On March 15, New York Sen. Kirsten Gillibrand announced bipartisan legislation alongside Colorado Sen. Cory Gardner to combat the opioid crisis. The bill, like many others before it, is misguided and dangerous. Titled the John S. McCain Opioid Addiction and Prevention Act — in honor of the late senator who was the former GOP lead on the bill — the legislation, in Gillibrand’s own words, is designed to “limit prescriptions for acute pain to [seven] days.” After intense pushback via Twitter, Gillibrand posted an addendum to the bill stipulating that the seven-day limit “would not apply to the treatment of chronic pain; pain being treated as part of cancer care, hospice care, or other end-of-life care; or pain treated as part of palliative care.”
On paper, to those who have not studied the crisis, legislation of this type may seem logical and appropriate. There is no doubt that the over-prescription of opioids played a significant role in perpetuating the crisis, but pulling back in this manner often drives people reliant on these medications, which are regulated by a physician, to illicit substances. That’s when fentanyl — the synthetic opioid that is 50-100 times more powerful than morphine, and is the leading cause of overdose in the United States — can be introduced. David H. Gorski, a surgical oncologist at the Barbara Ann Karmanos Cancer Institute, called the proposed legislation, a “horrifically bad idea” on Twitter, and said that it will only succeed in making the lives of chronic pain sufferers “much worse” while making it “much harder” for their doctors to care for them. If you scroll through the Twitter responses to Gillibrand’s announcement, you’ll see thousands of concerned people who are afraid the medications they rely on to function will be taken away.
It’s a common fear. In 2017, I was a guest on C-Span’s “The Washington Journal” to talk about a few articles I published on the opioid crisis. Most of the calls I received were from people who were terrified of having their medications taken away. When I discussed the risks associated with overreacting to the prescription boom and putting too many restrictions in place, which would, in turn, drive people to the street for relief, the phone lines lit up. People from all over the U.S. called in.
Yes, the out-of-control pill mills littered throughout Florida, West Virginia and elsewhere needed to be shut down. And clinicians needed to be made aware of the dangers associated with these drugs, and of the deceptive way they were marketed. But limiting prescription quantities is not how we will solve this crisis.
This is a health care crisis. It was ushered in by the rampant abuse inherent to our health care system, and it will be alleviated the same way.
We need to expand treatment. We need to ensure that every person in this country who needs it has access to medication-assisted treatment (MAT). MAT is cognitive behavioral therapy and counseling in conjunction with opioid agonists and antagonists like Suboxone (buprenorphine and naloxone), Subutex (buprenorphine), Vivitrol (naltrexone) and methadone. MAT has been shown to be the most effective modality of treatment available. Patients who receive MAT are more likely to remain in treatment and less likely to use illicit opioids. While the Affordable Care Act (ACA) expanded MAT access, it was hamstrung by our for-profit health care system, and didn’t go nearly far enough. And recently, things have begun to backslide, with the number of uninsured rising to 15.5 percent in 2018 — that’s 3.2 million fewer people with coverage, which brings the grand total to right around 30 million. This lurch backwards is largely due to the Trump administration’s war against the ACA. And if the Trump administration’s recent attempt to repeal the ACA through the courts is upheld (an unlikely, but not impossible scenario) things will be far worse. Same goes for Trump’s recently proposed budget, which aims to cut $845 billion from Medicare and $1.5 trillion from Medicaid, while instituting $1.2 trillion for state-run block grants and eliminating funding for the expansion that occurred under the ACA. The ACA should also be commended for issuing pre-existing condition protections and establishing essential health benefits. It was a step in the right direction, but the ACA — which subsidized the private health care industry with an influx of public money — is, and has always been, an insufficient vehicle for providing robust, universal coverage, even if it were given the chance to grow and adapt. It’s far better than what came before it, but there’s a clear limit to its powers.
A health care system that generates 21 billionaires will never provide true universal coverage. We have a patchwork, for-profit system, and it’s not designed to ensure coverage for the largest number of people; it’s designed to cover some people and make other people a whole lot of money in the process. We spend nearly double what other high-income countries spend on health care and often with poorer health outcomes. This has to do with the fact that our current system is an impossibly tangled network which warrants hours and hours of administrative work, which causes costs to rise. It also has to do with the fact that, again, our system is designed to turn a profit.
A single-payer system, however, does not create billionaires, or require hordes of administrative staff to slash through the labyrinth of health care billing. A single-payer system means that universal coverage is paid for through taxes and then financed by the government. Bernie Sanders’s popular Medicare for All bill aims to enhance and expand Medicare into a universal, single-payer system that operates without private insurers, and is available to everyone who lives in the United States. It would be similar to Canada’s current system, which covers all Canadian citizens and costs far less than U.S. health care (just over 10 percent of GDP as opposed to 18 percent). This bill, and others like it, have the power to provide medication-assisted treatment to all who need it. This is simply not possible under our current system.
On average, 130 people die from opioid overdoses every day in the U.S. From 1999 through 2017, more than 700,000 people have died from drug overdoses — that’s more than motor vehicle accidents and guns. The numbers are continuing to rise even though we’ve worked to address the issue of over-prescription. That’s because this crisis is much larger than that. Under a single-payer system, Purdue Pharma, the pharmaceutical company largely responsible for the exponential boom of opioid prescriptions, wouldn’t have nearly the same level of power and influence. The fragmentation of our system opens us up to abuse. We don’t need any more polite incrementalism presented under the guise of pragmatism. And we certainly can’t afford to cut the social programs we currently have.
This is not to say that single-payer will be a cure-all. Canada, which has single-payer health care, is dealing with a smaller (but far from insignificant) opioid crisis of its own. But the country is far better equipped to handle it. And we still have a lot of work to do when it comes to dismantling the stigma around addiction and addiction treatment.
But right now, we’re not even giving ourselves a chance. If we want to help as many people as possible live through their addiction, and if we want to keep Big Pharma in check, we need to dismantle our for-profit system. We need single-payer health care.