Aug 17, 2018 at 5:00 AM
As a clinician I‘ve seen the worst of the opioid epidemic across the continuum of U.S. health care. The ongoing state of the crisis in Ohio has deep resonance with my own experiences. I’ve cared for far too many drug overdoses in the ICU while struggling to address addiction disorders in my outpatient clinic, making it impossible to ignore the profound impact that this epidemic has had on affected individuals and their families.
Yet, as a voter in Ohio’s upcoming November elections, this issue (and mental health disorders writ large) has transcended in importance from being more than just personal to being a clear existential threat to not only the public health of Ohioans but to the good governance and future fiscal prosperity of our state.
Which is why we, as voters, must be able to parse through all the election-year rhetoric and have clarity on what needs to be done to more effectively curb this problem, arguably our state’s defining generational issue.
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Let’s begin by revisiting some of the most troubling aspects of the epidemic for Ohio, examining facts and exploring potential solutions in some detail; I’ll leave it to you to judge which candidates are taking this problem seriously.
This epidemic cost the United States an estimated $1 trillion between 2001 and 2017 and is estimated to cost an additional $500 billion between now and 2020. Of that $500 billion, Ohio accounts for an enormous chunk, $40 billion as last measured in 2015, one of the highest levels in the nation. These estimates measure not only direct health care-associated costs but lost economic productivity due to illness and death.
In contrast, the very politically fraught expansion of Medicaid in Ohio, which provided basic health coverage to an additional 700,000 Ohioans, an estimated one-third of whom suffer from addiction disorders, cost the federal government $5 billion.
Consider, for a moment, that any addiction treatment service requires payment in kind. It is easy to reflexively advocate for the increased provision of these services, but they are not free.
Consider, also, that many individuals with opioid addiction exist on the socioeconomic fringe, their ability to access potentially life-saving treatment or detox services, including cessation medications and behavioral therapy, requires that Medicaid benefits are accessible, at a minimum.
Now isn’t the time, in other words, to impose work requirements or other stipulations which would undeniably make it more difficult for our neediest to enroll in Medicaid.
One of the biggest obstacles in contending with opiate addiction are the pre-existing barriers which exist for patients to receive critical therapies. Medications like Suboxone, an opioid-like medication that helps individuals gradually wean off addiction, require prescriptions from licensed physicians. Particularly in more rural parts of Ohio, these certified doctors are in short supply, hampering any multipronged treatment effort from actually being effective.
Newer medications like Naltrexone, studied as equally effective to Suboxone, require that a patient be sober for a week prior to medication initiation, an exceptionally difficult ask for patients mired in a cycle of addiction. No wonder only 10 percent of individuals with substance abuse disorders get treatment, as per a 2016 surgeon general report.
Yet, solutions do exist. Some of the most promising care-delivery platforms focus on supporting individuals as they experience withdrawal from opioid use. A recently opened “withdrawal clinic” in Ross County provides combination behavioral and medication therapy to individuals seeking to stop opiate use, all while being in a monitored setting. These care innovations are what we need more of to help provide support in the days and weeks immediately post-cessation. And, importantly, this Ross County clinic, like others of its kind, accepts Medicaid.
In this upcoming election cycle, there are no shortage of political platforms that heavily prioritize stopping the flow of opiates into Ohio or increasing the number of drug courts that could crack down on traffickers. While important, these should not be the singular focus.
Rather, our state needs more resources from federal programs like the Comprehensive Addiction and Recovery Act and, without question, continued Medicaid expansion to expand both the visibility and number of withdrawal clinics and other similar treatment services statewide. Doing otherwise would be a moral, civic and fiscal failure of our government on a scale rarely seen or imagined in Ohio’s history.
Vin Gupta, MD, MPA was raised in Ohio for two decades and still calls Toledo his permanent home. He is a major in the U.S. Air Force medical corps and part-time health policy researcher and pulmonologist at Harvard Medical School.