Rep. Erin Koegel
Minnesota House of Representatives
Opioid use disorder is a costly epidemic. Policymakers are searching for solutions to this public health crisis, but who should pay to combat this problem? That simple question creates a lot of tension when crafting public policy.
For my family, the opioid epidemic is linked to two numbers: $60,000 and one. It cost $60,000 for treatment to save my brother who had an opioid use disorder. My brother started using opioids nine years ago. His addiction began when he underwent an appendectomy and was given opioids at the age of 15. It almost bankrupted my family as my mom maxed out every credit card to pay for treatment.
It was worth every penny to save his life so he could meet my husband and I’s daughter, Clara, who was born just before Christmas in 2018.
My family is fortunate my brother was able to find a treatment plan that worked for him; many are not as fortunate. More than 42,000 Americans died by opioid overdose in 2016.[i] That means that more than 100 Americans – every single day – die from opioid abuse. This statistic is appalling and almost unfathomable. It is unacceptable that private companies are able to amass record profits while their product has such a devastating effect on people.[ii]
Those lucky like my family are able pay for treatment, and possibly go bankrupt, while hoping their loved one finds a path to recovery. The less fortunate likely become another overdose statistic.
From a public policy point of view, the opioid crisis is creating a significant strain on local government budgets. When parents with an opioid use disorder are no longer able to take care of their children, or children are born with neonatal abstinence syndrome and require additional care, state and/or local officials step in to protect the children.[iii] These actions create a significant burden on local government budgets, costing taxpayers a significant amount of money.
How can we, as a country, allow this to continue? How did the issue grow to this extent, and with so little public knowledge?
The truth is that a lot of factors have contributed to the opioid epidemic. Regulatory agencies, health care providers, pharmaceutical companies and others have all played a role. Extended-release opioids were introduced to health care providers in the 1990s with assurance from pharmaceutical companies that they weren’t addictive.[iv] We now know that this assertion was inaccurate.
With this assurance, doctors and dentists began prescribing more opioids after less-serious procedures than they had previously. In the early 2000s, the Center for Medicare and Medicaid Services required doctors to assess their patients’ pain levels, which was defined as a quality measure tied to their reimbursement. If you have ever had to rate your pain on a scale of 1 to 10 while you’re at the doctor, you know how this goes.[v] By 2010, Hydrocodone was the most prescribed drug in the United States.[vi]
Minnesotans, and Americans, deserve a comprehensive approach to end this epidemic that continues to cause too many tragedies and deaths. Increased investments in prevention, treatment, recovery, and emergency response are urgently needed to reduce these trends. The opioid epidemic affects many families and disproportionately harms vulnerable populations, tribal communities, and people of color.[vii]
Opioids, a product provided by pharmaceutical companies, are costing tax-payers millions of dollars, while these companies are making record profits. Funding for new methods to end the opioid epidemic should come from their massive profits, not from Minnesotans.[viii]
In 2018, the Minnesota Senate passed a bipartisan proposal, by a vote of 60-6, that created a licensing fee for opioid manufacturers and distributors based on the ratable market share these companies make in profits in Minnesota.[ix]
Although this proposal could not pass the Republican-controlled Minnesota House in 2018, I am optimistic that with new Democratic leadership and 39 newly elected members of the Minnesota House, policymakers will advance legislation to further combat the opioid epidemic.[x] [xi]
If passed, the aforementioned proposal would generate $20 million dollars in new money in Minnesota to be used for treatment and prevention programs.[xii] One of the key features of this legislation is that Minnesota taxpayers are not on the hook for a crisis created by the pharmaceutical industry.
My family is incredibly lucky that my brother successfully completed treatment, is thriving in recovery, and is now working in a sober living facility. He has been able to build up a community around him that supports him in his sobriety journey. However, only 10% of addicts are given the opportunity to receive treatment,[xiii] which is unacceptable. Minnesotans deserve the care they need to save their lives and those of their families. Therefore, companies who are creating, selling, and distributing opioids should share in the cost.
[i] Disease Control and Prevention. (2016-2017 increases). Drug Overdose Deaths. Retrieved from https://www.cdc.gov/drugoverdose/data/statedeaths.html
[ii] www.statista.com – 2018 ranking of the global top 10 biotech and pharmaceutical companies based on net income (in billion U.S. dollars) https://www.statista.com/statistics/272720/top-global-biotech-and-pharmaceutical-companies-based-on-net-income/
[iii] Minnesota Department of Human Services: The Opioid Epidemic in Minnesota – https://mn.gov/dhs/assets/federal-opioid-briefing_tcm1053-336378.pdf
[iv] Barry Meier, Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused, N.Y. TIMES (May 29, 2018), https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html.
[v] Scott G. Weiner, Olesya Baker, Sabrina J. Poon, Ann F. Rodgers, Chad Garner, Lewis S. Nelson, Jeremiah D. Schuur, The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio, 70, Annals of Emergency Medicine, 799, 799-808 (Dec. 2017)
[vi] Eric Patterson, Hydrocodone History and Statistics, DRUGABUSE.COM (Jan. 28, 2016), https://drugabuse.com/library/hydrocodone-history-and-statistics/
[vii] MINN. DEP’T OF HEALTH, RACE RATE DISPARITY IN DRUG OVERDOSE DEATH, 1st Sess., at 11 (May 7, 2018), available at http://www.health.state.mn.us/divs/healthimprovement/content/opioid-dashboard/documents/raceratedisparity.pdf
[viii] 2018 ranking of the global top 10 biotech and pharmaceutical companies based on net income (in billion U.S. dollars) https://www.statista.com/statistics/272720/top-global-biotech-and-pharmaceutical-companies-based-on-net-income/
[ix] See S.F. 730 (5th Engrossment), 90th Minn. Leg., R.S., (2017-18)
[x] Briana Bierschbach, Opioid fee dies in final hours of session, MINNESOTA PUBLIC RADIO (May 19, 2018, 2:44 PM), https://blogs.mprnews.org/capitol-view/2018/05/opioid-fee/
[xi] 2018 Election Directory for the 2019-2020 Minnesota Legislature, (Minn. House of Representatives Pub. Info. Serv.), Nov. 19, 2018, avaliable at https://www.house.leg.state.mn.us/hinfo/leginfo/elecdir18.pdf
[xii] Minnesota Management and Budget Fiscal Notes Search: SF730 from the 2017-18 Legislative Session, https://mn.gov/mmbapps/fnsearch/ (last visited Jan. 7, 2019)
[xiii] Katharine Q. Seelye, Fraction of Americans With Drug Addicition Receive Treatment, Surgeon General Says, N.Y. TIMES (Nov. 17, 2016), https://www.nytimes.com/2016/11/18/us/substance-abuse-surgeon-general-report.html