Louisiana’s elected officials seem determined to write the wrong prescription to combat opioid abuse.
Tracking the rest of the country, Louisiana has seen a sharp escalation in painkiller usage over the past few years and deaths associated with it. Worse, this has accelerated faster than in most states, in 2016 resulting in an age-adjusted opioid mortality rate of about 22 per 100,000 Louisianans, ranking Louisiana about in the middle of the 50 states.
In response, Louisiana has sued opioid manufacturers, although Gov. John Bel Edwards and Atty. Gen. Jeff Landry are sparring legally over which of their offices will oversee that litigation. Additionally, a number of parishes, including Lafayette, and cities, including Baton Rouge, have also pursued legal action.
The suit filed by the Edwards administration last year alleges manufacturers intentionally misled consumers about risks and pushed pain products to spur greater profits, causing greater health and public safety costs for taxpayers. The Baton Rouge suit makes the same claim and goes after distributors as well, faulting them for insufficient monitoring.
In reality, government policy and its blindness to the true nature of the problem has led to misunderstanding of the crisis. And that has fed a jackpot-justice mentality that distracts from an effective response.
Only about 1 to 2 percent of individuals taking prescribed opioids experience addiction, and in clinical settings — a hospital, for example — deaths from overdose occur at minuscule rates of 0.02 to 0.2 percent. Numerous data sources confirm that opioid addictions and deaths occur overwhelmingly among people already abusing other substances or who suffer from psychological difficulties, or both. Further, these overdoses usually involve other addictive, controlled, or banned substances.
So, the problem is not a flood of opioids pushed by pharmaceutical companies and brokered by uncaring sellers hooking drug-naïve individuals. The issue is one of easier, typically illicit, access to drugs that feed the addiction of people who are already veterans of illegal drug use.
Worse, recent state policy decisions seem to have facilitated this abuse.
A growing body of evidence indicates Medicaid expansion has made opioids much more readily available on the black market. A report released last month from the U.S. Senate’s Homeland Security and Government Affairs Committee reveals how Medicaid drug fraud cases increased significantly after expansion began in the states; expansion states disproportionately registered these higher numbers, and overdose deaths rose about twice as fast in expansion states.
The data is consistent with increased usage mainly by experienced abusers of multiple drugs who skirt the law; that population in Louisiana faces elevated risk. Six months after the Edwards administration initiated Medicaid expansion in 2016, the state registered one of the highest ratios nationally of opioid prescriptions per resident, at almost 1:1.
Given this situation, clamping down on fraudulent prescribing and underground sales would best alleviate the epidemic. Yet, as Advocate columnist Dan Fagan recently recounted, even with a skyrocketing quantity of criminal complaints lodged with the state about Medicaid fraud, the Edwards administration has resisted pleas to budget more money dedicated to fighting the problem.
Instead, Edwards and local officials would rather fleece presumed bogeymen in lawsuits that have a better chance of padding government coffers and enriching trial lawyers than in significantly curtailing painkiller-induced abuse and deaths. Even Landry, who showed proper circumspection at this strategy of legal action when the administration first filed suit — perhaps because of Edwards’ aggressiveness — has ramped up efforts in this regard.
To tackle this problem, state government should reverse Medicaid expansion and use those savings to expand fighting Medicaid fraud and criminal activity involving opioids and focus on treating existing addicts. Local governments should target illegal drug trafficking. All should drop dubious lawsuits banking on big paydays that actually don’t provide a real solution.
Filed under: General Problems
Louisiana Medicaid will not pay for Pain Management Doctors. On the other hand, it will pay for Primary Care Physicians and other specialties to treat Medicaid Patients for chronic pain.
Louisiana is cutting Medicaid right and left. More severe cuts are expected to come this year. Louisiana is still trying to recover from the eight years Bobby Jindal was Governor.
Louisiana Medicaid has strict limits on the number of doses it will pay for for Hydrocodone. It will not pay for more than 720 doses of Hydrocodone in a rolling 365 day period. They also have strict limits on other medications. They also have a very strict policy of filling Schedule II prescriptions for out of state doctors that do not have a license to practice medicine in Louisiana. They will only pay for a 10 day supply. And they will not pay for another prescription for a Schedule Ii for 90 days. The pharmacist also calls the out of state doctor and explains to him why this is happening.
Couple of questions: So Medicaid expansion is the problem, and getting rid of it is the answer? And he’s saying the ratio of people in Louisiana to opioid prescriptions is 1:1? Both sound extremely questionable. Surely there are ways to crack down on fraudulent prescribing without ripping healthcare away from the people of Louisiana.
Lesley,, I have questions about these numbers associated with Medicaid Expansion too. I think the numbers are wrong.
It is possible due to more people having access to medical care more are having surgeries and receiving treatment for painful conditions. Which can lead to more people receiving prescriptions for opioids. Some of those people can become addicts. It is also possible some were addicts before Medicaid Expansion but no one knew.
Unfortunately, Trump and the Republicans are blaming everything on the ACA and Medicaid Expansion. Governor Edwards can only do so much. Louisiana Republican State Legislators prefer to see more severe cuts to Medicaid than the renewal of a one cent tax due to expire soon.