With the House of Representatives having just passed a bunch of opioid crisis-related bills, the U.S. Senate is now teed up to begin consideration of its own series of opioid crisis counteraction measures.
This may sound small-ball compare to some of what has convulsed us lately, but it’s absolutely critical for both moral and demographic reasons that the GOP does not dabble in half-measures here. People across America are dying—and more often than not, they voted Republican in 2016.
Here’s the brutal truth: Trump country is also opioid country. Fully 77 out of 82 counties with very high rates of opioid deaths—defined as 15 people or more per 100,000— voted for Trump in 2016. According to research published in JAMA Network Open, “in the 693 counties with adjusted rates of opioid prescription significantly higher than the mean county rate, the mean (SE) Republican presidential vote was 59.96% (1.73%), vs 38.67% (1.15%) in the 638 counties with significantly lower rates.”
These are the parts of Trump country where economic anxiety is real, not a talking point to distract from concerns about waning socio-economic status or cultural change—and where unemployment and opioid overdoses and deaths directly correlate. Trump voters are dying in these places. If the GOP wants to keep winning elections, it needs to stop this trend.
Unfortunately, the bills Congress has been working on thus far look like weak sauce given the scope of this problem.
Yes, it’s good to pass measures that offer non-opioid solutions to patients in pain. IV-administered Tylenol is obviously less deadly than opium-based drugs. However, it’s also pricey: $37 per vial compared to $2 per vial for morphine. According to JAMA, one factor in some addicts switching from prescription opioids to heroin is drug pricing. So, unless we go after drug prices and hard—and to be clear, Republicans are not doing that— we’re not eliminating a root cause of heroin addiction with this bill.
And that’s assuming that a policy decision is even made that it’s okay for doctors to just keep on prescribing opioids, even if someone is clearly addicted. It’s not clear medical professionals, let alone Congress or the Trump administration, are comfortable with this; so, on “non-opioid solutions,” we’re still looking at a half-measure.
Ditto efforts like Rep. Joe Kennedy III’s bill requiring state Children’s Health Insurance Programs (CHIP) to cover mental health benefits related to substance abuse, which passed the House by a voice vote. To state the obvious, white men in Martinsburg, West Virginia, are not receiving health coverage through CHIP (the bill is focused on pregnant women and minors who’ve developed addiction problems).
Maybe some are receiving care through Medicare or Medicaid—but certainly not all. And even if they are covered by Medicaid, if they’re in a place like Martinsburg, they’re probably facing a weeks or months-long wait to get to rehab—or such was the case around this time last year, per Kevin Knowles, Berkeley County’s recovery services coordinator, who cited a chronic shortage of rehab beds last year.
Says Knowles, “The number of beds would have to increase by a factor of three or four to make any impact.” West Virginia absolutely cannot accomplish that on its own, and that means the federal government getting involved in a way it simply hasn’t via any bills yet passed by the House—in this specific case, yes, by spending money (and perhaps cutting defense pork or farm subsidies as a trade off).
Another bill considered by the House—but it appears not actually passed—would have required treatment programs funded by the Substance Abuse and Mental Health Services Administration to be “evidence-based,” as opposed to “abstinence-based.” Coming from an addiction-prone family, I’m personally a big fan of “abstinence-based” treatment. But plenty of experts will tell you replacement therapy is more feasible for many addicts than pure abstinence—especially where we’re talking, say, heroin addiction as opposed to alcoholism.
Another proposal apparently not taken up by the House was one to push for naloxone—an anti-overdose drug—to be prescribed wherever a CDC guideline-meeting opioid is also prescribed. The U.S. Surgeon General has recommended that opioid users, their families and friends keep naloxone easily to hand.
Proponents of the plan argue it would save money by reducing opioid prescriptions in the first place, scaring the hell out of opioid users, and preventing the most serious and costly overdoses from occurring. Obviously, more prevalent naloxone would also prevent actual deaths—not a “dollars and cents” issue per se, but surely a moral imperative.
But it’s also worth remembering that in some places, keeping plenty of naloxone on hand is not actually done. While insurance and social programs often provide it to individuals at a low cost or for free, it costs the city of Baltimore enough that under the current addiction care-related set-up, they ration it.
Beyond all this, there is the broader question of whether any governmental response will be adequate when actual health care costs are going up—faster than inflation, for the first time since 2010— as are insurance premiums in at least some opioid crisis-afflicted states.
It’s also not clear that even if every single thing conceivable were done to address the opioid crisis, we’d stop the massive number of deaths we’re seeing. Fentanyl users say it delivers a high like no other. For some, a clean life will simply never compare to the high. Government cannot solve that problem.
But for users, their families, friends, and their suffering communities, even a 3 percent reduction in deaths, relapses, EMT visits, and overdoses would make a huge difference and be a massive win for whichever political party delivers it.
Clearly, Trump country bet on the GOP being able to accomplish this. Now, they need to do it. That will start by recognizing that what’s currently on the table is not nearly enough in real-life terms, even if it gives incumbents legislation to reference in ads to claim that they are doing something meaningful while Trump country keeps on dying.