Treatment for addiction at risk

This op-ed of mine on WV's opioid crisis and how killing the ACA would make it worse ran in today's Gazette-Mail.

There’s hardly a community in West Virginia that hasn’t been impacted by our opioid/addiction/overdose crisis. For that matter, there probably aren’t even that many families that haven’t felt the effects of it directly or indirectly.

I knew it was bad, but I had no idea of the sheer magnitude of addictive pills dropped like little bombs into the state by drug companies and wholesalers until I read Eric Eyre’s series on the issue in the Gazette-Mail. While this has damaged the lives of many individuals, it goes way beyond the level of a purely personal problem.

It reminds me of a basic insight by sociologist C. Wright Mills. In his classic “The Sociological Imagination,” he talked about the distinction and overlap between personal troubles and social issues.

Personal troubles “occur within the character of the individual and within the range of his immediate relations with others.” Potentially, these troubles can be understood and resolved at the individual level.

Social issues, on the other hand, “have to do with matters that transcend these local environments of the individual and the range of his inner life.” These include many institutions, organizations, and social forces that operate and interact in a given social and historical situation.

It’s a question of level of magnitude. Social issues can cause huge suffering to any number of individuals, but they involve larger forces and institutions at work that help cause the damage.

Mills uses unemployment as an example:

“When, in a city of 100,000, only one man is unemployed, that is his personal trouble, and for its relief we properly look to the character of the man, his skills, and his immediate opportunities. But when in a nation of 50 million employees, 15 million men are unemployed, that is an issue, and we may not hope to find its solution within the range of opportunities open to any one individual.”

In the same way, if a few individuals in a rural state fall victim to opioid addiction, this could be regarded as a personal trouble for those involved. But when, as Eyre has reported, a handful of drug wholesalers pumped 780 million hydrocodone and oxycodone pills into the state over six years — or 433 pills for every man, woman and child in the state — while more than 1,700 West Virginians died of drug overdoses, we’re talking about a huge social issue.

I’ve had a hard time getting a handle on what 780 million pills would even look like. For starters, I took a (pretty uninteresting) pill out of my medicine cabinet and measured it. It came out to 2.5 pills per inch. Then I reached for a calculator ...

You may want to double check this, but here’s what I came up with if you placed them end to end: at 2.5 pills per inch and 63,360 inches per mile, that comes to 4,924.24 miles of pills. That’s about the distance in air miles from New York City to Honolulu (4,909).

Which is to say, a lot.

Eyre’s research found that many of these were prescribed in economically depressed coalfield counties, which had high levels of fatal overdoses. Kermit, in Mingo County, for example, with a population of 392 received nearly 9 million hydrocodone pills at a single pharmacy in a two-year period.

There’s plenty of blame to go around on this, from aggressive marketing by drug manufacturers and wholesalers to doctors who ran “pill mills” to unscrupulous pharmacies cashing in on misery to lax oversight by public agencies.

There has been one bright spot in all this in some states, including West Virginia. Medicaid expansion under the Affordable Care Act has made treatment for addiction accessible to many people for the first time.

The Pew Charitable Trusts reported in 2015 that at least 2.5 million adults out of the estimated 18 million potentially eligible for expanded Medicaid coverage had substance abuse issues. Around 2.8 million people with slightly higher incomes would be eligible for subsidized substance abuse treatment through state health exchanges.

According to Pew, “In addition to increasing the number of people with health insurance, the ACA for the first time made coverage of addiction services and other behavioral health disorders mandatory for all insurers, including Medicaid.”

It’s hard to get a handle on exactly how many people are getting addiction treatment for the first time through the ACA. According to Kaiser Health News in December 2016, in Rhode Island, more than 3,600 people were treated for addiction. Between January 2015 and March 2016, more than 63,000 people in Massachusetts got help. Around 10,000 people in New Hampshire were able to get treatment in 2015.

Closer to home, The Columbus Dispatch reported in July: “Nearly 500,000 low-income Ohio adults, most of them uninsured, received mental health and addiction services under the state’s hard-fought Medicaid expansion.”

According to WFPL public radio, in Kentucky, a new report “shows a 740 percent increase in substance abuse services for Medicaid expansion beneficiaries. The number of Kentuckians with traditional Medicaid who received treatment for substance was four times higher between 2014 and 2016, according to the report.”

I haven’t been able to find exact figures for how many West Virginians have received or are now receiving treatment for addiction under Medicaid expansion, but if we extrapolate Pew’s estimate that around 14 percent of the Medicaid expansion population nationwide has addiction issues, that would amount to around 24,500 people here who would be eligible for it, not counting those who gained coverage through the exchange.

That’s enough to take a big bite out of the problem. And we know this is something people want and need.

That’s the good news. Unfortunately, the new president and the Republican majority in the U.S. House and Senate plan to repeal the Affordable Care Act. Unless it is replaced by something comparable, this would pull the rug out from under many individuals, families and communities now on the road to recovery.

It remains to be seen if West Virginia’s delegation will let that happen.