The opioid epidemic, which killed 64,000 Americans in 2016, is making governments resort to unprecedented policies for saving lives and preventing addiction in the first place.

First it was the expanded access of naloxone, the overdose-reversing drug now available in many schools and pharmacies and often carried by first responders. On Monday, President Trump is set to announce new policies to fight the opioid crisis, including the death penalty for some drug dealers. Meanwhile, several states are exploring their own new policy: tax drug manufacturers for the opioids they produce.

“350 million opioid pain pills came into Kentucky last year. Drug companies get billions, our state gets nothing, and communities are devastated,” says Kentucky state Rep. James Kay, who sponsored an opioid tax bill.

Bills are also circulating in Minnesota, New Jersey, New York, Tennessee and West Virginia. They vary on tax amounts, how the law would be enforced and how the money would be used. Some propose putting the new revenue toward expanded treatment options. Others would use it for funding public schools or adding to the General Fund.

But even among supporters of taxing opioids, there are still a lot of questions: How could they prevent the tax from being passed on to consumers? Would it hurt patients who need pain pills? And could a tax actually reduce the number of overdoses and drug users?

“To prevent cancer, you tax cigarettes to get people to stop buying and smoking. But do we want to tax people’s medical treatment? That’s trickier,” says Richard  Auxier, research associate for the Urban-Brookings Tax Policy Center.

Because legal opioids aren’t a consumer good that can be bought over the counter, it’s unclear if this tax would slow prescriptions in the same way a cigarette or soda tax is supposed to deter people from consuming those things. 

“We can keep saving people [with] naloxone, but until we start talking about how [opioids] get dispensed, we’re going to keep having this problem. And the drug companies have to be a part of the solution,” says Minnesota state Rep. Dave Baker, a Republican who supports the tax.

In Baker's state, the bill calls for sending opioid manufacturers a quarterly tax bill based on how many pills were prescribed. Lower-dose opioids like codeine would be taxed less than stronger opioids like oxycodone.

“I do believe a significant tax would cut back on the supply," says Kay, the Kentucky representative.

It's no secret, though, that pharmaceutical companies spend a lot of money lobbying against laws that could hurt their bottom line. For instance, despite bipartisan anger over soaring drug prices, the industry successfully campaigned against two ballot measures in the last couple of years that would have regulated drug prices in California and Ohio.

Indeed, in Kentucky, Rep. Kay admits that getting the opioid tax bill to pass the Senate will be a challenge because pharmaceutical interests have stepped up their lobbying “three-fold” since it picked up steam. However, he is encouraged by the bipartisan nature of the proposals.

These opioid tax proposals come at a time when more than 300 states, cities and counties are suing opioid drug manufacturers and distributors for their role in the opioid crisis. Most of them are seeking monetary damages for the cost of fighting the epidemic. 

“We want to make the people who created this epidemic pay, and I empathize with that," says Auxier, the researcher. "But I just don’t know how that will work [with opioid taxes]."

Instead of passing an opioid tax now, Auxier advises states to first increase funding for substance abuse treatment and mental health care -- and then experiment with how a tax could supplement that cost. It might be more helpful to think of it like a gas tax, he says: as a tool for revenue rather than changing behavior.

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