Yesterday I mentioned that the states with the highest prevalance of diagnoses of opioid use disorder didn’t comport with my preconceived notions. This article at U. S. News on the Congressional districts with the highest rates of opioid prescription does. All of the ten Congressional districts with the highest rates of opioid prescriptions are in Alabama, Arkansas, Kentucky, Oklahoma, or Virginia. The Congressional districts with the lowest rates of opioid prescriptions are in California, New York, or Virginia.
If you relate the graph in yesterday’s post with the tables in the article I’ve linked to today, a story emerges. Districts with very high median incomes and, presumably, very high rates of private insurance coverage have lower reported rates of opioid prescription. Districts with very low median incomes and, presumably, high rates of enrollment in Medicare have high reported rates of opioid prescription.
What lesson does Arlington, Virginia have for the rest of the country? That we spend too much money in Washington? Do the reported rates for private insurers comport with the actual rates?
I think we need to know more before we have enough information to start talking about policies.
“I think we need to know more before we have enough information to start talking about policies.”
We know enough to do and not do lots of stuff. Waiting of perfect knowledge won’t change a lot of what we already know.
1) Give up the War on Drugs. People can’t buy prescription drugs illegally because they cost too much, so they turn to heroin. Al these years with the War on Drugs and drug prices haven’t changed. Should tell us something.
2) Use some of that War on Drugs money for treatment programs. By and large treatment programs have had a t least some success.
3) Figure out ways to pay for treatment of pain and drug addiction. For example, the following is something I have been working on with my partner. Assume someone gets hurt in a rural area. They need treatment, maybe including surgery. Smaller rural hospitals don’t have pain specialists. That patient is having their pain treated with narcotics. How do we get pain specialists to the small hospitals, remembering that insurance doesn’t pay much for that kind of pain care? If they do get addicted, if they do want treatment, how do we provide it?
Steve
What does that mean? Does it mean decriminalization of use? Does it mean abolishing the drug schedules and making everything available OTC? Does it mean making Schedule 5 drugs completely OTC? 4-5? 3-5?
If it means making everything available OTC, I think that would be a very bad idea with serious medical and social repercussions. You’re probably more aware of the medical implications than I am. As the schedule number rises I think it’s a slightly less bad idea.
If you mean anything other than making everything legal and available OTC, I think you’re overestimating the cost savings. I also think you’re overestimating the effect on prices. Biologics for RA are horrifically expensive and it has nothing to do with the War on Drugs. In other words there is no straight line relationship between drug cost and legality or production costs.
I would decriminalize everything when it comes to using. Putting people in jail of using heroin just introduces them to more criminals. I would still make it criminal to see Heroin, Meth and Cocaine. I would completely legalize pot and most of the hallucinogens, treating them like alcohol. Cant use and drive.
Total cost of the War on Drugs is about $40 billion/year. We spend about $9 billion of that on pot enforcement. (probably net that much in taxes if legal.) We spend about $30 billion a year on substance abuse treatment. Hard to get exact numbers since so much is done by states and not federal, but link gives some general ideas.
As far as prices go my point is just using prices as a metric to see if the War on Drugs has had much effect would indicate it has not worked very well. Accounting for inflation, costs have not changed much, and heroin in particular has become cheap again.
https://www.addiction-treatment.com/in-depth/what-america-spends-on-drug-addictions/
Also, we average about a million pot convictions a year, the large majority for use. That means we have nearly a million people a year who then have difficulty getting into the job pool.
https://www.aclu.org/gallery/marijuana-arrests-numbers
Steve
I don’t have much objection to decriminalization of the categories you mention or the legalization of marijuana. I strongly suspect you’ll be disappointed with the results. For most people there are only three ways of supporting a habit: dealing, stealing, and prostitution. What I think will happen is that the option of pleas down to simple possession will be gone. I also think that anything short of complete legalization of everything will result in less cost savings than you might think.
If I were going to implement a policy, I would legalize marijuana first, then Schedule V drugs. Incremental. That gives you a chance to correct course if necessary.
“supporting a habit: dealing, stealing, and prostitution.”
For Heroin, Meth and Cocaine. Not so much for pot. We save $10 billion at least with legalizing it. Add in another $10 billion of taxes on its sales. Ad in the billions we gain when people can successfully gain jobs because they don’t have a drug history. Take that and spend on treatment. Should be able to double that spending. Add in the billions from not jailing heroin, cocaine and meth users. We aren’t making up the $500 billion to a $trillion numbers used as estimates of total losses due to drugs, but if we can double treatments that is a good start.
Steve
I am pretty darn skeptical that legalization of marijuana is the solution to the opioid crisis.
It might not make matters worse but it won’t make it better. Marijuana has been illegal for 80 years and during that time opioid addiction rates seemed to have gone up and down. For that matter, is there a study that shows when marijuana was/is legal opioid addiction is lower (with definite proof of causation?)
I come to this with a pessimistic eye – probably the best solution is to keep people from getting addicted in the first place. Treatment can amoliate the consequence of addiction but it can never reverse it. By all means we should increase spending on treatment; but my guess is if you look at cost effectiveness of all approaches, the ones with best bang for the buck are the ones to prevent addiction.
By the way, I am okay with marajuana legalization if the producers and distributors embrace that classic term; strict liability.
And remember, most employers require hire and random drug tests for THC. A high penalty enough for marijuana use, unemployment. So legalize it. But then how do we keep R.J. Reynolds from packaging and marketing it?
When prohibition was repealed, they threw the doors wide open. Legalize any illegal drug with significant restrictions and you’ve still got a black market.
“I am pretty darn skeptical that legalization of marijuana is the solution to the opioid crisis.”
I don’t either. I am making the case that if we stop wasting money on the War on Marijuana, we can maybe double what we currently spend in drug treatment. The weak part o this argument is that in reality it would probably just go to tax cuts for the wealthy.
“But then how do we keep R.J. Reynolds from packaging and marketing it?”
We don’t. Do you really think many people don’t use marijuana now because they can’t obtain any?
Steve