Should an Opioid Tax Be a Tool to Fight an Epidemic?

In the fight against the nation’s epidemic of opioid and heroin addiction, states have enhanced prescription registries, armed first responders with naloxone, and capped the number of days on the first prescription. Earlier this year, New Jersey took just over 30 days to create new mandates for insurers to get people in treatment when they are ready to go.

Now, some states are weighing a new tool—a special tax on prescription opioids, which proponents say would discourage use. Both California and Alaska lawmakers are weighing 1-cent-per-milligram taxes, with advocates for the California tax saying it would raise tens of millions of dollars for treatment.

In Congress, US Senator Joe Manchin, D-West Virginia, has re-introduced a federal opioid tax to fund treatment; his state has the highest per-capita death rate from opioids in the nation.

Advocates for the tax say it’s a way to make drug companies and wholesalers help pay treatment costs after the suppliers have been blamed for fueling the addiction crisis in the first place. (This week, a reporter from the Charleston, West Virginia, Gazette-Mail won the Pulitzer Prize for documenting the role of wholesalers in creating an oversupply of prescription opioids in his state.)

But critics of the tax strongly disagree with this approach, and say the costs will be passed to people with pain who are using the drugs legally. In a commentary that appeared in several Alaska news outlets, Paul Jenkins wrote that an opioid tax, “muscles the state into the doctor-patient relationship, and selling the tax as a way to reduce painkillers’ use is disingenuous.”

Opinion over a tax may be split, but data on the opioid crisis are clear: CDC reports that the number of prescriptions quadrupled between 1999 and 2014, and so did the number of overdoses. About 2 million people were addicted or abusing prescription painkillers by 2014, and the recent rise of the synthetic opioid fentanyl has only made things worse for public health officials and emergency responders.

Cigarette taxes have been a key tool in reducing smoking rates over the past 5 decades, but those taxes are levied at the point of sale. And unlike opioids, which can have a legitimate medical use, tobacco use is universally discouraged by public health experts.