For starters, I am rather disappointed with one of the authors of this article  Kate M. Nicholson, she is a chronic pain pt and a civil rights attorney and in this article it is reported that 93,000 drug overdose deaths in 2020- which includes an estimated 15,000/yr deaths from the use/abuse of NSAIDS – mostly from GI bleeds and untold number of other drugs – legal and illegal….. and in the article stated that OD’s were largely due to Fentanyl – not ILLEGAL FENTANYL…according to Wikipedia there is some 400 known fentanyl analogs and ONLY ONE ANALOG is FDA legal for human use.  Historically, bureaucrats have used what they considered “socially unacceptable behavior” as a vehicle to generate tax revenue.  Just look at the sin taxes that have been added to Tobacco, Alcohol, Gambling over the years.  After nearly a half century of damning Marijuana as a DANGEROUS DRUG and ILLEGAL… 40 states have not legalized it use in some form or another. Some states – like Ohio – apparently decided that MJ was going to be a sizeable revenue stream and established taxes and fees on all segments of the MJ growing/distribution system that ONE OUNCE of MJ in Ohio is abt FOUR TIMES what it is in Colorado. BUT… MJ is still ILLEGAL at the Federal level.

I find it interesting that Senator Manchin introduced this bill whose Daughter, Heather Bresch, was CEO of Mylan… at one time a large pharma that produced opiate dosing,  before the company merged with another and the WV plant was closed – 1400 workers lost their job and operations was moved to India and Australia.  One would think that these 11 Senators would take notice what happened when NY implemented a opiate tax… the state of NY largely became a opiate desert.  The taxes and fees were imposed on the pharma and wholesaler and while they could pass those taxes and fees along to the pharmacies, the insurance companies/PBM would not reimburse the pharmacy for those added costs of those opiate to the pharmacies…. so pharmacies stopped ordering and/or filling opiate Rxs for Rxs that were being paid for by the pt’s insurance/PBM.  How many other pts dealing with chronic diseases are being taxed to treat others dealing with a related chronic disease ? Why doesn’t the bureaucrats use the taxes generated from sin taxes on Alcohol, Nicotine, Gambling to help fund the treatment of those dealing with various mental health issues of addictive personalities ?

 

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

https://washingtonmonthly.com/2021/08/19/the-opioids-crisis-dont-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.

 

Filed under: General Problems