Commentary: Tax Revenue for Treatment
The abuse of prescription drugs is well documented. Many
possible solutions and remedies have been offered – at various levels of
government – ranging from expanded treatment and prevention, to
prescription drug monitoring systems. However, we find ourselves in an
era of shrinking budgets, for all domestic programs at all levels of
government. Whether the solutions we face lie in the health system,
justice system or elsewhere, there will be very little budget growth to
fund this fight for at least the remainder of the decade. If we are to
expand our fight against prescription drug abuse and want the support of
policy makers, it is incumbent upon us to find new sources of revenue
that will pay for the changes that must be made.
Although the word “tax” represents an incredibly sensitive and
politically charged topic these days, we need to explore it if that is
where our answer lies. Specifically, a sumptuary tax on the product that
is at the root of this problem: prescribed controlled substances (FDA
Schedules C-II through C-V). Ideally, this tax revenue would only be
used for preventive and rehabilitative services, and related expenses.
The funds would assist those without medical insurance, or the means to
pay for treatment.
Strong precedent exists for such a concept, such as the federal tax
on medical devices for the purpose of paying for health care services,
or state and federal excise taxes on alcohol or cigarettes. The
motivations behind so-called “sin taxes” vary. Taxes on products such as
tobacco and alcohol exist in part as a deterrent, with policy makers
holding the belief that a higher price on a product will discourage use
to a level that becomes abusive. This sounds fair in theory, but it does
not take into account the disease of addiction. For someone who is an
addict, whether to tobacco, alcohol or any other substance or behavior,
price is rarely an object. Our focus needs to be on the portions of
these tax revenues that are set aside for treatment and prevention
programs.
There is also precedence for the setting aside of funds generated
from legal activities in order to assist those that develop conditions
based on an abuse of said activity; specifically, problem gambling.
Casinos or racetrack casinos (“raceinos”) exist in 20 states, operating
legitimately, yet millions of people suffer from an addiction to
gambling. In many states, those who profit from gambling enterprises,
whether they be private or state entities, are required by law to set
aside a pool of funds to provide treatment for problem gamblers.
Depending on the state, this pool of funds can go toward assisting
localities, individuals, or both, especially with counseling and
prevention services.
We absolutely recognize the medical need for prescription drugs such
as OxyContin, Vicodin and others, as they play a vital role in pain
management for patients with no other alternatives, and who use them as
prescribed or under a doctor’s care, without abuse. Yet due to the lack
of institutional control over these substances – over prescription,
counterfeiting and inadequate monitoring- we are facing nothing short of
an epidemic caused by their abuse. Tax revenue of controlled
substances, sold with a prescription, can be an invaluable funding
stream used to address the damage that is known to result from the
widespread availability of and poor control over prescribed controlled
substances. Such an idea is easy to espouse, but far more difficult to
accomplish. The resources and commitment required to draft, introduce,
enact and enforce such legislation – at the state and federal levels –
could turn out to be exhaustive. Yet our calls for more treatment,
prevention and awareness have only taken us so far, and time is against
us. All of the details are far from ready, but the time for dialogue on
this idea is now. Let’s start talking.
Andrew Kessler is founder and Principal of Slingshot Solutions LLC, a consulting firm based in Fairfax, Virginia that specializes in substance abuse and mental health policy.
Sharon Blair is a national advocate
for prescription drug abuse treatment and prevention. She is the mother
of Jennifer Reynolds-Gonzalez, who lost her life to an overdose in 2009
at the age of 29.
