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Opioid Tax?

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The opioid epidemic is real and terrible. However, a tax on opioids, even if it claims to be paid by the manufacturer, will probably end up leading to higher costs to the people who actually need these drugs to function on a daily basis with chronic pain. That’s not to say that doctors don’t overprescribe them or that we have to take these drug epidemics seriously. But they aren’t like alcohol or tobacco, unless we want to make them over the counter. I’m not reading much into Hillary Clinton actually supporting Joe Manchin’s idea on this, especially given that it seems to have just been a conversation, but I hope she reconsiders it.

Sorry for forgetting the link. Here it is. I was getting this out quickly before going to my wife’s college reunion. Turns out she and Shakezula share the same alma mater, but Shakezula failed me by not attending, giving me no one to talk to (or more accurately, I just don’t like to talk to people I don’t know). A very sad story.

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  • keta

    Geez, Erick, hook a guy up wontcha’ and include a link.

    • keta

      I guess Erik got busy with other stuff, but this piece must be what he’s referring to:

      Hillary Clinton on Tuesday backed Joe Manchin’s plan to tax opiods, telling the West Virginia senator that his call to levy a 1-cent tax on prescription opioid pain pills was a “great idea.”
      Manchin, whose state is dealing with the highest rate of drug overdose deaths in the country, proposed earlier this year a tax of “1 cent on each milligram of active opioid ingredient in a prescription pain pill to be paid by the manufacturer or importer.”

      And what would the money collected from this new tax be used for?

      The funds raised from the plan to tax opioids be used to “expand access to substance abuse treatment” and would be distributed to states as part of a drug prevention block grant program, according to Manchin’s office.
      The plan would also offer a rebate for “opioids prescribed for cancer-related pain and hospice patients and an exemption for opioids used as part of medically assisted treatment.”

      Gee, that sounds great! Except how many times have we all seen a new ___ tax instituted and then not dime one being spent on ___? And is this approach the best way to address a dangerously growing problem?

      Accidental deaths are up over 15% from a decade ago, and “the higher accidental death rate is being fueled in large part by the opioid and heroin epidemic.”

      • cpinva

        “The plan would also offer a rebate for “opioids prescribed for cancer-related pain and hospice patients and an exemption for opioids used as part of medically assisted treatment.”

        correct me if I seem to be misreading this, but it appears that the only drugs the tax would actually be levied on, would be those gotten/used illegally. so how, exactly, does Sen. Manchin propose to go about taxing the drugs sold illegally? this could be seen as an incentive to the manufacturers, to make damn sure their product doesn’t end up on the street (how they’re supposed to accomplish this goes unsaid.) which, laudable a goal as that might be, would reduce the revenues to, um, carry the 5, times 3, add 1……………….-0- dollars. hardly enough to establish/fund rehab programs. is he really as big a dumbass as he always has seemed to be, or is this just for public consumption?

        • Warren Terra

          Apparently the idea is to tax them at the factory, and rebate the tax when they’re used legally. It’s actually an interesting notion, if you think the source of black-market opioids is the selling of them at some point between leaving the factory and the patient with the prescription picking them up, rather than bad prescriptions or reselling from valid prescriptions (which would get the rebate) or theft (which wouldn’t pay the tax).

          That scenario seems unlikely to me, but this plan would address it.

          • keta

            As per this report:

            A group of U.S. Senators has introduced legislation that would establish a federal tax on all opioid pain medication. If approved, it would be the first federal tax on a prescription drug levied directly on consumers.
            The opioid tax would raise an estimated $1.5 billion to $2 billion per year. In an interview with the Portland Press Herald, King said the fee would range between 75 cents and $3 for a 30-day prescription, depending on the dose. He claimed many patients wouldn’t have to pay the additional cost because their insurance would cover it.
            King said treatment programs need funding, and tacking the cost onto the price of the drug is a fair way to do it, much like automakers are required to install seat belts and air bags in vehicles.
            “The obvious way to fund this is to build it into the price of the drug,” said King. “The cost of the drug should reflect the danger of the drug.”

            (my bold)

  • Frank Wilhoit

    One of the problems with opioids — to some audiences, THE problem — is the fact that there is a black market in them. Taxation can only make this worse, possibly unbelievably worse.

    • c u n d gulag

      BINGO!

    • ThrottleJockey

      There are a lot of overdoses from Legally prescribed opiates. Prince was hardly the only one to overdose from a legal prescription. Opiates have an especially nasty impact when the patient is also on benzos like Xanax.

      • ChrisTS

        What’s a ‘benzo’? I very, very occasionally get a few Xanax from my doctor when I know something extremely stressful is coming up. Like, 5 tabs every 8-10 years or so. I never use them for fun (why would that be fun?), and I am very cautious about using them at all.

        • NeonTrotsky

          benzodiazepines are a broad class of anti-anxiety medication, of which Xanax(Alprazolam) is a part of.

        • ThrottleJockey

          Sorry, Chris, ‘benzo’ is short for Benzodiazepine. Its a perfectly legitimate class of drugs often used to treat anxiety and insomnia. But if, say, your primary doctor prescribes you Xanax, and a specialist later prescribes you Vicodin–unaware of the earlier Xanax prescription–you could face some extremely dangerous issues. Because doctors are rushed and patients, especially the elderly, are confused or poorly informed about the medications they’re on, this happens frequently. Its a series of honest mistakes with bad consequences…and this isn’t even taking substance abuse into account…Its also a risk that is only now reaching mainstream awareness.

          “Benzodiazepines and the opiates both can cause death when you take too much of them,” he adds. “But they potentiate each other — they make each other stronger. And so one plus one doesn’t equal two; it equals three or four.”

        • ThrottleJockey

          The problem, according to Paulozzi and other experts, is that both types of drugs can cause disorientation and affect balance, compounding the risk seniors face of falling. And combining the two, which many physicians do, can depress respiratory function at high doses — a potentially fatal problem for older people, who often are weakened by other ills.

          CDC data from 2010 show that 75% of pharmaceutical overdose deaths involved opioid painkillers, and nearly a third of those cases also involved benzodiazepines.

          Yet the number of seniors using — and misusing — those drugs continues to climb.

          “The problem really is being fueled by over-prescribing,” says Andrew Kolodny, chief medical officer for Phoenix House, which runs scores of addiction treatment programs nationally, and president of Physicians for Responsible Opioid Prescribing.

        • pseudonymous in nc

          That’s a really… American attitude. (You notice it if you’re not American.) There’s an middle-class expectation that benzos and opoids should be available on demand, and so doctors anticipate that and offer them. My non-American friends in the US are staggered by how many doctor/dentist visits include an offer of Xanax or Valium for slightly anxious situations, or Percocet for pain relief. And of course, they get hoarded.

          I’m sure it goes back to the 50s when magazines were advertising Valium to housewives and Thorazine to keep grandad quiet.

          • vic rattlehead

            I was pretty surprised when my oral surgeon kept offering me Valium when I got my wisdom teeth out. He also kept asking if I was sure I didn’t want laughing gas-I guess he makes money on that? I just had the novocaine. I don’t like to fuck around with stuff if I don’t need it. Except pot.

            • CD

              I sprained an ankle a while back, which was a drag but needed no more than ice and ibuprofen. ER automatically prescribed oxycodone.

              (I did try a little ’cause I’d never had it before and “opioid” sounded … happy. Christ, what an unpleasant drug.)

              • Ahuitzotl

                no shit.
                literally.

          • I’m sure it goes back to the 50s when magazines were advertising Valium to housewives

            Life’s just so hard today, I hear every mother say.

            and Thorazine to keep grandad quiet.

            The day can come when you get old and sick and tired of life, you just never realize maybe the choice you made wasn’t really right.

          • Origami Isopod

            That’s a really… American attitude. (You notice it if you’re not American.) There’s an middle-class expectation that benzos and opoids should be available on demand, and so doctors anticipate that and offer them. My non-American friends in the US are staggered by how many doctor/dentist visits include an offer of Xanax or Valium for slightly anxious situations, or Percocet for pain relief. And of course, they get hoarded.

            Last I heard, you could get codeine OTC in Canada. And plenty of other countries are less puritanical than us when it comes to pain relief.

            • Last I heard, you could get codeine OTC in Canada.

              Also in Switzerland (and, I think, France).

            • Denverite

              Every fall we ask our doctor for a prescription for codeine cough syrup if we don’t have sufficient stockpile for the upcoming cold and flu season. It works so well for a cough/sore throat that would otherwise keep you or the kid up all night.

          • Ahuitzotl

            Yes, we were staggered by my wife’s dentist prescribing her demerol (unasked) after some relatively minor dental work (i.e. not a root canal), shortly after arriving in the US.

    • cpinva

      “Taxation can only make this worse, possibly unbelievably worse.”

      my boy, you’re missing the beauty of this proposed regime: it provides critical revenue/jobs, for a host of law enforcement/penal system activities. everything from hiring masses of new police officers/DEA Agents, to building/staffing new prisons/filling already existing ones, and extending the “useful” lives of politicians that have long since outlived their actual usefulness, by giving them a “lawnorder” platform to shriek on.

      it’s a win-win for everyone! well, except those immediately and negatively impacted by it, but they’re just a bunch of druggies, so who cares about them? certainly not the pols.

  • c u n d gulag

    Look, after reconstructive ankle surgery, and being in a metal halo for almost 5 months – and then a series of cast’s for another month – I was on Percocets for about 6 months.

    Even with them, the pain was unbelievable. And I have a pretty damn high pain tolerance.

    I quit taking them about 3 months ago. It was tough, but do-able.
    Now I take generic versions of Aleve and other over-the-counter pain pills when I need them.

    I’m lucky, in that I didn’t get addicted to Perc’s. I’m not going to lie, and say I didn’t like them. But I didn’t go through any sort of serious withdrawal symptoms when I stopped taking them – ok, I was cranky for a couple of days…

    The folks who take them regularly to control pain are finding it harder and harder to get them legally from a Doctor.

    So, what’s their choice?
    They go out, and seek opiods on the streets.
    FSM knows what the fuck is in them.
    Some people die from opiods.

    But not necessarily from legally prescribed drugs, but from some tamped-on shit with who knows what the fuck is in there. After all, the more a dealer can stretch an illegal drug, the more the profit!

    There are always unforeseen consequences to some laws that we pass. The one limiting Doctor’s abilities to prescribe opiods, is one of them.

    We have an “epidemic” in NY.
    But it’s NOT from legally prescribed opiods, it’s from people seeking relief out in the streets. Or, from people who are addicted, and willing to swallow, snort, and/or inject, any fucking thing they can find.

    We have Methadone clinic’s.
    Why not opiod ones?
    Ones where the dosage is gradually decreased, and less addictive pain-killers made available.

    Them’s my stupid $0.02 worth!

    • I’m sorry for what you went through, CUND. There has to be a better way of tackling the problem than just taxing the opiods.

      • cpinva

        how about taxing the idiots, like manchin, that make such suggestions: every time he burps out something vaguely resembling a “thought”, it costs him $1,000? he’ll shut the fuck up or go bankrupt, doesn’t matter to me either way.

        before the era of modern pharmaceuticals, people used alcohol and whatever else worked, to numb their pain. in spite of this, the country didn’t collapse. anytime more than a half dozen people show up in a hospital ER, suffering the affects of ODing on something or other, an “epidemic” is declared, the DEA (the US’s worst excuse for a money sucking gov’t agency) demands more funding and greater powers to “fight the scourge”, and a lot of otherwise innocent people suffer even greater harm, at the hands of said gov’t.

        so, I have to ask myself, “who actually benefits from this?”. the answer, not surprisingly, are the same people who always benefit from a sudden “increase in crime”, the lawnorder politicians, the DEA, and the legal/judicial/penal industries, all of whom get to crow about themselves, and suck up more tp funds, put more people (amazingly enough, mostly of a not heartlandishly hued persuasion), while the rest of us wonder what the hell just happened?

        if Ms. Clinton even mentions, in passing, something as obviously stupid an idea as this (other than to deride it as obviously stupid), it would be enough for her to lose my vote, because it would show she’s not as smart as I thought she was.

        • ChrisTS

          The thing about HRC is that she never, as far as I can tell, takes action on anything until she’
          s researched it to death.

          So, she might say “Oh, great idea!” but change her mind after more study.

        • ThrottleJockey

          We’ve had both Prince and Heath Ledger die in recent years from opiate overdoses (in Ledger’s case opiate and benzo overdose). I don’t know why you think this is just another iteration of the War Against Crack, or the War Against Meth. This is a Baby Boomer and Middle Class epidemic and its scary to see grandma hooked up to a ventilator because she accidentally took too much Vicodin. Or accidentally took it the same time she took her Xanax.

          Why are you surprised that a senator from the epicenter of the ‘Hillbilly Heroin’ epidemic wants to stop this?

          If there’s anything that government should help do its keep people alive, no? I mean, taxing it and handing out block grants is both idiotic and useless, but there’s a legitimate motivation at root here.

    • Dr. Ronnie James, DO

      There is something similar to that now, called pain management centers. They use a wide range of techniques specifically to control pain – physical therapy, epidural injections, osteopathic manipulation, trigger point injections, transcutaneous electrical stimulation, Botox injections (helpful for migraine), and several other non-opioid means, reserving opioids for only last-ditch efforts and trying to keep their use to the smallest dose for the briefest amount of time possible. The options available for pain management are now so complex many docs are not fully aware of them, and typically just refer their most difficult chronic pain/ migraine patients to these centers. They’re also helpful at helping patients who’d become used to large doses of opioids get weaned to smaller/ safer doses.

      • DocAmazing

        Pain management centers are great–if your patient can access them. I don’t have many patients with chronic pain, but one was a notorious drug-seeker and the pain management clinic bounced her back to me like she was on fire, and others have found that the pain management folks don’t like MediCal. There’s still some work to be done there.

        • Dr. Ronnie James, DO

          For sure – the community health center I worked at referred their patients (90+% Medicaid) to pain management, but it felt like they were just washing their hands of them (to be fair, they’d have 2-4 drug seekers a day). And I have no idea if the CHC followed up or tracked outcomes. Luckily, the pain management center I rotated at did great work and did take Medicaid, but was in an entirely different state.

          OT, Doc, I’m applying to residencies soon (FM) and from comments you’ve given in the past about your practice, I’d be very interested in contacting you offline. Let me know if there’s a way you’d be willing to do that. Thanks

          • DocAmazing

            Drop me a note at [email protected]. Do you speak Spanish and have a taste for poor kids and vaccine-shy parents?

            • Dr. Ronnie James, DO

              Well, I worked in free clinics and public health in LA County for ~10 years, so we can at least be certain I’m not allergic to those things. ;)

              Thanks for the contact information – will e- mail you shortly.

      • cpinva

        yes there are. I was referred to one, after cortisone injections failed to help with the shrieking, chronic pain of frozen shoulder syndrome, in my left shoulder. this was two years after the same thing in my right shoulder! the second cortisone shot did the trick for right one, don’t know why it didn’t for the left? go figure.

        anyway, I was taking 2 20mg Oxycontin, one every 12 hrs, for long-term relief, and 1 10mg Oxycodone, for short-term relief, of the extra, extra pain incurred, by doing physical therapy exercises, in an effort to break the damn frozen shoulder up. both drugs just barely took the edge off, but enough so that I could function, without passing out in the process.

        if you’ve never had frozen shoulder syndrome, you don’t know what your missing: the shrieking pain from moving the wrong way, and the wrong way changes all the damn time. pain so white hot, you literally end up on the floor, in a fetal position, screaming in agony. crumpling in the hospital room your terminally ill wife is occupying, while the staff is attempting to fix or at least temporarily ameliorate whatever is going on with her. you try, desperately, to at least give the appearance of being ok, because you don’t want them switching their attention to you, hoping the pain will eventually subside, so you can be of at least some use to your wife. or at least not a distraction to the staff working on her. it’s great goddamned fun I tell ya!

        so now, I’ve been told, at my last appt. with the pain mgmt. clinic people, that I need to either have surgery, or something, something with an orthopedist and physical therapy, because they don’t feel “comfortable” continuing my pain medication regimen. read: “we’re scared shitless the DEA and/or the state will come down on us, because of you.”

        they’ve put me on a downward scale, to take me entirely off the pain meds, for their benefit, not mine. that I have neither the time nor the money to undergo surgery, because my wife could be called in for a possible transplant at literally any moment, isn’t, apparently, their problem, or even something to be considered by them. and it isn’t as though I have to go on the street for these drugs, I have health insurance that pays for most of it, and the co-pay is fairly nominal, when compared to the pain it’s helping relieve. and that pain is coming back, in both shoulders, as my dosage has been decreased. I’m scared shitless of what it may be like, with two shoulders at one time hammering me, and I shouldn’t be put in this position, so some scumbag politician can troll for votes.

        fuck Manchin, and fuck anyone who listens to him seriously!

        • ChrisTS

          Jesus, cp. I’m so sorry. That’s all.

          • c u n d gulag

            Ditto!

            • Origami Isopod

              Another ditto. My God.

        • vic rattlehead

          I’m sorry to hear about your wife, and your shoulder. Did you have a flu shot before the frozen shoulder happened? That happened to someone I know.

        • ThrottleJockey

          Geez, I’m sorry to hear about that. I’ve heard shoulder issues are the worst.

        • so now, I’ve been told, at my last appt. with the pain mgmt. clinic people, that I need to either have surgery, or something, something with an orthopedist and physical therapy, because they don’t feel “comfortable” continuing my pain medication regimen. read: “we’re scared shitless the DEA and/or the state will come down on us, because of you.”

          Stories like this are so frustrating. Practices aren’t getting busted for providing appropriate treatment to patients, they’re getting busted for failing to monitor patients and make sure they’re compliant and drug dealing.

    • ThrottleJockey

      Ouch, now that’s painful. Sorry to hear that man.

      • c u n d gulag

        Yeah, no fun having 18 of what looked like bicyle spokes running though my foot, ankle, and leg bones from one side to the other, and two huge screws bolted into the front of my shin-bone!

        But, that’s nothing compared to what millions of poeople have to deal with every day!

        So, I’m not complaining. Just saying how fortunate I was not to get addicted…

    • pseudonymous in nc

      I’m sorry too.

      Pain management and relief is a mess in many countries, no matter how good the underlying healthcare system. Because it’s not something doctors can test for on their magic machines, it’s often treated like something that doesn’t exist.

      So opoids get given to people who don’t need them and withheld from people who do. It’s cruel.

      (Lindsay Beyerstein’s work on this topic is very good.)

    • ok, I was cranky for a couple of days…

      I’m sure everyone noticed the difference.

    • cpinva

      “I quit taking them about 3 months ago. It was tough, but do-able. Now I take generic versions of Aleve and other over-the-counter pain pills when I need them.”

      I am truly glad that’s worked for you, and I only wish it worked for me. it’d be a lot cheaper, both in terms of the drugs themselves, and the cost of each visit to the pain mgmt. clinic.

      interestingly, one thing they did early on, was to have a DNA analysis run, to see which drugs, if any, would be most effective for me. lo and behold, it turned out that the Oxy’s were it, in the right dosage. this took a bit to get right, but since then, it’s helped immensely.

      one of the problems with using OTC medication, in any quantity, for any length of time, is that they have a nasty habit of destroying your liver, which is what happened to my wife. normally, this isn’t a problem, because for most people, they take one or two for relief of temporary pain, and that’s it, no problem. unfortunately, for chronic pain sufferers, this isn’t an option, at least not if you want to keep your liver, which I’d kind of like to do. one liver donated to medical science is quite enough, thank you.

      • DocAmazing

        To be more specific: Acetaminophen (Tylenol) trashes your liver; non-steroidal anti-inflammatories like naproxen (Aleve) and ibuprofen (Motrin, Advil) trash your kidneys (though they don’t exactly massage your liver, either). When you’re taking OTC pain meds, you have to decide which organ you want to beat on.

        I’m really sorry you and your wife are having to go through all of this.

        • sparks

          This is the reason that I insisted on a migraine med that contained (among other things) aspirin rather than Tylenol. Now that I have RA, it turned out I chose well.

    • Origami Isopod

      I’m really sorry, c u n d. I’ve had sciatica, so I hear you.

  • K

    a lot of drugs will mess people up we can’t just legalize everything drugs will mess people up too much if we did that. hillary is being a hippocrit about this because she and bill used to sell drugs at an airport so they shouldn’t be talking about stuff like this. we shouldn’t raise taxes either people are paying a lot as it and more taxes won’t stop people from useing drugs. a better solution is to put the people who sell the drugs in prison for a long time people who are just using shouldn’t go to jail but the people who are selling drugs on street corner need to go to jail in order to stop them.

    • brad

      Is there something wrong with me that I see K as around the age of 6, gap toothed, and read these comments in my head in an appropriately adorable child’s voice?

      • ChrisTS

        Well, I don’t get the ‘adorable’ vibe, but otherwise a good guess.

        • Well, I don’t get the ‘adorable’ vibe

          NB: appropriately adorable.

          I would interpret that contextually, as I am often moved to interpret “due” in “with all due respect”.

          • N__B

            NB: appropriately adorable.

            Yes. Yes, I am.

      • Murc

        I really hope that K is a brilliant performance artist.

        • Ronan

          That’s what I was thinking

        • DocAmazing

          Award-winning, from my seat.

        • wjts

          I wouldn’t say “brilliant”, but otherwise, yes.

        • vic rattlehead

          Either that or huffed way too much paint thinner/ate too many lead paint chips.

      • muddy

        I always hear them in the voice of Mr. Mackey on account of the “K”.

        mmKay?

      • alex284

        You must live in a strange neighborhood, with 6-year-olds running around spouting off 20 year old Clinton conspiracy theories.

        Do you hang out with Dan Burton’s grand kids?

        • brad

          I think it’s more the lingering memories of Wonder Showzen, somehow. Granted, the kids there would randomly spout Marxist revolutionary slogans, but still.

          Also, I can’t take him the least bit seriously. He’s just so stupid, it becomes, to my weird self, cute.

      • cpinva

        no, I get him as a 36 year-old, mentally challenged individual, with an 8th grade education (barely), who spends his days & nights listening to Rush/Sean/Bill/etc., absorbing every idiotic claim they make, as though it were actually true.

        barely functionally illiterate.

    • Judas Peckerwood

      people who are selling drugs on street corner need to go to jail

      But not those selling drugs at an airport? Hippocrit!

      • Honoré De Ballsack

        Well, if she took the Hippocritic Oath, she’s allowed to write prescriptions, at least. :P

      • alex284

        Hippo Crib? I thought they shut that place down years ago!

    • Origami Isopod

      Sadly for you, I don’t see airplane glue or paint thinner being made illegal any time soon.

  • Judas Peckerwood

    Joe Manchin’s idea

    Be afraid. Be very afraid.

    • Aaron Morrow

      If his idea to encourage more people to switch to cheaper heroin, then it should work as planned.

      • Steve LaBonne

        Took the words right out of my mouth. It’s already happening now because even without the tax heroin is cheaper.

        • DocAmazing

          Well, once Bayer lost the patent…

    • busker type

      Manchin is about as dumb as a box of rocks when it comes to policy, but he looks good in a suit and he’s the best senator that’s gonna get elected from WV in the next 30 years.

  • Without a link I can’t comment beyond saying it sounds extraordinarily stupid, which means it’s the sort of thing that will attract pols because opioid tax sounds more exciting than requiring docs to demonstrate competency before they’re allowed to prescribe any narcotics, which would actually help.

    • DocAmazing

      Well, the DEA does kinda require certification an’ all. In addition, in California we’re required to do Continuing Medical Education on pain management.

      • Yes and it is painfully obvious that there’s a huge gap between what it takes to get a DEA license and what it takes to prescribe narcotics safely (and I’m not even talking about the pill mills).

        A huge part of the reason we’re where we are now is docs with DEA pads didn’t question the information they were given by sales reps. However, I’m relieved to hear Cali has a continuing ed requirement. If memory serves they were ahead of the game on prescription monitoring programs as well.

        • ThrottleJockey

          I’m pretty hard on doctors, my own, but especially my parents. Their doctor I think resembled a lot of other primary care physicians: over worked, trying to fit 4 patients into every hour of the day. (What can diagnose and fix in 15 minutes???) It took me a while but I really came to empathize with his predicament, even though he was drastically under informed about the risk of opiates.

        • DocAmazing

          There’s a whole new one that came into being just this year. And hey, be fair: check out Lee Fang’s reporting on Perdue Pharmaceuticals. They withheld the info about likelihood of addiction from the FDA, so we docs looking up OxyContin in Facts and Comparisons found the same information that the drug reps were giving us, and without the free pens.

          • Couple of thoughts on Perdue – even though I assume that the average doc didn’t know about the pain specialists who were very concerned about Perdue’s claims from the start (and we know Perdue focused its sales efforts on primary care physicians for a reason) there was a point when doctors should have noticed they had a bunch of non-compliant/addicted patients on their hands.

            In addition, I think it’s fair to say that when Perdue’s settlement hit the news, oxy’s risks stopped being a secret.

            • shah8

              This subthread covers what I was going to rant about…

              except this addition… We don’t have enough doctors and nurses, and involved pharmacist/technicians, period. That we don’t have enough doctors who know what they’re doing when prescribing opioids, and who are willing to oversee the patient’s health, is a subsection of that. Prince, in reality, died because his doctors weren’t on the ball. He actually needed his pain pills.

              And this farce of an idea about taxing opioids is a distinct example of what reformers are dealing with, wrt prostitution, recreational drugs, gambling, etc are dealing with. Everyone with power doing AAAAAAAaaaaanythhhiiiiiing they can do or say that doesn’t involve empowering the dignity of the people who are the object of any proposed change. Balancing opioid addition and pain management? Means lots and lots of expensive doctors, who spend more and more time for their patients. Which means they have more power vis a vis our little corporate overlords.

              Informative about a slight angle of this subthread.
              https://www.statnews.com/2016/06/09/opioid-prescriptions-addiction/

    • ThrottleJockey

      Isn’t that what we call “boards” and continuing education?

      • Dr. Ronnie James, DO

        Boards – definitely not (most schools don’t cover pain management much if at all).
        E – some places yes, some no.
        A lot of docs are now referring patients to dedicated pain management centers, which are great if they’ll take you, but many won’t take Medicaid etc (see DocA’s comment above).

        • DocAmazing

          Add in another complication: in California, if I undertreat your pain, I can go tojail. For reals. So it’s a fine line we walk.

          • sharculese

            Skeptic’s Guide talked about this a couple weeks ago in the similar problem of antibiotic prescriptions – even if doctors know about the problem of over-prescribing antibiotics, in the case of individual patients the duty of care still exists.

            They also concluded that the solution was more aggressive education on how to handle these situations, especially for primary care docs.

            • DocAmazing

              “Handle”, in most cases (at least in my experience) means talking some anxiety-ridden patient/parent out of demanding cutting-edge antibiotics for obviously viral infections.

              The biggest contributor to antibiotic resistance, though, is probably routine use of antibiotics in livestock feed to encourage more rapid growth. (Seems to work. I have no idea why.)

              • ThrottleJockey

                +1,000. The FDA should’ve gotten after that decades ago but Farm Lobby.

  • K

    you seem to have misunderstood me i wasnt speaking literally i meant that people who were sell drugs need to go to prison not the people that use them. that includes people selling on street corners and also airports and other places like people who sell out of their cars and also the people who go house to house and sell. people who sell drugs need to be dealt with because drugs will mess people up. i used like near people who used meth and they were really messed up the people who are selling it need to be stopped.

  • K

    brad you are making the mistake of insulting me. i didn’t come here to cause trouble i can here to debate things civilly but all you do is insult me. im not opposed to everything you guys want so it would be a mistake to keep insulting me for no reason.

    • busker type

      tell me more about Bill ‘n Hill’s airport drug emporium.

      • alex284

        I can’t think of a better place to sell drugs than an airport, what with the total lack of security there. It’s just the sort of thing 2 yale law school grads would do to earn cash… is there really any other marketable skill for their degrees?

        • Dennis Orphen

          Get rid of those annoying hare krishnas first. Then worry about the dealers.

        • Best Duty-Free shop EVAH!!

    • Malaclypse

      We insult you because you are demonstrably stupid.

  • Apparently our Gov’t, our Big Thinkers learned absolutely nothing, zero, ZIP from “Prohibition” and the stupid “War on Drugs”. Or maybe they did, and they LIKE having a country torn apart by addiction and violence?

  • Dilan Esper

    If our society and government was not so moralistic about both recreational drugs and palliative care, I would be fine with having a public policy discussion on what to do about this.

    In the world we actually live in, we should have the most liberal policy possible with respect to legal access to drugs.

    • ThrottleJockey

      We don’t need the most liberal policy, we need the most correct policy. Addiction to opiates is a pretty serious thing and it catches many if not most people completely off-guard. We want to make sure people get pain relief, but we don’t want them to get addicted either. We can see the result of that in Princes’ recent death.

      • Dilan Esper

        The problem is that policymakers who are obsessed with stopping people from enjoying themselves or voluntarily killing themselves will never get you that correct policy anyway.

      • alex284

        I don’t think an opioid tax would have stopped prince.

        • ThrottleJockey

          An opiate tax is no the most correct policy, its just a dumb policy. To call it ham handed would be to insult ham. Further, using the proceeds to hand out block grants to states is a recipe for malfeasance and failure.

          • DocAmazing

            A ham reduction strategy?

            • Warren Terra

              A ha! Creeping Shariah!

      • cpinva

        “We can see the result of that in Princes’ recent death.”

        no, we can’t. Prince died from not well treated chronic pain. had he been appropriately taken care of by the medical profession, he wouldn’t have needed to take anything more than what was prescribed. clearly, that was not the case. the problem with pain is that you can’t see it or measure it, so Dr’s are kind of dependent on the patient describing the pain, and attempting to find out the root cause of it. in most cases, the root cause can be fixed, and no more pain, and I go happily on my way pain and drug free.

        unfortunately, there are other kinds of pain, where the root cause either can’t be identified, but the pain is obviously very real, or it can be identified, and nothing can be done to fix it, the patient just has to deal with chronic pain, possibly for the rest of their lives. and that’s where meds like Oxycontin come in, long-term relief for chronic pain. my Dad was on them before he passed away (from old age) a year and a half ago. it helped both he and my Mom. and you know what? if he was addicted, so what? who the fuck cares who actually counts to my family? no one, that’s who. and if they help me get through my day, through my work and dealing with my terminally ill wife, who the fuck else’s business is it, as long as I’m not robbing 7/11’s to pay for them? no one’s, that’s who’s.

        • ThrottleJockey

          Well if Prince can’t get good medical treatment then its hopeless for the rest of us…I can’t begin to understand what its like to deal with your situation, but I hope you recognize that other families face different situations. There’s a dialogue below from the Minneapolis Star-Tribune about one woman who got hooked on opiates after trying to cope with the pain of fibromyalgia. Since every person’s situation is different we need to have a public policy that humanely helps people address their unique situation.

          MP: This sounds frightening. What did it feel like?

          JM: The feeling of respiratory depression is really scary. It is beyond your control. It is almost as if you are lying down and someone is stacking bricks on your chest. You can’t breathe. I am very fortunate that I didn’t die.

          MP: I know that this question may be going too far, but I’m still going to ask it: When you experienced that feeling of respiratory depression, were you ever at the point where you just thought, “Maybe I should surrender to this?” If you’d rather not answer, I’d respect that.

          JM: Actually, it’s a really great question, because so many people are overdosing these days and a lot of the discussion about addiction is being driven around whether people who fatally overdose actually do it on purpose. I personally think that a lot or even most of these overdoses are accidents. People don’t actually want to die. They either have taken heroin that is spiked with a drug that is stronger than they thought it was, or they take an opioid with alcohol or a benzodiazepine and that makes it fatal.

          Those few times when I experienced respiratory depression, I didn’t want to die. I had a young child and I wanted to stay alive for him. One of the reasons I got sober was because I wanted to be present for my son and for other loved ones in my life. Then, as I started to get better, I realized that I had things I wanted to do in life that might actually help other people and I needed to stay alive and sober in order to do that.

          • Origami Isopod

            JM is:

            Jennifer Matesa, blogger, recipient of a SAMHSA Voice Awards Fellowship, and author of “The Recovering Body: Physical and Spiritual Fitness for Living Clean and Sober.”

            Yes, just the kind of “expert” I’d trust to tell me about addiction.

            SAMHSA, I note, is flogging Reefer Madness in their most recent newsletter.

  • NeonTrotsky

    It strikes me that this really wouldn’t do much about the problem anyway. Opiates are addictive, therefore they presumably are very price-inelastic. Hell its not like prescription drugs are cheap as it is.

    • cpinva

      “Hell its not like prescription drugs are cheap as it is.”

      they are, if you have health insurance, which everyone is supposed to have now. actually, pain meds are cheaper than anti-biotics and other kinds of meds, by comparison. I get a 30 day’s supply of 10mg Oxycodone (60 tabs), for a co-pay of $2.50, a hell of a lot cheaper than a Z Pack of anti-biotics.

  • Warren Terra

    I don’t trust Manchin, and I’m open to this being a bad idea; that being said:

    1) It’s important opioids be available, people need the pain management.
    2) Legal availability of opioids will increase the misuse of opioids, and increase or dramatize the need for facilities and programs treating problems associated with opioid misuse. This doesn’t override (1) but remains an issue.
    3) It’s a good idea to subsidize or fund such facilities and programs.
    4) Why not build the cost of such subsidies into the cost of making and selling opioids? Doesn’t that make sense?
    5) One answer to (4) is if building the cost in interferes with (1), and means people have trouble getting the medication they need. But: medication costs shouldn’t prevent people from getting the medication they need (within reason) no matter what. If people are having trouble affording their prescribed medication, that’s a problem unlikely to result from a small tax ($0.01 per pill is mentioned in the first comment or so?), and we could address it directly.

    Of course, if we do come up with the public healthcare subsidies to pay the opioid tax to pay the drug abus centers it seems like we’ve paid for the drug abuse centers inefficiently. But that aside, the basic idea doesn’t seem to me obviously crazy or abusive.

    • Denverite

      Manchin’s proposal is a one cent tax PER MG, which ends up being a couple of bucks per pill. The intertubes tell me the street value of percocet is $5 per pill, so you can do the math.

      • Warren Terra

        Okay, so his specific proposal seems extortionate (unless, on the other hand, we really think the societal costs of legally manufactured opioids are that high). But the basic idea doesn’t seem automatically invalid.

      • ThrottleJockey

        The street value problem can be finessed. It all depends on where the in the supply chain you apply the tax. Apply it early enough in the supply chain and the black market would incur the tax as well, no?

        More likely it would just shift demand to Heroin or Fentanyl which would be worse.

    • shah8

      this sort of thing needs dedicated revenue out of central tax pool.

    • cpinva

      “4) Why not build the cost of such subsidies into the cost of making and selling opioids? Doesn’t that make sense?”

      for the very simple reason that this is a public health issue, not a morality issue. see, that’s why proposals such as Manchin have such traction, that other kinds of taxes wouldn’t have: the use of drugs (pharmaceuticals/alcohol) is seen as a moral issue (people who use these products are immoral, hence they should have the living shit taxed out of them, to teach those immoral people a thing or three!), not a public health issue, except for the AMA, maybe.

      public health issues (such as the Zika virus) potentially affect all of us, not just those immediately at risk. consequently, the cost of dealing with them should, legitimately, be borne by the entire general public, not just those at immediate risk.

      in short, Joe Manchin, or any other public official, who suggests an excise tax on a specific class of pharmeceuticals, to “fund rehab for addicts of said pharmeceuticals”, should have, if there were truly a just world and a pissed off god, have their asses kicked back into whatever slimy hole they crawled out of.

      • Colleen

        But of course, we aren’t even dealing with the Zika virus by funding mosquito control, patient education and increased access to birth control in areas of concern. The bill is still awaiting reconciliation in Congress and the House bill doesn’t increase funding, just moves some money away from Ebola and other programs.

  • vic rattlehead

    I’m apparently in the minority of people who experiences no nausea or any other noticeable side effects from opiates (aside from the constipation). That scares me, because I felt really fucking good with no downside on Percocet. But I wouldn’t want to reduce access or create even more of a black market.

    • cpinva

      me too, including the constipation, which seems to be about the single most common side-effect.

    • Colleen

      I’ve had Percocet once after having 2/4 wisdom teeth removed and it was a nightmare. Endless vomit which is super fun when one side of your jaw is sewn shut.

      I also have never had a doctor that was quick to prescribe pain medications. I had one oral surgeon prescribe a single pill for pain after removing a tooth for an implant. Even that was only because he said it was the worst removal of his career.

      • vic rattlehead

        I honestly don’t know what’s normal with narcotics. My oral surgeon prescribed me 20 percocet. No questions about history of addiction in my family (which there is). And this was New York, presumably a state with a functioning regulatory apparatus when it comes to this type of stuff.

  • The Temporary Name

    Oh so dumb.

  • Gwen

    At the risk of sounding like a moron or Matt Yglesias (possibly both), wouldn’t it just be cheaper to legalize marijuana?

    Sure, it’s not a hard-core painkiller, but it ought to let people get their jollies in a safer way.

    • busker type

      I’m all for legalizing weed, but I’d be really surprised if legal weed made any dent in opioid addiction… these are very different drugs.

      • DocAmazing

        Actually, used properly, cannabis (see? I’m all professional and stuff) can be quite effective against chronic pain and can decrease the need for opioids and other breakthrough-pain medications. It just isn’t legal in a lot of places, and not at all for minors. (You might want to write a prescription for pot for a fourteen-year-old with chronic migraine; I’m just going to broadly hint about its probable efficacy and general availability and keep my license, thankyouverymuch). They are indeed different drugs, but they both have a role in treating pain.

        • busker type

          Oh, I get it now… Yeah, that makes sense. I thought the notion was that addicts would turn to pot I steadof pills or heroine.

        • DocAmazing

          And along those lines, I give you the irreplaceable Lee Fang:

          http://www.thenation.com/article/anti-pot-lobbys-big-bankroll/

          tl;dr: Anti-pot lobbying groups are hugely funded by drug companies like Perdue Pharmaceuticals, proud manufacturer of OxyContin. Very civic-minded of them, I’m sure.

          • Dennis Orphen

            Let them tattoo Scumbag on their foreheads. It makes them easier to identify.

    • cpinva

      “Sure, it’s not a hard-core painkiller, but it ought to let people get their jollies in a safer way.”

      and there’s the catch. while I’d happily indulge in a few bong hits in the evening, after work and all the house chores of the day are done, it wouldn’t relieve the chronic pain from both of my shoulders. unfortunately, only the opioids seem to do the trick, for me anyway. in fact, absent the opioids, I suspect the pain would be kind of a buzz kill.

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    • ironic irony

      Okay, I don’t want you to take this the wrong way, but……

      The people who blog/comment here (myself excluded) are REEEAAALLY fucking smart, and if you post incoherent arguments with run on sentences, they cannot take you seriously. If you post arguments with no citations, references, or links from legit sites, your argument with be dismissed quickly.

      Work on those things first, then try again.

      Good luck.

      ETA: WELL, DAMN IT! Lol.

      • cpinva

        “Okay, I don’t want you to take this the wrong way, but……”

        actually, I kind of hope whoever it was that you were responding to does take it the wrong way.

  • Aaron Morrow

    Should this federal money be given to the states for a specific purpose, rather than being granted with few strings under a block grant?

    Seriously. I’d like to hear specific arguements for categorical grants vs. for block grants in this instance if anyone else cares.

  • altofront

    There was a great article in the LA Times about the marketing of Oxycontin last month. If I recall correctly, Purdue Pharma had determined that the most profitable way to prescribe the drug was on a 12-hour schedule: more frequent doses would risk insurance companies not covering the drug. So they made 12-hour pain relief the center of their massive marketing campaign, and told doctors that it should only be prescibed on a 12-hour schedule.

    Unfortunately, at standard doses Oxycontin doesn’t actually last 12 hours for many people. Purdue’s recommendation: stay on the 12-hour schedule, but increase the dosage substantially so it’ll last longer. This, of course, is a recipe for addiction: patients are high as a kite for the first few hours, and jonesing hard for the last few. “Evil” seems an inadequate word.

  • Rob in CT

    In addition to those above recounting stories about docs trying to give them heavy-duty pain meds for relatively minor things, I had an ER doc try to give my then-3-year-old (low dose, I believe) Percocet for what he thought was a not-quite-fractured arm.

    Turns out it was a fracture, actually, but she was totally fine with Tylenol.

    As to the tax: terrible idea.

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