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Commentary: Tax Revenue for Treatment

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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.

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