Stephen Skoly: Opioid Stewardship Fee Straining Patients and Healthcare Community

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As the opioid epidemic rages on, with more than 100 Americans dying each day from illicit misuse, policymakers, the healthcare community, and researchers are scrambling to find a solution, and with good reason.

In Rhode Island, efforts to end the epidemic are fierce and plentiful. The federal government has issued millions of dollars to the state for opioid treatment and prevention programs, and our own Brown University is leading national efforts to find data-driven ways to treat addiction. Lawmakers, rightfully, are trying to put their best foot forward to reduce opioid overdoses, especially under the Governor’s Overdose Prevention and Intervention Task Force.

A recent report in the Journal of the American Medical Association analyzed the reversal of historical patterns in longevity and its effect on life expectancy in the United States. Despite massive healthcare expenditures we have experienced increasing mortality and falling life expectancy significantly driven by the opioid epidemic.

However, despite the critical steps we’ve made toward ending opioid abuse and addiction, last session lawmakers made an extremely hasty, ill formed policy decision. While well intentioned, it is now creating chaos within our healthcare community instead of properly addressing the problem. The Opioid Stewardship Act, an annual $5 million registration fee on pharmaceutical manufacturers and wholesalers, is finally showing the consequences that countless health care stakeholders warned lawmakers of for months. Opioid medications are now being stigmatized and becoming increasingly unavailable within the state.

As a surgeon, I deal with controlled opioid substances daily. While understandably controversial, these medications serve a clinical and legitimate medical purpose in managing postoperative analgesia, cancer, trauma, childbirth, chronic diseases and end of life palliative care. They provide patients comfort and pain relief in serious cases and are only prescribed and administered under the supervision of licensed physicians and caregivers.

Unfortunately, these medical treatments and patients are the target of the excessive fees lawmakers adopted- not the illicit substances like black-market fentanyl and heroin, which are responsible for the vast majority of overdose deaths.

We ‘ve seen the same outcomes in our neighboring state of New York, which passed a similar law last year. Pharmacies, healthcare facilities and patients are all experiencing medication shortages and increased costs. This, in my opinion, begs an important question: If Rhode Island is securing significant amounts of money from the federal government, why are they reaching into the pockets of patients for additional funding.

Beyond the clinical issues with the legislature’s response to the opioid epidemic, it is important to note that the Opioid Stewardship Act is also bad public policy. Initially intended to punish big pharmaceutical companies, the fee has proven ineffective. As a medical professional with a keen interest in understanding and promoting economic growth in Rhode Island, I have become familiar with how the pharmaceutical supply chain works in our state. We are small with no distribution centers located in state. As a result, we source our prescription medications from out-of-state pharmaceutical wholesale distribution centers. Due to this unique feature within our state, this new law is predominantly taxing the distributors servicing our pharmacies and medical facilities.

Additionally, opioid makers are facing criminal charges in districts around the country for their role in the opioid epidemic. These are the same drug makers who through their research, development and investments have pioneered innovations saving lives around the world.

If the legislature is truly interested in curbing the crisis, the Opioid Stewardships Act is not the answer. This is a short-sighted approach stemming from political motivations and it needs to be corrected before the unintended consequences become too severe, leaving patients to suffer. Our state has made strides to reduce opioid addiction and overdoses and we should continue using federal funding and university research to find the most effective solution-not the most politically-expedient one. Policy makers should look to the Hippocratic Oath, first, do no harm.

Dr. Stephen Skoly is a practicing oral & maxillofacial surgeon and Chairman of the Rhode Island Center for Freedom and Prosperity.



  • D J Dub

    Its not about patients

    Its a money grab