The States Need to Step Up to Opioid Crisis
Our federal system is based on a balance between national and state partners. Any serious public problem needs action at both levels. But for over a decade state governments have been very slow to react to what has become a truly national crisis. Opioid-related death and addiction have spread across our communities, a tragedy recognized on the individual and local level, but for many years missed as a national epidemic in need of proactive government intervention.
Now with an average of 115 people dying from opioid-related causes a day, many states and localities have entered into lawsuits against the manufacturers of these drugs, including a mega-lawsuit assigned to the Northern District of Ohio that combines more than 400 cases.
But entering into litigation and waiting for an outcome is not a solution. There is nothing wrong with seeking additional resources for dealing with the problem, or pointing out the various parties with a share of responsibility for the crisis, but we need to go beyond publicity-drawing actions to more proactive, addiction-reducing steps. The time is now for specific regulatory and enforcement actions at the state level to solve this crisis.
It has been over a decade since governments first became aware of the addictive properties of opioids and their risk for abuse. Yet as the problem expanded, there were often only partial actions taken to deal with a decentralized and intense situation.
States initially responded to the problem by enacting a variety of laws requiring that information on opioid prescriptions be shared. But the authorities to whom reporting takes place, the parties with whom the information is to be shared, and the penalties for not participating, vary from state to state. As a result many state systems do not communicate with each other, leaving a gap in which over-prescribers and doctor shoppers can operate.
Much more can still be done to disrupt the pill mills that helped give rise to the crisis, and to treat those suffering from addiction. In the Pennsylvania General Assembly, for example, a bill requiring the registration of pain management clinics, which have been trouble spots for over-prescription, is still awaiting senate action. Meanwhile, a new report from Blue Cross and Blue Shield (BCBS) recently found that although there has been a 493 percent increase nationally in people diagnosed with opioid-use disorders from 2010 through 2016, there has only been a 65 percent increase in the number of people using medication-assisted treatment, the so-called “gold standard” for opioid-addiction care.
There are reasons for hope, however. Pew Foundation’s Allan Coukell has recently pointed out five examples that illustrate the various strong actions states can take when they set their minds to it. In Virginia the Medicaid system has been revised to offer a spectrum of services to addicts, resulting in a 51 percent increase in availability of addiction services for those on Medicaid. In Indiana, methadone treatments have been approved for addicts on Medicaid and nine new treatment centers have been opened. In Rhode Island it is now possible for addicts to be identified and for treatment to begin in emergency rooms, where addicts in distress frequently end up. In Wisconsin, the ability of trained Mental Health Counselors to treat opioid addicts has been strengthened. Vermont has created a “hub and spoke” method in which the addict is treated at a central “hub” and then supported regularly at the local level.
The federal government recently budgeted an additional $4.6 billion to help fund such state-level initiatives. This is a significant start, but the money needs to be spent wisely and expeditiously to combat this crisis.
As we have seen, states are capable of action and can be incentivized effectively. Let us hope that, as often happens in the federal system, states observe, emulate, and compete with one another to provide solutions to this policy challenge. It’s time for the states to step up in the critical fight against opioids with more than just rhetoric and lawsuits.
Earl Baker is a former state senator in Pennsylvania. Prior to his Senate service, he was elected as a county commissioner and served as statewide committee chairman of Human Services.