How You Helped Pay for America’s Opioid Addiction Crisis
A stunning detail from Nicholas Eberstadt’s opus in Commentary, revealing how the national opioid addiction crisis was largely fueled by Medicaid:
How did so many millions of un-working men, whose incomes are limited, manage en masse to afford a constant supply of pain medication? Oxycontin is not cheap. As Dreamland carefully explains, one main mechanism today has been the welfare state: more specifically, Medicaid, Uncle Sam’s means-tested health-benefits program. Here is how it works (we are with Quinones in Portsmouth, Ohio):
[The Medicaid card] pays for medicine—whatever pills a doctor deems that the insured patient needs. Among those who receive Medicaid cards are people on state welfare or on a federal disability program known as SSI. . . . If you could get a prescription from a willing doctor—and Portsmouth had plenty of them—Medicaid health-insurance cards paid for that prescription every month. For a three-dollar Medicaid co-pay, therefore, addicts got pills priced at thousands of dollars, with the difference paid for by U.S. and state taxpayers. A user could turn around and sell those pills, obtained for that three-dollar co-pay, for as much as ten thousand dollars on the street.
In 21st-century America, “dependence on government” has thus come to take on an entirely new meaning.
You may now wish to ask: What share of prime-working-age men these days are enrolled in Medicaid? According to the Census Bureau’s SIPP survey (Survey of Income and Program Participation), as of 2013, over one-fifth (21 percent) of all civilian men between 25 and 55 years of age were Medicaid beneficiaries. For prime-age people not in the labor force, the share was over half (53 percent). And for un-working Anglos (non-Hispanic white men not in the labor force) of prime working age, the share enrolled in Medicaid was 48 percent.
By the way: Of the entire un-working prime-age male Anglo population in 2013, nearly three-fifths (57 percent) were reportedly collecting disability benefits from one or more government disability program in 2013. Disability checks and means-tested benefits cannot support a lavish lifestyle. But they can offer a permanent alternative to paid employment, and for growing numbers of American men, they do. The rise of these programs has coincided with the death of work for larger and larger numbers of American men not yet of retirement age. We cannot say that these programs caused the death of work for millions upon millions of younger men: What is incontrovertible, however, is that they have financed it—just as Medicaid inadvertently helped finance America’s immense and increasing appetite for opioids in our new century.
We did this to ourselves – or more specifically, generous federal health care spending programs, who had the best intentions about helping the poor and disabled, worked with reckless doctors to finance life-destroying addictions from coast to coast. No terrorist group could have hit Americans this hard.
The good news is that states are belatedly taking steps to address this:
States such as New York, Rhode Island, and Maine adopted new limits on the number of pills that doctors can prescribe, and West Virginia will, starting next year, require prior authorization from the state’s Medicaid program for opioid painkiller prescriptions. In the 2016 fiscal year, 22 states either adopted or toughened their prescription size limits, and 18 did so with prior authorization.
As mentioned in my profile of West Virginia attorney general Patrick Morrisey last week, the WV AG office has targeted pharmaceutical companies, contending they provided massive quantities of painkillers to small-town pharmacies and doctors, and obtained $47 million in settlements that will go to drug-abuse prevention and treatment programs.
In January, Morrissey’s office won a fight to sue McKesson Corp., the nation’s largest wholesale drug distributor, in state court, contending the company failed to develop an adequate system to identify suspicious drug orders. The company shipped more than 100 million doses of painkillers such as hydrocodone and oxycodone to West Virginia —a state with fewer than 2 million people — in a five-year period.
His office isn’t just pursuing high-dollar settlements from the biggest fish, either. In December, he filed suit against Larry’s Drive-In Pharmacy in Madison, W.Va., alleging the pharmacy failed to identify suspicious prescriptions. The pharmacy dispensed nearly 10 million doses of prescription painkillers over eleven years — in a county of fewer than 25,000 people.
There aren’t a lot of cases where conservatives will instinctively root for lawyers against pharmaceutical companies, who are often unfairly demonized and rarely given enough credit for developing life-saving drugs. But if a company has profited from the jaw-dropping explosion of painkiller use and abuse, it seems fair to ask them to kick in for solving a problem they helped create, even if it wasn’t deliberate.