By Adriane Fugh-Berman and Sophie Krensky
A groundbreaking New York law designed to collect $600 million from opioid manufacturers and distributors to combat the opioid epidemic recently went into effect.
The surcharge is based on the volume and potency of opioids sold or distributed. New York invoiced 75 companies and subsidiaries; Purdue was assessed $7 million, and drug distributor AmerisourceBergen estimates it will pay $22 million. Arguing that taxing legal distribution of drugs is unconstitutional, affected companies have lodged three lawsuits against New York State.
While the interests of the companies in opposing the Opioid Stewardship Act is clear, it is mysterious why some chronic pain patients oppose the law. Several have written pieces arguing that the law will increase opioid costs to consumers and result in medication shortages.
In fact, the new law prohibits passing on costs to New York consumers, and drug companies are certainly not going to stop selling opioids.
Besides, the market for opioids ought to be a relatively small one. Opioids are very effective for acute conditions such as trauma or surgery, and are necessary for cancer pain and end-of-life care. However, these uses are inherently limited.
Patients using opioids long-term may become tolerant to the euphoric or pain-relieving effects of opioids, but they do not become tolerant to adverse effects, including respiratory depression and other potentially deadly effects.
Chronic pain patients using opioids are understandably concerned about keeping access to the drugs on which they are dependent, but the hard truth is that opioids are simply not the most effective treatment for chronic pain.
In fact, opioids can increase sensitivity to pain. The higher the dose a patient takes – and the longer the duration of use – the higher the chances of developing opioid use disorder.
Aggressive marketing by Purdue and other opioid manufacturers convinced both doctors and patients that opioids were the answer to chronic pain, but that message was based on marketing, not science.
The Opioid Stewardship Act requires manufacturers and distributors to report all opioid transactions to or within New York State to prevent irresponsible flooding of the market with opioids.
It also levies a tax to help defray costs related to the epidemic. The act supports public health and ought to garner broad support from patients and prescribers.
Adriane Fugh-Berman is the director, and Sophie Krensky the project manager, for PharmedOut, a Georgetown University Medical Center project that exposes unethical pharmaceutical marketing practices.