After reading this New York Times editorial on the states where the rate of drug overdose has declined, I was filled with questions. First, why single out the responses in Massachusetts and Vermont? I got part of my answer from this article by Stoddard Davenport and Katie Matthews, from which the graphic above was sampled. The prevalence of opioid use disorder per 1,000 does not comport with my assumptions. I had thought it was a problem of poor Red States but, mirabile dictu, it is a much graver problem in rich Blue States. Both Massachusetts and Vermont have above-average state median incomes. Maryland has the highest median income (although I’d like to know the standard deviation).
Second, in what direction does the causality between insurance coverage and opioid use disorder go? Do states in which more people have health care insurance have higher incidence of opioid use disorder or do states in which people are more likely to use opioids have greater health insurance coverage?
Third, does the widespread use of naloxone result in fewer deaths due to overdosing or just fewer deaths relative to the number of overdoses?
Finally, which is the gravest problem? The rate of deaths due to overdose, the prevalence of opioid use disorder, or the role of physicians in both of the other problems? I don’t know the answers. I just have questions. It seems clear to me that these problems may have different solutions, indeed, the solutions may actually impede one another.
” I had thought it was a problem of poor Red States but, mirabile dictu, it is a much graver problem in rich Blue States. Both Massachusetts and Vermont have above-average state median incomes.”
Might be true but cannot tell based on how this was done. Red states provide many fewer people with Medicaid coverage, so they are probalby missing a lot of people. Stats from private insurers are notoriously unreliable as most are not willing to give up the data, and they won’t let us see how the collect it. Since Medicare has near universal penetration and they don’t cloak their processes in secrecy, that is the only data here I would trust.
“Third, does the widespread use of naloxone result in fewer deaths due to overdosing or just fewer deaths relative to the number of overdoses?”
Fewer due to overdosing.
” Do states in which more people have health care insurance have higher incidence of opioid use disorder or do states in which people are more likely to use opioids have greater health insurance coverage?”
May just be more likely to get diagnosed. If you don’t have insurance, you won’t get the diagnosis. Also, so me states are more aggressive in looking for it. Some have programs where every opioid prescription requires a data search to make sure others are not active. I am signed up for programs like that tin both PA and in NJ. Some states don’t want big government involved in that kind of stuff. A big problem is that many if not most insurance plans do not pay for, or inadequately pay for treatment. As I noted before, most health network don’t have even one addiction specialist.
“Finally, which is the gravest problem?”
Depends on your perspective. At least on the doc side it is now seen as a problem and efforts are being made to work on it. I have a team of docs and nurse practitioners who work to monitor treatment of pain throughout our main hospital. We have managed to improve pain scores while reducing the amount of opioids used.
Steve