Policymakers across the country are looking for ways to stem the tide of opioid-related overdoses and addictions. Gov. Andrew Cuomo’s idea, taxing prescription opioids, won’t do it.

My colleague, Professor Jia Goa, and I studied the real-world impacts such a tax is likely to have, and we found that, not only is the governor’s proposal unlikely to help but it may make matters worse. It could lead to higher insurance and medical costs for patients and make it harder for patients to access needed medicines — all without addressing New York state’s opioid addiction crisis.

The first and most important question on a proposal like this is: Who will pay for the tax?

Both theory and experience teach us that the answer to this question depends on the ease with which consumers and producers can change their behavior to avoid taxation. When it comes to pain management, in many cases there simply aren’t any good alternatives to prescription opioids.

And when there are few good substitutes for a product — think gasoline or cigarettes — consumers tend to bear most of the burden of a tax, because the costs can be passed on to consumers without losing most of them.

In contrast, there are lots of options for the goods’ producers to avoid taxation — such as shifting a portion of the sales to other states, where taxes are lower. Taken together, these factors suggest that consumers — patients and insurance companies — will bear the lion’s share of the tax.

The fact that most, if not all, of the cost of the proposed opioid tax will be borne by consumers means it’s likely to have unintended consequences.

Private insurance companies are likely to respond to higher prices by increasing policy premiums and passing additional costs on to consumers in the form of higher out-of-pocket prescription costs.

Since insurance is designed to spread the costs of health care over a large number of people, this means New Yorkers who may never need to take prescription pain medicine would be paying for the tax through higher premiums.

In addition, because the state itself purchases so many opioid medicines through Medicaid, New York taxpayers will end up footing the bill for the higher prices — again, regardless of whether they ever come within a mile of prescription pain medicine.

In addition to making medication more expensive, the tax is poorly designed to target addiction and abuse.

Rates of opioid abuse are small relative to medically appropriate opioid use. And since the rate of opioid prescribing is greatest in treating serious medical conditions such as cancer and post-surgical pain, the proposed tax amounts to a tax on cancer treatment, emergency medicine, surgical intervention, the treatment of chronic pain and end-of-life hospice care.

I realize “opioid tax” sounds more palatable than “cancer tax” or “hospice tax.” But when you think the proposal through to how it will actually work, “cancer tax” is closer to the truth.

Additionally — and this should alarm anyone concerned about the opioid abuse epidemic — making prescription pain medicine harder to obtain may very well push people to cheaper illegal street drugs.

These drugs are often of lower quality and increased variability in purity and potency, which increases the risk of fatal poisoning or overdose. The substitution of heroin for prescription opioids is particularly dangerous, because heroin is often laced with illegally sourced fentanyl, a powerful synthetic opiate linked to accidental overdose deaths.

The available evidence suggests extreme caution in adopting policies that may reduce the availability of prescription opioids, as any gains in public health from the reduction of prescription opioid abuse will likely be offset by a much more socially destructive rise in illegal opioid abuse and overdose deaths.

Bottom line: If you look at how the governor’s proposed tax will play out in real life, it will increase the cost of medical care in New York and, far from stemming the opioid crisis, may actually make it worse.



Lewis Davis is a professor of economics at Union College.