By most accounts, the opioid epidemic began with the 1996 introduction of the painkiller OxyContin, which contains a chemical cousin of heroin. Within a few years, OxyContin was being massively overprescribed and abused. In 2010, OxyContin maker Purdue Pharma replaced the drug with a reformulated version that is harder to abuse. But this perversely gave addicts reason to look elsewhere for more potent opioids. This resulted in a burgeoning market for heroin, often supplied by Mexican drug cartels.
The entire country is in thrall to a large and growing opioid crisis. From celebrity deaths to the ever‐growing number of individuals struggling with addiction, everyone, it seems, has been affected in some way. Wisconsin politicians have reacted admirably to the crisis, but to truly arrest this epidemic — here and elsewhere — requires a more concerted effort from the federal government.
Heroin is much more dangerous than OxyContin, and on the black market, its potency and quality are vastly less predictable. Worse, producers have taken to mixing heroin with fentanyl, a lethal synthetic opioid roughly 100 times more potent than heroin. As the nation learned after the death of the musician Prince, a small amount of fentanyl can kill.
Beyond the lives lost and countless other tragedies related to addiction, the opioid epidemic imposes a heavy monetary cost in Wisconsin. Many addicts have lost employment and insurance and thus have their myriad health crises paid for by Medicaid. A substantial number of addicts end up in jail, with their health care and other expenses falling upon the state.
Drug‐company shenanigans also have increased the state’s cost of treating opioid addiction. For instance, Indivior, the maker of Suboxone — which is used to reduce opioid cravings — took advantage of its exclusivity period granted by the Food and Drug Administration by voluntarily recalling its product, in tablet form, and replacing it with a medically unchanged product in strip form. The FDA granted Indivior additional years of exclusivity.
The higher price that resulted from the patent extension continues to cost the state millions of dollars in higher Medicaid expenses, and the Suboxone strip is now a popular contraband in Wisconsin prisons, which has led to increased personnel costs.
The Wisconsin Medicaid Pharmacy Prior Authorization Advisory Committee, scheduled to meet May 10 in Madison, can change the current preferred drug list for buprenorphine, which now lists Suboxone as the sole preferred drug covered by state Medicaid, without the need to fund pilot programs or any other new state initiative. By doing so, the committee would likely ease the burden on law enforcement while expanding access to new, innovative treatments for addiction.
To Gov. Scott Walker’s credit, he has acknowledged the epidemic’s complexity. The state Senate on May 2 approved legislation to expand opioid treatment and other initiatives, and the governor has said he would sign the bills.
Walker’s Task Force on Opioid Abuse has, among other things, addressed the state’s rural opioid crisis by creating “addiction fellowships” for rural medical‐training programs. It moved to allow school nurses to administer opioid blockers, which can reverse the effects of an overdose.
Unfortunately, the opioid epidemic isn’t going away soon. No matter how big a wall we build on the Mexican border, as long as the demand for drugs remains, a supplier will exist. Facile slogans or stiffer penalties on drug abusers or their sellers will not be enough to reverse the epidemic.
Wisconsin is on a good path for treating those already afflicted, but reducing the demand for opioids must be done nationwide, and it will require original thinking both about how to revive the economy as well as how to renew faith in our institutions and communities.