NEW ORLEANS -- Family physicians considered a handful of controversial policy measures, including whether to lobby for a tax on guns, whether to establish an immunization registry, and whether to pilot safe injection sites at the American Academy of Family Physicians (AAFP) Congress of Delegates meeting this week.

The proposed 2% tax on guns and gun ammunition, introduced by the AAFP's California chapter, suggested that revenues of the tax could be funneled into mental health support services in public schools.

Taxing Guns

More specifically, the chapter proposed expanding access to behavioral health therapists; designing strategies for identifying at-risk children; offering parenting classes; and providing post-incident support for students who are affected by gun violence.

Tax revenues could also be spent developing a curriculum for life skills classes to include conflict resolution, mindful meditation, and anger management, the resolution stated.

In committee discussions on Monday, supporters of the resolution spotlighted the rise in school shootings and suicide and the lack of mental health resources in schools.

On Tuesday, when the resolution came before the full Congress, Jesus Lizarzaburu, MD, a delegate from Virginia, speaking on his own behalf, was among the opposition.

While he agreed that increasing funding for mental health was laudable, he argued that taxing gun owners seemed both "political" and "punitive."

"If we truly want to get more funds for mental health support, I would be a lot ... happier to tax cell phone use," Lizarzaburu said to loud applause.

Sarah Woolsey, MD, a delegate from Utah, also opposed the proposed tax.

"This is a community problem, it needs to be solved, and taxing gun owners is not the avenue for that," she said.

Others saw the tax as an appropriate solution.

Jeffrey Luther, MD, a delegate representing AAFP's California chapter, argued that there was "ample precedent" for using certain types of taxes to support public health initiatives, especially those that aim to improve children's health and safety.

Tobacco and alcohol are just two examples, he noted, adding that it's "not much of a stretch" to add guns to the list.

Following a voice vote, the proposed resolution was not adopted.

Tracking Immunizations

A separate resolution seeking to create a national web-based immunization registry for children and adults, introduced by the South Carolina chapter of the AAFP, was adopted, after some discussion on Tuesday.

The original resolution had two parts, one of which suggested that the Department of Health and Human Services (HHS) be responsible for overseeing any such registry.

"We need one search to keep up with all immunizations," said Hugh Morgan, MD, a delegate from South Carolina, who testified before the full Congress that creating a national registry would lessen the burden on clinicians, reduce taxpayer waste on repeat vaccinations, and help ensure appropriate vaccination of unvaccinated patients.

Morgan also noted that while some states have their own registries, interoperability among them is lacking.

Michelle Jones, MD, a delegate from North Carolina, also expressed support for a single registry, noting that she has difficulty tracking such information when patients leave the state.

"I don't have the data to prove this, but I think that vaccination opportunities are missed, because we don't really know what kids have had and what they haven't had," Jones said.

However, Scott Dunn, MD, a delegate from Idaho, opposed the idea: "What we want is, we want to be able to access previous records of immunization, and linking all of the state registries would accomplish that, without creating another federal [registry], which in Idaho might actually dissuade people from participating," he said.

Several delegates suggested that they would not support HHS overseeing the registry, although Madalyn Schaefgen, MD, a delegate from Pennsylvania, who supported the resolution, said there wasn't another organization appropriate for the task.

Ultimately, the resolution calling for the establishment of a national immunization registry was adopted, but the resolution requiring HHS oversight of such a registry was not.

Controversial Harm Reduction Policies

A resolution supporting efforts to pilot safe injection facilities (SIFs) in the U.S., an issue that often incites heated debate, sailed through the Congress unopposed.

The policy measure called not only for the AAFP to support the testing of SIFs -- places where people can use illicit drugs under medical supervision -- but also to lobby state and federal authorities to explore ways to overcome barriers to their implementation, including developing legal protections for medical providers working in the presence of illicit substances.