How should Alabama fight opioid addiction?
It’s no secret that opioid abuse in the U.S. has reached an epidemic level. In 2016 alone, opioids claimed the lives of 42,000 Americans. In Alabama, the overdose death rate climbed an alarming 82 percent between 2006 and 2014.
States and cities across the nation are grappling with how to combat the problem. Last year, Governor Kay Ivey established the Alabama Opioid Overdose and Addiction Council to address the crisis in the Yellowhammer State.
In December, the Council released its Opioid Action Plan, with recommendations for better education, increased access to care, legislation and other strategies.
The report specifically identifies the importance of protecting the rights of patients who need opioids as the war against addiction is waged, a common view among stakeholders.
“It’s critical that we carve out exceptions for hospice, cancer and palliative patients, because it is not our intent to put barriers for people who need those treatments,” says Dr. Anne Schmidt, a council member and Senior Medical Director at Blue Cross and Blue Shield of Alabama. “That’s why legislation may not be the way to address this problem, as it tends to make blanket solutions that aren’t necessarily best for everyone.”
Alabama Attorney General candidate Joe Siegelman agrees.
“There must be a balance between restricting dangerous and addictive opioids while making sure they’re still accessible to those who need them,” says Siegelman. “I’ve met a number of people who’ve told me that, without their opioid prescription medication, they would not be able to function throughout the day due to pain.”
Tennessee recently enacted legislation that puts limits on what doctors and pharmacists can provide patients, with exemptions for hospice and other patients in need of palliative care.
Still, Dr. Schmidt and others believe education may be a more effective plan of action.
Each year there are more opioid prescriptions per capita in Alabama than in any other state. As medical schools, communities, health departments, the CDC and others educate doctors and patients alike, those numbers improve.
“We’ve seen a significant decrease in the number of opioid prescriptions,” says Dr. Schmidt. “But Alabama remains the number one state for opioid prescriptions filled because other states are beginning to come down too.
“Furthermore, people should know that they’re covered for naloxone, a popular anti-overdose drug, by Blue Cross and Blue Shield of Alabama and most health insurance plans,” says Dr. Schmidt.
“We want to increase the availability of that medication,” she says. “In fact, there’s a standing order statewide, so anyone can fill naloxone at a pharmacy without a written prescription.”
But, she concedes there’s still a barrier for uninsured Alabamians.
“In our state we didn’t expand Medicaid,” she adds. “So, because of the cost naloxone, access for uninsured Alabamians remains and issue.”
However, several state organizations have applied for grant money to get anti-addiction and anti-overdose drugs for underinsured and uninsured patients, so while the need is still significant, there is hope.
To further decrease opioid access, the state is pushing to create stricter laws for trafficking fentanyl, an opioid that is 1,000 times more lethal than heroine.
Critics say this could strain an already overcrowded prison system in the state.
“We must keep in mind that the opioid epidemic is largely a public health issue, and not one we can prosecute our way out of,” says Siegelman. “Drug dealers peddling these dangerous drugs should and will absolutely be prosecuted and held accountable.
“However, we cannot continue to warehouse individuals with drug addiction in our prisons,” he adds. “Studies show we save taxpayer money sending those with drug addiction to treatment programs rather than prison whenever possible.”
With per capita tax revenue lower in Alabama than anywhere else in the nation, opioid treatment may certainly be a cost-saving issue on the minds of voters at the ballot box this November.