Louisiana’s elected officials seem determined to write the wrong prescription to combat opioid abuse.
Tracking the rest of the country, Louisiana has seen a sharp escalation in painkiller usage over the past few years and deaths associated with it. Worse, this has accelerated faster than in most states, in 2016 resulting in an age-adjusted opioid mortality rate of about 22 per 100,000 Louisianans, ranking Louisiana about in the middle of the 50 states.
In response, Louisiana has sued opioid manufacturers, although Gov. John Bel Edwards and Atty. Gen. Jeff Landry are sparring legally over which of their offices will oversee that litigation. Additionally, a number of parishes, including Lafayette, and cities, including Baton Rouge, have also pursued legal action.
The suit filed by the Edwards administration last year alleges manufacturers intentionally misled consumers about risks and pushed pain products to spur greater profits, causing greater health and public safety costs for taxpayers. The Baton Rouge suit makes the same claim and goes after distributors as well, faulting them for insufficient monitoring.
In reality, government policy and its blindness to the true nature of the problem has led to misunderstanding of the crisis. And that has fed a jackpot-justice mentality that distracts from an effective response.
Only about 1 to 2 percent of individuals taking prescribed opioids experience addiction, and in clinical settings — a hospital, for example — deaths from overdose occur at minuscule rates of 0.02 to 0.2 percent. Numerous data sources confirm that opioid addictions and deaths occur overwhelmingly among people already abusing other substances or who suffer from psychological difficulties, or both. Further, these overdoses usually involve other addictive, controlled, or banned substances.
So, the problem is not a flood of opioids pushed by pharmaceutical companies and brokered by uncaring sellers hooking drug-naïve individuals. The issue is one of easier, typically illicit, access to drugs that feed the addiction of people who are already veterans of illegal drug use.
Worse, recent state policy decisions seem to have facilitated this abuse.
A growing body of evidence indicates Medicaid expansion has made opioids much more readily available on the black market. A report released last month from the U.S. Senate's Homeland Security and Government Affairs Committee reveals how Medicaid drug fraud cases increased significantly after expansion began in the states; expansion states disproportionately registered these higher numbers, and overdose deaths rose about twice as fast in expansion states.
The data is consistent with increased usage mainly by experienced abusers of multiple drugs who skirt the law; that population in Louisiana faces elevated risk. Six months after the Edwards administration initiated Medicaid expansion in 2016, the state registered one of the highest ratios nationally of opioid prescriptions per resident, at almost 1:1.
Given this situation, clamping down on fraudulent prescribing and underground sales would best alleviate the epidemic. Yet, as Advocate columnist Dan Fagan recently recounted, even with a skyrocketing quantity of criminal complaints lodged with the state about Medicaid fraud, the Edwards administration has resisted pleas to budget more money dedicated to fighting the problem.
Instead, Edwards and local officials would rather fleece presumed bogeymen in lawsuits that have a better chance of padding government coffers and enriching trial lawyers than in significantly curtailing painkiller-induced abuse and deaths. Even Landry, who showed proper circumspection at this strategy of legal action when the administration first filed suit — perhaps because of Edwards’ aggressiveness — has ramped up efforts in this regard.
To tackle this problem, state government should reverse Medicaid expansion and use those savings to expand fighting Medicaid fraud and criminal activity involving opioids and focus on treating existing addicts. Local governments should target illegal drug trafficking. All should drop dubious lawsuits banking on big paydays that actually don’t provide a real solution.
Jeff Sadow is an associate professor of political science at Louisiana State University-Shreveport, where he teaches Louisiana government. He is the author of a blog about Louisiana politics at www.between-lines.com, where links to information in this column may be found. When the Louisiana Legislature is in session, he writes about legislation in it at www.laleglog.com. Follow him on Twitter, @jsadowadvocate or write to firstname.lastname@example.org. His views do not necessarily express those of his employer.