Congress Should Pay Attention to State Solutions to Opioid Crisis
One hundred fifteen people needlessly die every day across our states from opioid overdose. That’s almost 42,000 deaths from opioids each year. One person’s death to the scourge of opioids is one too many, but this public health issue has not been given the attention — and federal action — it deserves. In 2017, opioid overdoses killed more people than breast cancer, while there were only 30,000 deaths from prostate cancer.
While no one denies the criminal component of illegal opioid use, legislators must address the opioid epidemic in the same way as we treat other public health issues: by treating the disease. Like cancer, opioid addiction is a disease. It affects Americans of every age, race, ethnicity, political party, and socioeconomic status. For three years, I’ve read about increased awareness of the looming national epidemic, but state legislators have been debating and developing solutions — state by state — for almost a decade. I urge Congress to look to the states for innovative solutions.
The public health and criminal justice infrastructure in the states represent the front line in the fight against opioid abuse. Until recently, little had been done to halt the spread of opioid addiction, even in some of the hardest hit areas. Places like New Hampshire, West Virginia, Texas, and Maryland all struggle with an increasingly addicted population and the resulting civil and criminal issues. State spending on corrections alone has grown faster than nearly every other budget item, topping $50 billion. But a focus on crime and prison time without equal attention to addressing the underlying causes of addiction is a futile endeavor.
I know first-hand how hard it can be to watch someone suffer in the grips of addiction. For the past five years, I have helped lead Wisconsin’s legislative efforts to combat the opioid epidemic through the Heroin, Opiate, Prevention and Education (HOPE) Agenda. HOPE resulted in 30 new Wisconsin laws addressing drug treatment and law enforcement as well as the implementation of the Prescription Drug Monitoring Program (PMPD) — a nationwide database for doctors to monitor their patients’ opioid prescriptions, preventing abuse or “doctor shopping.” Wrap-around programs like those implemented in Wisconsin are making a difference: Since 2015 opioid prescriptions are down nearly 20 percent in Wisconsin. But, Wisconsin isn’t the only state legislature taking action; other legislatures are implementing innovative approaches and are creating a vast library of proven options for Congress to consider.
In New Hampshire, the legislature created a program that takes non-violent offenders and places them in treatment and diversion programs instead of prison. The cost to taxpayers is massively reduced as non-violent offenders are treated and counseled instead of jailed. Nationally, 60–80 percent of drug offenders commit a new, typically drug related crime, upon release; 95 percent return to drug abuse after leaving prison. We know incarceration doesn’t work. Directly addressing the problem does.
Lawmakers in Texas have combined approaches to getting addicts the treatment they need. While addressing addiction, the court system also ensures dealers are hit with harsher sentences. Texas lawmakers Jerry Madden and John Whitmire successfully sent a bill to then-Governor Rick Perry to spend $241 million on treatment, mental health, and rehabilitation programs, instead of expanding prison facilities. The results speak for themselves. In three years, taxpayers saved $2 billion, prison populations declined by 15,000 and the recidivism rate for ex-offenders dropped by 25 percent, leading to the lowest Texas crime rate since 1968.
In Maryland, the legislature passed laws that target criminals, offer new treatment options, and decrease the incarceration rate among non-violent offenders. Bills like the HOPE Act and the Prescriber Limits Act all take steps to address addiction in the state. In Maryland SB 539, the legislature took a particularly hard line on drug dealers who knowingly sell fentanyl — an opioid 50–100 times more potent than heroin. The bill allows prosecutors to seek an additional 10 years in jail for these predatory criminals. To help curb the amount of prescription opioids available to abusers, Maryland passed the Prescriber Limits Act of 2017, which requires healthcare providers to prescribe the lowest effective dose of an opioid to patients.
It isn’t just state legislatures seeking better solutions to the opioid crisis. Pharmaceutical innovations are proving instrumental in the fight against opioid addiction. One of the most important tools for those treating and reversing opioid overdoses is naloxone, an injection that blocks the effects of opioids. First developed in the 1970s and widely distributed to first responders since 1996, the CDC estimates this one drug has saved 26,000 lives. Probuphine, the first ever implant approved by the FDA, is a microchip developed by two American pharmaceutical companies that delivers a drug that helps counter opioid withdrawal symptoms. Ninety-six percent of Probuphine users remain opioid-free for at least four months. These are just two of many examples of non-incarceration interventions that work.
As Congress debates the opioid epidemic, it’s too easy to play the blame game. It’s the user’s fault, the dealer’s fault, the drug manufacturer’s fault. But seeking fault obscures the issue and focuses decision makers on regulation rather than treatment or addressing underlying causes. “Because I can get it, and I want to do it” is a contributing factor. It’s a symptom of a disease — a treatable disease.
The viable solutions from Wisconsin, Maryland, and other states prove solutions exist. In many cases, states are spending less and achieving better outcomes. Appropriation and regulation are useful, but treatment is key. Congress should pay attention to what the states have learned and apply those lessons to national solutions.
Wisconsin State Representative John Nygren is the 2014 Wisconsin Medical Society Legislator of the Year, the 2017 American Medical Association Dr. Nathan Davis Award for Outstanding Government Service recipient, the 2018 Wisconsin Pharmacy Society Legislator of the Year, and the chairman of the ALEC Health and Human Services Task Force.