Guest Editorial: Tobacco Taxes and Schizophrenia
With any change in state policy there is always unintended consequences. It is estimated by researchers that 44% of all cigarettes sold in the United States are sold to people with mental illness. Studies show that persons with mental illness spend 27% of their income seeking tobacco products. It is well known there is a strong connection between schizophrenia and how nicotine works in the brain. The nicotine provides brief alleviation of psychotic symptoms or “voices” this is one reason many law enforcement officers know something as simple as a cigarette can help reduce tension.
In Florida there are 5379 individuals with a mental illness who are reported to live in a state licensed limited mental health assisted living facility. Many of these residents have a primary diagnosis of schizophrenia and 90% are addicted to smoking or nicotine products.
For most of these people the terrible consequences of nicotine addiction include cardiac problems, COPD, bladder cancer and a host of other complications. It seems to make sense, just raise the price and they will quit. This is a case of easier said than done.
Even though residents will seek to quit smoking and we get them started on the nicotine patch, because of the diminished insight that accompanies schizophrenia many will keep on smoking cigarettes in addition to using the nicotine patch, a very dangerous combination. Often once the physician knows they are doing both they will discontinue the patch out of caution.
At our facility we have a tobacco resale license which allows us to purchase cigarettes from a wholesaler. We will purchase the cigarettes each month on behalf of the residents, for what we consider to be a month's supply would generally be $38/month at wholesale prices. This provides enough tobacco for 4 cigs per time four times per day.
The new federal cigarette tax will pay for children's health insurance will exact a significant toll on persons with mental illness. According to our sources the average cost of cigarettes will increase by $6/carton and so what use to cost $38/month will now be around $56/month just for cigarettes. The next proposed wave of taxes from the state will drive up costs another $10/carton for a total of $86/month.
When you think about the problem this can create, Florida spends $250 million each year caring for the mentally ill who have committed a crime, 48% of the people charged are charged with battery on a law enforcement officer.
The utilization rates of hospital emergency rooms, already "psychosis" is the number three diagnosis seen in Florida's hospital emergency rooms. The unintended consequences of this higher cost of cigarettes will include an increase in petty crimes such as shop lifting by persons desperate for a cigarette to calm their “voices”.
There are no smoking cessation programs in place that address the needs of persons with schizophrenia. Despite the tobacco lawsuits of the 1990’s, Florida’s adults with schizophrenia have paid a higher cost in terms of increased costs associated with tobacco and the debilitating effects these products have on their general health.
For many people with schizophrenia they would prefer to get their nicotine needs met and will elect to live at a homeless shelter, take up housing in an unlicensed assisted living facility where there is no supervision or will seek housing in settings that could be best described as unstable. This all creates a tsunami for state budget planners and new challenges for patients and families.
Douglas D. Adkins, Director
Dayspring Village, Inc.
PO Box 1080
Hilliard, Florida 32046