center, a nonprofit that takes no industry funding and advocates for the health and human rights of people with pain.

Sally Satel

is an addiction psychiatrist, resident scholar at the American Enterprise Institute, and Visiting Professor of Psychiatry at Columbia University’s Vagelos College of Physicians and Surgeons.