By Chris West, Civitas Communications Fellow
- Many assume that the opioid crisis is either caused by or solved through government intervention into the healthcare market
- Legislative leaders are placing blame on healthcare providers
- The real goal is to expand Medicaid which disregards the needs of addicts
Let that sink in. We hear frequently about the opioid crisis but we hear very little about the actual cause or real solutions to this growing epidemic.
One option for combating the opioid epidemic being suggested by progressives is the expansion of the Medicaid program. Most arguments for Medicaid Expansion are based on poor economic reasoning or just altogether false claims, as we at the Civitas Institute have highlighted numerous times.
Expanding Medicaid to help fight opioid abuse, however, merely provides the promise of a quick fix to care for those who are victims of this public health crisis in a quick, straightforward way.
In an open letter from 2017, NC Department of Health and Human Services Secretary Mandy Cohen encouraged physicians and healthcare providers to play a part in ending this epidemic. Citing North Carolina’s 13,000 overdose deaths since 1999, Cohen points to Attorney General Josh Stein’s recommendations for better recognizing the potential for addiction and the CDC’s guideline for prescribing medicine for common pain as the answers to this problem. In simple terms, their solution is to have healthcare providers get better at writing scripts. They place blame almost totally with the doctors, pharmacists, and healthcare providers.
I agree with Cohen’s presumption that physicians and pharmacists are at the front line of this crisis and could be the biggest allies in ending this crisis. However, Cohen did not account for the fact that Medicaid and other government programs have made it more possible than ever to get a prescription filled while providing no incentive to protect against prescription pill abuse. Cohen also ignores the fact that the opioid crisis may not even be caused by over-prescription or abuse by those prescribed opioids for pain. In fact, despite what Dr. Cohen’s letter suggests, screened patients rarely become addicted.
However, Medicaid expansion may increase access to prescriptions which could easily make them more accessible and cheaper for those suffering from addiction. For example, the population with the fastest growth in Fentanyl abuse has the most access to Medicaid and coverage under the Affordable Care Act (ACA). This is a very hard correlation to overlook when considering what is the best path to overcoming the issue of opioid abuse in North Carolina.
Is the ACA or Medicaid the cause of the opioid epidemic, as some have dared to suggest? No, of course it’s not. However, these programs do create more pathways to attain subsidized prescription drugs without tackling the root causes of the opioid epidemic.
There are a number of theories as to the root cause of the opioid epidemic but none are quite sure about what the primary contributor is. Many have suggested lack of economic opportunity, an absence of community, or a desire to self-medicate because of mental health issues or lack of economic opportunities in rural areas. It is unlikely that one could lay the majority of the blame at the feet of Medicaid or a government program. It is likely a mix of cultural factors and the increased availability of prescription drugs. When we are considering expanding Medicaid, we may find that instead of helping people we are making the lives of those around us worse off or putting pills in the pockets of those struggling with addiction.
Many have argued that expanding Medicaid would make drugs like Buprenorphine more accessible which would help those addicted to opioids recover and open access to rehabilitation centers. Unfortunately, this band-aid does not combat the causes of the opioid epidemic or prevent addiction in any foreseeable way.
Rather than addressing the issue of costs and creating competition in these rehabilitation market, which would naturally lower the price, many argue for government expansion which may actually lead to inferior care, more unnecessary prescriptions, or more bureaucratic hurdles to ensure patients receive the necessary treatment.
North Carolina needs more innovation and less unnecessary opioid prescriptions. To quote Sam Adolphsen in the National Review, “If lawmakers want to address the opioid epidemic in their states, they should focus on substance-abuse treatment for those who truly need it and are willing to accept it, rather than on maintaining the costly expansion of Medicaid to millions of able-bodied adults.”
At a time when drugs pose a bigger problem than automotive accidents, the last thing we want to do is pave the way for more abuse, over-medication, and lower standards for opioid prescriptions.