Searching for Alternatives to Opioids -Way Too Late

http://acsh.org/news/2017/01/10/searching-alternatives-opioids-way-too-late-10676

Anyone who reads a newspaper these days has been exposed to the ongoing hysteria concerning a so-called (and largely fictitious) “epidemic” of deaths due to prescription opioid drugs.  Nine months after the issuance of a highly restrictive CDC guideline, we are learning that the CDC writers group for the most part ignored the input of expert pain management specialists as they developed their guidelines on opioid prescription for chronic pain.  Worse still, the consultants violated the CDC’s own research protocols, in what appears to have been an effort to bias the outcomes of their work against the use of prescription pain relievers – regardless of the reality that available medical evidence fails to justify such action [Ref 1]. 

In the meantime, tens of thousands of chronic pain patients have had proven and essential pain medications arbitrarily reduced or outright withdrawn by doctors afraid of being maliciously prosecuted by the US Drug Enforcement Administration for over-prescription.  Doctors are leaving pain management, often “dumping” hundreds of their patients without referral.  Some patients have committed suicide, unable to deal with the agony and disability that their own government has imposed on them. Others may follow.

An especially disturbing aspect of this policy debacle is that restrictions on prescription opioids have occurred in the absence of clearly effective alternatives for pain management or relief.  This is despite a program of research mounted by the US Government including the Agency for Healthcare Research and Quality (AHRQ, within the US Department of Health and Human Services).  Most recently, AHRQ has issued a public call for comment on a series of questions intended as a basis for analyzing available medical evidence pertaining to “noninvasive, non-pharmacological treatment” of five types of pain in adults:

• Chronic low back pain
• Chronic neck pain
• Osteoarthritis related pain
• Fibromyalgia
• Tension headache (excluding migraine)

The types of medical interventions discussed by AHRQ as potential treatments include “exercise (e.g. physical therapy (PT), supervised exercise, home exercise, group exercise), psychological therapies (e.g., cognitive behavioral therapy, acceptance and commitment therapy, biofeedback, relaxation training), physical modalities (e.g., traction, ultrasound, TENS, low level laser therapy, interferential therapy, superficial heat or cold, back or neck support, magnets) manual therapies (e.g., manipulation, massage) mindfulness and mind-body practices (e.g., meditation, mindfulness-based stress reduction, Yoga, Tai Chi, Qigong), acupuncture, and multidisciplinary/ interdisciplinary rehabilitation” [Ref 2].  For each type of pain, three “sub-questions” are addressed:

1. What are the benefits and harms of noninvasive non-pharmacological therapies compared with sham treatment, no treatment, waitlist, attention control or usual care?
2. What are the benefits and harms of noninvasive non-pharmacological therapies compared with pharmacological therapy?
3. What are the benefits and harms of noninvasive non-pharmacological therapies compared with exercise? (for tension headache, “exercise” is replaced by “biofeedback”)

These questions are supplemented by one other general inquiry: “Do estimates of benefits and harms differ by age, sex or presence of co-morbidities (e.g. emotional or mood disorders)?”  Overall observations are also solicited (note: public commentary will be closed on January 16, 2017).

I read these questions against a background of 20 years of active participation as the spouse and father of chronic pain patients.  I am also a technically trained information miner and research analyst who daily interacts with hundreds of pain patients via social media.  As a peer to peer support site moderator, healthcare writer and patient advocate, I have communicated with well over 15,000 people in pain, and heard their experience with just about all of the “noninvasive” techniques noted above.

Having myself commented at the AHRQ gateway, my fundamental question about this process is “Are you people SERIOUS?”  If you had been talking with chronic pain patients themselves instead of your presumably educated colleagues, you would already understand the status of these so-called alternative therapies.  Not to put too fine a point on this, but they seem to temporarily help fewer than half of those treated – and even smaller numbers when pain is sufficiently severe and sustained that opioid medication would even be considered as an option by a Board Certified specialist in pain management.  

The AHRQ Draft Analytical Framework contains a number of obvious non-starter assumptions that should prompt its being thrown out and done over from scratch. Primary among these assumptions is the notion that opioid treatment of chronic pain is only temporarily effective and entails a high risk of patient addiction.  I have read letters and postings from or talked with hundreds of patients who have used opioids at high stable doses for years, with strongly positive effect in maintaining the quality of their lives and no evidence of addiction behaviors.  Just about any pain management specialist that you bother to consult will confirm this observation.

Just as bad is a fallacy in the present analytical framework— the apparent assumption that emotional or mood disorders may comprise a cause of chronic pain.  While erudite papers are published by practitioners of so-called psychosomatic medicine, what I see is a much different picture from their optimism.  I have never talked with a chronic pain patient in whom any form of Rational Cognitive Therapy has been effective against medically diagnosed pain.

Psychiatric professionals have little to offer beyond assistance with anxiety and stress control – and much to answer for in their too-often casual assumption that “the pain is all in your head.” Appearance of a mental health diagnosis in a patient record can literally be the kiss of death for ongoing medical assessment and effective treatment.  Sometimes it is the kiss of death for the disregarded and isolated patient him/herself. [Ref 3]

Several other factors are of concern in this framework.  For instance, chronic neck pain and low back pain are not single medical entities.  They are symptoms of multiple underlying disorders, sometimes neurological, sometimes neuropathic and not infrequently caused by treatment itself, particularly surgery.  Medical treatment and patient response to treatment can vary significantly between individuals.  Moreover, it is common for chronic pain patients to deal with multiple medical disorders which include forms of neuropathic pain — which AHRQ has chosen to exclude from its studies.  Such complications will likely confound the extraction of convenient generalities concerning either primary therapies or alternative treatments.

My recommendation to the AHRQ is to withdraw the draft analytical framework and solicit the help of the American Academy of Pain Management in re-drafting it.  Then advertise widely for participation in review by pain patients themselves and their doctors.  As an old but often true cliché would have it, it can be very difficult to get where you want to go when you start out not knowing where you are.  And you folks clearly don’t.

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Marine Vet Suffering From Chronic Pain Writes Congress

nationalpainreport.com/marine-vet-suffering-from-chronic-pain-writes-congress-8832641.html

By Ed Coghlan

With the coming of a new President, comes a familiar promise – to do more for the country’s military veterans with an eye toward reforming the VA Medical System.

No disrespect to President-elect Trump, but there doesn’t seem to be much in his plan that screams change.

As Newsweek wrote: “So what’s his plan? On Trump’s website, there’s a 10-point V.A. reform “vision.” But that plan basically amounts to firing bad managers, hiring better ones and then taking some other unspecified steps that fall under the heading of “modernization” while maybe putting more money toward providers.”

While President Obama’s performance in reforming the VA has largely gone wanting, veteran groups actually asked Trump to keep VA Chief Robert McDonald, the former Proctor and Gamble CEO who has run things since 2014.

In addition to the normal VA shortcomings, National Pain Report readers know that veterans have been hit hard by the CDC Guideline for Prescribing Opioids for Chronic Pain.

We are publishing a story today – not to review VA shortcomings – but because we received the copy of an interesting and personal letter written by a former Marine to Congressional representatives and staffers and the media about what the guidelines have done to him.

Robert Rose

His name is Robert Rose and he lives in Gray, Tennessee and his letter, spawned by what he felt was an unfair news story. We asked him for permission to republish some of the letter which he tells his story in a way that may be familiar to some of his fellow vets.

“Personally these guidelines and the “opioid safety initiative” have had a devastating effect on my family and my quality of life. First, because my mother and sisters do not understand the true extent of the injuries to my body and the havoc they incite in my body and mind. Therefore it is impossible for them to comprehend why I would challenge the government or the Veterans Administration. Actually with their limited knowledge about my situation they consider me a “pill popper” and just another veteran addicted to drugs because of the VA’s ineptitude. What else are they supposed to think considering some of the shoddiest reporting since beginning of the technology age (in many aspects the old gumshoe reporter is preferred). The result of this nightmare, we are barely on speaking terms.

Robert Rose shopping

Closer to home, my wife and sons do understand the challenges I am faced with due to the chronic pain, blackouts and constant struggle to simply be a man. They do in fact support me for standing tall (metaphorically) in this struggle. Regrettably I am an old school Marine infantryman which makes me very hardheaded. I see a problem and I attack, attack, attack head on. My boys believe I need to be more politically correct such as omitting references to Jesus Christ my Lord and Savior. To me, this would be tantamount of denying my God (see below) and spending an eternity in the real Hell and not just the one the Veterans Administration has created for so many. This one ends, the other is for eternity.

Additionally, because the pain and sleep deprivation created by being denied pain medications due to the “opioid safety initiative,” there’s something within my mind or body which generates an anger deep inside. Sporadically this fury erupts on my wife (and sometimes my sons) sporadically. God has blessed with enough self-control to not employ physical violence but anyone who had been in an abusive relationship can tell, sometimes the anger and the words do more damage.

This woman has stood through thick and thin for thirty years. The Marines, rehabilitation after my medical discharge, severe bouts of depression because I was once again a “civilian,” a graveyard shift in a prison while I attended college during the day, and so much more. If anything this woman deserves a monument erected in her name because as many of you know, I can be and am an “obnoxious asshole.” As a consequence of this nightmare, and the suffering they see daily as I simply try to walk upright to the restroom, it is taking a severe toil on my beautiful wife. Worse considering I have been waiting five years for an appeal from the Veterans Administration so that I might finally be eligible for health insurance to care for her cancer (in remission), heart issues (her mitral valve was replaced with a St. Jude mechanical valve), all her medications, specialists needed on top of all her the anxieties of having been on death’s door three separate times (and still is according to her) because of these conditions. Prior to October, I was doing everything in my power to care and provide emotional support to her. Going to the store, cooking, whatever she needed I was there. Only now, it is a struggle for either one of us to care for the other. Now, I pray daily I will not snap or yell at her because of my own weaknesses.

One other casualty of this campaign of misinformation is Sparky, our Yorkie. This is my wife’s constant companion (I believe she loves him more than even me). Unfortunately Sparky is getting on in years and has been diagnosed with arthritis among other things that occur to his breed as they age. We ran out of his medication in early December 2016. We have been so debilitated by our respective conditions, we have been unable to schedule an appointment for him to alleviate his suffering. How many others are dealing with similar situations simply because someone is getting rich off our ordeal created by the CDC guidelines? 

As you can see, these are real life issues brought about faulty (and fraudulent) research by the CDC, the DEA and other interested parties. People are suffering and only you, our esteemed representatives and caring professionals, can put an end to this madness.”

We’ve asked Mr. Rose to keep us apprised of any response he get.

In the meantime, let us know your thoughts.

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“Hooked Rx: From Prescription to Addiction”

https://cronkite.asu.edu/news-and-events/events/featured-event/%E2%80%9Chooked-rx-prescription-addiction%E2%80%9D

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This is a section of the CDC opiate dosing guidelines…  Those prescribers and corporations that create policies and procedures based on portion of this guidelines and not the guideline in its entirety may be walking into a legal minefield.

This is just ONE PARAGRAPH from the CDC guidelines… but contains a lot of very important information that if a prescriber or prescriber group ignores or chooses to omit from the policies and procedures … could put them at legal/financial risk of malpractice, failing to meet a standard of care and best  practices, pt abuse for starters..

First of all the guidelines are based on “limited information” and are VOLUNTARY and primarily directed towards primary care clinicians.  Pts in need of palliative care – most/all chronic pain pts – has cancer and/or terminal are AUTOMATICALLY EXEMPT from dosing limits.

Primary focus of the guidelines The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.

The very act of arbitrarily reducing a pt’s dose/medication(s) causing the pt to endure increased pain levels, become house/chair/bed confined because of increased pain – that were previously being well/better managed.. would seem to be in direct conflict with the intent of the guidelines.

Finally, it is clearly stated in these guidelines that Clinicians should consider the circumstances and unique needs of each patient when providing care.  So once again, a prescriber that arbitrarily limits a pt’s medication therapy would seem to be in conflict with these guidelines.

Likewise, a prescriber practice and/or an employer entity – like a hospital – mandates these guidelines and dosing limits be followed… would appear to be “practicing medicine” … for which they don’t have the legal authority to do.

I am not an attorney, but large medical practices or corporate entities (hospitals) that implement only portions of these guidelines … while ignoring other portions of these guidelines… could be setting themselves up for some law firm that specializes in class action lawsuits… since the harm to pts could and should be consider INTENTIONAL by their actions… and intentionally harming another human being via a specific action(s) or lack of action(s) could have legal/financial consequences.

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

This guideline provides recommendations for the prescribing of opioid pain medication by primary care clinicians for chronic pain (i.e., pain conditions that typically last >3 months or past the time of normal tissue healing) in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care. Although the guideline does not focus broadly on pain management, appropriate use of long-term opioid therapy must be considered within the context of all pain management strategies (including nonopioid pain medications and nonpharmacologic treatments). CDC’s recommendations are made on the basis of a systematic review of the best available evidence, along with input from experts, and further review and deliberation by a federally chartered advisory committee. The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function, and reduce the number of persons who develop opioid use disorder, overdose, or experience other adverse events related to these drugs. Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context. The recommendations in the guideline are voluntary, rather than prescriptive standards. They are based on emerging evidence, including observational studies or randomized clinical trials with notable limitations. Clinicians should consider the circumstances and unique needs of each patient when providing care.

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https://www.consumeraffairs.com/rx/riteaid_rx.html

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Internal Server Error

The server encountered an internal error or misconfiguration and was unable to complete your request.

Please contact the server administrator, webmaster@pharmaciststeve.com and inform them of the time the error occurred, and anything you might have done that may have caused the error.

More information about this error may be available in the server error log.

Additionally, a 500 Internal Server Error error was encountered while trying to use an ErrorDocument to handle the request.

I have exchanged some emails with my ISP and because of increased traffic on my blog along with some issues with Word Press … there are some intermittent errors being thrown…

Fortunately, nearly 100% of the time when a post is being made and this error is thrown… the post is actually saved to the blog… if you just refresh the screen… things will come back to normal…

Technology that is outside of my doing anything about it… except asking everyone has some , patience while those providing services for my blog… make some adjustment to make this problem less frequent

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Carrie Fisher’s Urn Is Her “Prized Possession” Antique Prozac Pill

http://www.hollywoodreporter.com/news/carrie-fishers-urn-is-a-huge-prozac-pill-961625

I wonder where she got that “Prozac pill” in the 50’s… since Prozac was not brought to market until 1987 ?

The family will plan a public memorial for Fisher and mother Debbie Reynolds in the future.

Carrie Fisher was always making people crack a smile in life, and she made sure she got just one more out of them in death.

It was revealed on Friday that Fisher’s ashes were placed in a gigantic Prozac-pill urn.

“It was a porcelain antique Prozac pill from the ’50s that was one of Carrie’s prized possessions,” Todd, Fisher’s brother, told The Hollywood Reporter.

Fisher died after suffering a heart attack late last month. She was 60. Her mother, the iconic starlet Reynolds, died a day later. She was 84.

Fisher was honest and open about her battles with drugs and mental illness throughout her career. She also had a kooky sense of humor, so it makes sense the Princess Leia actress would want her urn to resemble an antidepressant pill.

A private gathering for friends and family was held in Beverly Hills on Thursday. Meryl Streep was among those in attendance.

Todd Fisher has said the family will plan a public memorial for the two actresses in the future.

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Below  (IN BLACK)  is the second email that I have received in the last couple of days from chronic pain pts where their “pain clinic” has decided to CAVE to the CDC guidelines… SCREW … practicing medicine… just care for pts “BY THE NUMBERS”..  That is NOT PRACTICING MEDICINE… that is just filling in the blanks on a bill and collecting money for doing so.. A grade schooler could do that … Apparently we have another epidemic going on… pain specialists and prescribers that are becoming SPINELESS and BALL-LESS. 

Below is my response to this pt (IN BLUE) ..might save me having to answer a number of similar emails that I presume it is just a matter of time before they start flooding my email inbox.  Feel free to share this to the far corners of our country.

Medicare/Medicaid/Medicare Advantage have a new Star Rating System and the less STARS a healthcare provider ends up for the year ( hospitals, prescribers, pharmacies , Part D, Medicare Advantage provider, etc ) the less they get reimbursed the following year… and if they don’t have ONE YEAR out of three getting at least a THREE STAR RATING… they could be toss out of being a Medicare/Medicaid provider.  They lose STARS by pts filing GRIEVANCES with www.cms.gov (800-MEDICARE) for “PISS-POOR CARE”.  Here is a recent post   769 Hospitals Penalized For Patient Safety In 2017: Data Table  where 769 hospitals are getting REDUCED REIMBURSEMENTS in 2017  because pts FILED GRIEVANCES with www.cms.gov… if pts don’t SPEAK UP when they are provided poor/bad care.. they will continue to receive poor/bad care.  Most healthcare providers don’t want their reimbursements lowered….nor.. do they wish to get booted from the Medicare/Medicaid provider network. Over 200,000 people die every year from medical errors….but … the general public hears very little about this…  IT IS A BIG SECRET !!  That is like 800 commercial airliners FALLING OUT OF THE SKY EVERY YEAR and everyone on board DYING…  If that happened… how many people would continue to fly …but we keep going to hospitals and healthcare providers !!!!

Get you a copy of the CDC guidelines and point out to them that pts who are terminal, cancer, Hospice or require palliative care are EXEMPT from the dosing limits… Here is the World Health Organization’s definition of palliative care  https://palliative.stanford.edu/overview-of-palliative-care/overview-of-palliative-care/world-health-organization-definition-of-palliative-care/

The idiots who wrote the CDC guidelines.. apparently believed that palliative is part of Hospice but in reality palliative care can be its own singular stand alone modality and is not totally inclusive of Hospice.  There are two ICD10 codes (diagnostic codes) that are to be used for a pt needing palliative care…  IMO.. most/all chronic pain pts can easily have the ICD10 palliative care code added to their lists of diagnoses.

Have they performed the CYP450 enzyme testing on you to determine if you are a fast/ultra fast metabolizer ?  https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/cytochrome-p450-testing-high-dose-opioid-patients    Looking at the two particular enzymes 2D6 & 2C9 for abnormalities.  This should also help justify your higher than CDC  dosing limits.

If this does not budge them.. and you have a spouse or significant other there is always suing them for your significant other suing them for loss of consortium and companionship. https://www.pharmaciststeve.com/?p=12615  These type of lawsuits normally have a 300,000 – 400,000 limit on damages and should be large enough for an attorney take a case on …on a contingency basis… they take a per-cent of award.  Since this appears to be more than a single prescriber practice… and this is a decision of all the prescribers and the practice itself… might find an attorney to go after class action… surely a pain clinic has a fair number of pts that fit in the same mold that you do.  I just looked up DNA Advanced Pain Treatment Center and they have TEN PRESCRIBERS listed on their website… that is a lot of deep pockets for a law firm to go after…

If they still insist on pulling your dose back … especially if they fail to do the CYP 450 testing and/or they do and you are a fast/ultra fast metabolizer… presuming that you are on Medicare/Medicaid/Medicare Advantage you should file a GRIEVANCE with www.cms.gov ( 800-MEDICARE) for failing to follow standard of care and pt/senior abuse.. because cutting back your dose will make you house/chair/bed confined and unable to do personal care items… take a bath, brush your teeth, prepare meals etc…  I would also file a grievance with the state medical licensing board for the same.  Once the new AG/head of DOJ gets into place.. I would file similar grievances with Americans with Disability act.

Hi Steve, well I received the infamous letter from the pain clinic I have been going to for 7 years.  It states”DNA Advanced Pain Treatment Center will be following the CDC recommendations & policies on the dispensing of controlled substances including opiate medications.  Because of these policies, there will be adjustments made to your medications that will result in a result in a reduction in your dosage.  If this is not satisfactory to you we can provide you with a list of providers that may be willing to continue your medication. If you would like to discuss the changes with your practitioner, we would be happy to schedule an appointment to give you an opportunity to do so….Steve I would appreciate anything you could suggest to fight this uphill battle as u hav in the past made suggestions.   I hav had 4 hip surgeries & am in chronic pain & unable to walk very well or live life to it’s fullest extent.  I am om opana er 40mg tid & oxymorphone 10 IR QID prn  opana 15mg ER prn bid. These meds hav made life so much easier to get the activities of daily living done along wth being more apt to socialize.  Can you suggest what to do to reclaim my existence again?  I would so appreciate your help Steve.

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Judge Rules Insurance Company Must Pay for Injured Worker’s Medical Marijuana

hightimes.com/news/judge-rules-insurance-company-must-pay-for-injured-workers-medical-marijuana/

In what could become a precedent-setting decision, New Jersey Judge Ingrid French ordered an insurance company to pay for medical marijuana for an injured worker who suffers from lingering neuropathic pain after an accident involving a power saw at an 84 Lumber outlet in 2008.

The worker, 39-year-old Andrew Watson, was seeking reimbursement for MMJ he’d bought in 2014 after enrolling in the New Jersey’s medical marijuana program. He also sought to be covered for the treatment in the future.

French found that Watson’s intractable neuropathic pain fell under New Jersey’s list of qualifying conditions.

The judge took into account testimony from a psychiatrist/neurologist who said medical marijuana was an appropriate treatment for Watson to reduce prescription opiates to treat his complex regional pain syndrome (CRPS), an uncommon form of chronic pain.

“Evidence presented in these proceedings show that the petitioner’s ‘trial’ use of medicinal marijuana has been successful,” French said. “While the court is sensitive to the controversy surrounding the medicinal use of marijuana, whether or not it should be prescribed for a patient in a state where it is legal to prescribe it is a medical decision that is within the boundaries of the laws in the state.”

In her eight-page decision, French wrote that Watson’s testimony was credible: “Ultimately, the petitioner was able to reduce his use of oral narcotic medication… The court found the petitioner’s approach to his pain management needs has been cautious, mature, and overall, he is exceptionally conscientious in managing his pain.”

Another expert witness, psychiatrist Dr. Edward H. Tobe, described the benefits of medical marijuana and the risks of opiates.

“Opiates can shut down breathing (whereas) marijuana cannabinoids won’t,” he said,according to an excerpt of his testimony, reported The Inquirer. “Marijuana does not affect the mid-brain. The mid-brain is critical in controlling respiration, heart rate, many of the life-preserving elements.”

John Gearney, a labor attorney who writes a weekly blog on workers’ compensation cases, said the ruling was the first in New Jersey to address whether an insurer should pay for medical marijuana.

“There are about 50 workers’ compensation judges in the state, and they will read it and see what the judge thought when a case like it comes before them,” Gearney said.

Philip Faccenda, the lawyer who represented Watson, said the decision might also benefit insurance companies.

“We believe this will offer very powerful cost savings with respect to the entire workers’ compensation industry in New Jersey,” Faccenda said. “More costly pharmaceuticals can be reduced and medical marijuana would be a less expensive treatment modality.”

Thankfully, lawyers representing 84 Lumber said in an email on Thursday that they don’t intend to appeal the decision.

“With respect to the recent decision, we respect the court’s decision,” the email read. “At this juncture there is no plan to appeal.”

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Philadelphia residents up in arms over soda tax hit

http://www.foxnews.com/politics/2017/01/06/philadelphia-residents-up-in-arms-over-soda-tax-hit.html

just wait until Senator Manchin gets his opiate prescription tax to help fund treating addicts

Clinton backs Manchin plan to tax opioids

Philadelphia residents are getting hit by the first big-city soda tax in the country, and they’re not happy. Pictures are going viral of hefty receipts that show the 1.5 cent-per-ounce tax adding up to several dollars extra on a single purchase.

“The magnitude of this tax is historic and Philadelphian consumers can’t afford it,” said David McCorkle, CEO of the Pennsylvania Food Merchants Association. 

When the levy was approved last year, Philadelphia became the largest city in the nation to create a specific tax for soda and sugary beverages. The tax took effect on Jan. 1, with a per-ounce rate 24 times more expensive than the state’s tax on beer.

The 1.5 cent-per-ounce rate sounds small. But it can add up on purchases of packs and large bottles.

In one photo that went viral after being posted to Facebook, a receipt shows more than $3 in tax added to the cost of a $5.99 12-pack of Propel, an energy drink. Because of the broad language, the tax captures not only sodas but energy drinks, zero-calorie diet beverages, juice and even milk substitutes for lactose-intolerant people.  

Other shoppers also sounded off.

Philadelphia Mayor Jim Kenney first proposed the tax in March 2016; it passed the City Council 13-4. The revenue will be used to fund initiatives for areas in need of improvement like community schools, parks, rec centers, and libraries – and for expanding the city’s pre-K programs.

But the city has been in a legal battle with the American Beverage Association, which opposes the measure. And the Kenney administration has gone to the state Supreme Court seeking a final legal decision. A spokesperson for Kenney told FoxNews.com that without the tax, the city cannot fund additional pre-K seats come September – and stressed it’s not technically a sales tax.

“The Philadelphia Beverage Tax is a tax on the distribution of sweetened beverages intended for retail; it is not a sales tax to be paid by the consumer and collected by the retailer,” spokesman Mike Dunn said. “There are thousands of Philadelphians who are thrilled with the infrastructure this tax will pay for, so it depends on who you’re speaking to.”

The mayor’s office said there was no “mandate” on consumers, but rather on dealers and distributors who could choose whether to increase prices.  

“Since it is not a sales tax, distributors … do not have to pass it down to their customers, the dealers,” Dunn said. “They could choose to slightly lessen their seven-figure bonuses, for example.”

But McCorkle, a plaintiff in the case against the tax, said despite what the mayor’s office says, the tax will be passed onto consumers.

“I would ask anyone in the mayor’s office to walk through a supermarket or convenience store—the consumers are seeing a dramatic increase in the price of products in these Philadelphia stores and Philadelphians will vote with their feet by finding a neighboring community where they can buy the products they want at prices they did prior to January 1^st,” McCorkle said. “If Philadelphians shop outside the city, sales decline, not only in the beverage category, but in all categories.”

McCorkle said the Philadelphia economy in general could be affected.

“I think the city needs to take a hard look at the potential impact, and we suspect that if store revenue declines, cuts have to be made somewhere,” McCorkle said.

According to the mayor’s office, Philadelphia has established a Healthy Beverages Tax Credit to help those small stores and bodegas McCorkle is concerned about. The credit is offered to “qualifying merchants who increase their inventory of healthy beverages.”

Philadelphia’s experience could shape how the soda tax debate plays out across the country. Illinois is considering a statewide soda tax, and cities including Santa Fe, N.M., are considering new local levies. 

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