Editor’s note: This commentary is by Jack Fitzsimons, of Burlington, who is a second-year medical student at the Larner College of Medicine at the University of Vermont. He recently completed an internship for Physicians for a National Health Program, an advocacy organization that supports a universal, comprehensive single-payer national health insurance program.
[E]very day, more than 115 individuals die from opioid overdose in the United States. So many people have died from opioid abuse in recent years that life expectancy in the U.S. has decreased in both 2015 and 2016, the first time that life expectancy has decreased two years in a row since the 1960s. The mortality statistics are truly jaw dropping but do little to capture the grief of families and decimation of communities that the opioid epidemic has left in its wake.
There is no simple explanation for the opioid epidemic, but rather it is the confluence of numerous factors that created the perfect conditions for opioids to take hold in communities. Greed of the pharmaceutical industry and doctors running pill mills, where hundreds of patients were seen every day, barely any words were exchanged, other than asking the patient what prescription they wanted, certainly played a significant role in this epidemic. Additionally, automation and changing technology has led to the economic and social dislocation of the middle class in large swaths of the country which has provided the perfect conditions for this illness to run unchecked through many communities.
If the United States really wants to make progress combating the opioid epidemic, we must consider making momentous changes to our health care system and society. One of these changes that we must consider is to provide health insurance to every individual in the United States. I am not suggesting that universal health coverage will solve the opioid epidemic overnight, but I believe that it can be a large part of the solution.
For any progress to be made in combating this epidemic, addiction treatment must become more accessible than heroin and opioid painkillers. To ensure that treatment becomes more accessible, we must identify any barriers that patients may have accessing treatment and eliminate them. Nationally, financial concerns have been a barrier for many to receive treatment. Some progress has been made with the expansion of Medicaid under the Affordable Care Act. Thirty-six percent of individuals with opioid use disorder were uninsured in 2008 but this number dropped substantially to 27 percent in 2014 with the expansion of Medicaid. Increased coverage coincided with more individuals with opioid use disorder receiving treatment (22 percent in 2008 vs. 33 percent in 2014) and significantly decreased the rate of individuals forgoing substance use treatment for financial reasons (51 percent in 2008 vs 38 percent in 2014). Medicaid expansion has indicated that once individuals receive health insurance they are more likely to receive treatment for substance use disorders. Although some progress has been made in reducing uninsured rates under the Affordable Care Act, many individuals remain uninsured or with insurance that has unaffordable deductibles and copayments. If universal coverage was implemented, every individual with opioid use disorder would have coverage, eliminating a financial barrier and increasing their chances of seeking treatment.
If our country wants to adequately combat the opioid epidemic, we must also begin to look at the mental health care that is provided in this country. Substance abuse IS a mental health issue and oftentimes co-morbid mental health issues are inextricably linked with substance abuse. Financial concerns have been a barrier for many to receive mental health services. A report published in 2011 by the U.S. Substance Abuse and Mental Health Services Administration showed that the number one reason, at 50.1 percent of respondents, that individuals did not receive mental health services in the past year was because they believed that they could not afford the cost. A 2016 report from the same organization showed that Medicaid expansion under the ACA had made some improvement minimizing financial barriers for care, but still 37.2 percent of respondents cited financials concerns as the reason for not receiving care. Despite this improvement, financial concerns remained the number one reason that patients did not receive mental health services. It is certain that a portion of these individuals who did not receive mental health services turned to illicit drugs to self-medicate their mental health issues instead of receiving appropriate mental health treatment. It has been well-documented that there is a high prevalence of co-morbidity between drug use disorders and other mental illnesses. It is likely that if we eliminate financial concerns for receiving psychiatric care more individuals will receive care and fewer will turn to drugs to self-medicate.
As our country continues to grapple with the opioid epidemic we must ensure that our elected officials will act to expand health care coverage to all Americans and not act to take coverage away from Americans. If the number of uninsured Americans increases, it is likely that so will the deadliness and scope of the opioid epidemic. During this critical time of the opioid epidemic we must ensure that financial concerns no longer remain a barrier for individuals seeking opioid treatment.
