Sohn: Opioid crisis offers window into short-sighted health policy

Sohn: Opioid crisis offers window into short-sighted health policy

September 24th, 2017 by Pam Sohn in Opinion Times

The headlines are telling.

"U.S. drug overdose deaths reach new record high," was an August CNN banner over news from the National Center for Health Statistics that we were on track for another record year for drug overdoses — largely thanks to opioids. Those opioids include legal prescription painkillers as well as heroin and street fentanyl.

"Trump declares opioid crisis national emergency," was the clarion call of NBC News just days later.

"Drug overdose deaths jump to record level." That local headline last week led off a story about opioid abuse in Tennessee and Chattanooga.

All the while, the GOP majority Congress has been in a fever to repeal the Affordable Care Act and replace it with a Trump/GOPcare alternative that not only bumps about 30 million working Americans off their insurance plans in the coming decade but also would no longer cover addiction treatment. Depending on state "flexibility," it could also jack up the premiums for pre-existing conditions and middle-age enrollees, meaning many workers won't be able to afford it even if coverage is available.

Our president has said he'll be happy to sign the new zombie health care bill if and when it reaches his desk.

As for the opioid crisis national emergency? No one's heard any more about that.

That makes another headline we saw last week in The New York Times all the more intriguing.

"Amid opioid crisis, insurers restrict pricey, less-addictive painkillers."

This news makes us rethink the logic that drug companies and doctors have been the primary fuel for our growing opioid crisis. What the reporting shows is that the drug companies and the doctors are getting the gas for their prescribing habits from insurance companies that block patients' access to safer and more expensive drugs — in favor of cheaper generic opioids.

The example for this story comes from our own back yard. Alisa Erkes, 28, of Smyrna, Ga., suffers stabbing pain in her abdomen that, for more than two years, was made tolerable by Butrans, a designer drug with a low risk of addiction and overdose.

But in January, her insurer, UnitedHealthcare, stopped covering the drug, which had cost the insurer $342 for a four-week supply. After unsuccessfully appealing, Erkes and her doctor settled on long-acting morphine, a cheaper opioid that UnitedHealthcare covered with no questions asked. It costs $29 for a month's supply.

"Because my Butrans was denied, I have had to jump into addictive drugs," she told reporters with The New York Times and ProPublica, who worked together on the story.

It's the classic quandary: Opioid drugs are cheap while safer alternatives are expensive, so even as we are in the grip of an opioid epidemic, we — through insurers — opt for being profitable. Even if it's bad for the patient, and even if it's penny-wise and pound-foolish.

But not to worry, Congress is well on its way to chopping addiction treatment off the menu, so that pound-foolish part won't cost insurers much either.

Leo Beletsky, an associate professor of law and health sciences at Northeastern University, calls the insurance system "one of the major causes of the [opioid] crisis" because doctors are given incentives to use less expensive treatments that provide fast relief.

The Times story notes that data from Medicare prescription drug plans show "insurers were indeed placing more barriers to drugs like Butrans and lidocaine patches than to cheaper generic opioids."

As we have seen, this is a dangerous street: 20 percent of patients who receive an initial 10-day prescription for opioids will still be using the drugs after a year, according to researchers at the University of Arkansas for Medical Sciences.

Insurers counter that prescription opioid consumption has been decreasing as attention has been drawn both to pill mills and over-prescribers. That's good, but it doesn't address the addictions, and those addictions help explain the rise in street use of heroin and fentanyl — which is, in essence, synthetic heroin. To their credit, America's Health Insurance Plans and the Blue Cross Blue Shield Association said Wednesday they oppose the Graham-Cassidy Obamacare repeal bill.

Experts say this is the deadliest drug crisis in American history. Drug overdoses are the leading cause of death for Americans under 50, primarily because of opioids.

More people died last year of overdoses than by guns or by car accidents. Even in 2015, one in 50 American deaths was drug-related. In Tennessee, deaths from drug overdoses have doubled in five years.

Tennessee also ranks No. 2 nationally in the share of opioid prescriptions per capita, and is near the top in overdose deaths. Put another way, Tennessee doctors are the nation's second highest prescribers — and therefore suppliers — of opioids. And now we know why: Because insurers encourage it.

An independent survey by San Francisco-based Castlight Health (using insurance claims data from 2010 through the end of 2015) ranked Chattanooga 20th in opioid prescription abuse among the worst 25 cities in the U.S.

This raises important questions — both for our health and insurance industries and for Congress.

Where are the incentives to make non-addictive drugs generic and cheaper? Where are the incentives to make generic opioids more costly — before they become addictive?

Perhaps most importantly, where is Congress' heart and conservative logic in pushing to give the insurance industry a pass out of covering addiction and pre-existing conditions and the pain of middle-age?

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