Oklahoma has a substance abuse problem. Drug overdose deaths have been on the rise over the last decade and now nearly 1,000 Oklahomans die each year from an overdose. Medicaid plays a significant role in providing treatment for substance use disorders. Oklahoma took steps to address the problem by restricting opioid prescriptions in order to reduce the supply of these drugs. During this same time, deaths from methamphetamine and heroin skyrocketed. This suggests the solution is not only limiting the availability of addictive substances but addressing the underlying causes of drug addiction.
Legislators need to shift their focus from limiting the supply of opioids to curbing demand for all substances by providing those with substance use disorders a way to seek treatment for their illness. Accepting federal funds to expand access to health care — which Oklahoma has not done — is one of the most effective tools states have to combat the opioid crisis and other forms of addiction. Expanding access to care will provide Oklahomans with a pathway to recovery and make Oklahoma a healthier state.
Oklahomans struggle with addiction at staggering rates
Substance use disorder is a public health crisis that must be addressed. Between 2003 and 2018, drug overdose deaths in Oklahoma increased by 91 percent. More adults between the ages of 25 and 64 die of unintentional prescription opioid overdoses than car accidents. There have been some improvements in addressing the misuse of opioids since the creation of the Oklahoma Commission on Opioid Abuse in 2017. Based on their recommendations, legislators passed seven laws that attempt to fix the opioid crisis. These laws limit the number of opioids doctors can prescribe and establish guidelines for managing chronic pain with opioids that discourage misuse. The number of opioid-related deaths decreased since these changes were made but 300,000 people still struggle with substance abuse and only 1 in 3 get the necessary care. Deaths related to methamphetamine use increased by over 70 percent between 2014 and 2017. These changes are good, but not enough.
Expanding access to health care is the most effective and viable solution
Medicaid expansion is an effective approach to address the opioid epidemic. States that elected to take federal funds to make health care more accessible have seen trends begin to shift as more people access the treatment they need and take steps toward recovery. Since Ohio expanded coverage more people have access to care, and there are more treatment options–including wider access to Medication Assisted Treatment (MAT), the gold standard in treatment for opioid addiction. After expansion, West Virginia also saw dramatic increases in the number of people diagnosed with an opioid use disorder as more people had access to a doctor to treat their disease. Ultimately, the number of people participating in MAT increased sixfold.
Additionally, across states that expanded coverage, there was nearly an 80 percent decline in the uninsured rate of hospitalizations related to opioids, and expansion is credited with reducing the unmet need for substance use treatment by almost 20 percent. Medicaid lays the foundation for an effective strategy for dealing with addiction and states that have not expanded care, like Oklahoma, will continue to struggle. Nan Whaley–the mayor of Dayton, Ohio, where there was a significant drop in opioid-related death after Ohio expanded care stated, “If you’re a state that does not have Medicaid expansion, you can’t build a system for addressing this disease”. If the Oklahoma legislature is serious about fighting the opioid crisis and the widespread use of methamphetamines, expanding access to care is the best solution.
Expanding access to treatment for addiction addresses problems in the criminal justice system and supports workforce participation
Providing access to substance abuse treatment through expansion creates improvements in other areas as well. Adequate care for those with a substance use disorder will relieve some of the pressure on the overloaded criminal justice system. There are many in the criminal justice system facing punishment for crimes related to their disease. Expanding coverage will allow these people to participate in treatment instead. States that give those leaving the criminal justice system access to treatment find fewer people are arrested for crimes related to their illness. In one state, the reduction in arrests resulted in $275 million in savings.
Giving people a pathway to recovery also makes it easier for people with substance use disorders to get back to work. Untreated substance use disorders (which often co-occur with a mental health disorder) make working (and looking for work) a challenge. Expansion removes barriers to workforce participation by ensuring applicants aren’t fighting untreated illness while trying to get and keep jobs. Additionally, children who grow up with a parent who has an untreated substance use disorder experience trauma as a result of their parent’s disease. Providing access to care is a way to break these cycles of trauma and addiction.
The bottom line
The legislature has tried to address substance abuse with reforms that reduce the supply of drugs, but it is not enough. A comprehensive strategy for reducing the impact of substance use must include a pathway to recovery for those with this illness. The best way to create that pathway is taking federal dollars to expand health care and extend coverage to Oklahomans who need it the most.