August 21, 2018

JOHNS | Don’t Pour Medicaid Gasoline on New York’s Opioid Fire

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Ithaca Mayor Svante Myrick ’09 wrote a letter to Governor of New York Andrew Cuomo last spring, offering his solution to a problem that no state seems to be able to shake: the opioid epidemic. In his May 16 plea, Myrick included stark data about the way opioids have gripped the city and the county; he noted correctly that 2017 was the “deadliest year for fatal overdoses on record” in Ithaca and that 55.3 of every 100,000 emergency room visits and 15.2 of every 100,000 hospitalizations were overdose-related in Tompkins County in 2016. The mayor’s solution is to allow individuals to legally inject heroin in the city under city government supervision. While federal and other legal challenges almost certainly linger, he wants the governor to approve his plan.

Myrick argues that his proposal, “The Ithaca Plan,” lowers fatalities and gives addicts a better opportunity to seek help, though it almost certainly violates both international and domestic drug control laws. Canada’s equivalent of the plan, known as Insite, which the mayor cited when defending his policy at a session of the Cornell Political Union in April 2017, was criticized by the Canadian Federal Health Minister who noted that the research on the program’s efficacy is preliminary and inconclusive. The governors of several states, most recently Massachusetts, have reached the same verdict.

To be fair, Myrick can be credited for his responsiveness to the opioid crisis; other policymakers, less so. But this proposal is a serious misstep and overlooks other serious problems. On January 25, the U.S. Senate Homeland Security and Governmental Affairs Committee released a report detailing the connection between Medicaid and opioid addiction. One thing is clear: Medicaid offers cheap access to pills which sometimes end up in the wrong hands. In fact, according to several studies, most notably by the Centers for Disease Control and Prevention, Medicaid beneficiaries are twice as likely to be prescribed opioids compared to those on private insurance. In New York state, these patients have access to oxycodone and other opiates, which can be resold illegally for thousands of dollars. This path has become its own supply chain for the epidemic. Over the last eight years, more than 1,000 people have been convicted of precisely that crime. Like other supply routes that deserve attention — the unsecured border and Chinese fentanyl distribution, for example — this type of fraud is present and profitable.

This is ultimately a local problem. In the last four years, Tompkins County has seen a 19 percent rise in Medicaid caseloads, which far outpaces the national average of 5.2 percent over the same period. The Medicaid fraud crisis, at least as it relates to the opioid epidemic, has grown especially quickly in states that, as a part of Obamacare provisions, vastly expanded Medicaid eligibility, as Cuomo did in New York. According to the Senate’s report, “the number of criminal cases increased 55 percent in the first four years after Medicaid expansion, from 2014 to 2017, compared to the four-year period before expansion.”

Nor are these merely partisan findings from the Republican-controlled Senate. The nonpartisan CDC found that overdose deaths rose twice as much on average in states like New York, which expanded Medicaid, compared to those that didn’t. This correlation also exists on opioid-related emergency room visits and hospitalizations. Those who do seek help in the system aren’t given effective treatment by state Medicaid programs, either; according to the Agency for Healthcare Research and Quality, the number of opioid-related hospital stays paid for by Medicaid increased by 40 percent between 2012 and 2014. This is especially alarming when viewed in context — that figure grew by about four times the rate that Medicaid enrollment did in that period. Medicaid wasn’t taking on new addicts and treating them — it was simply creating new addicts.

These are staggering statistics, but they are also cold and depersonalized ones. Ultimately, it is the personal cost of the national opioid crisis that hits home. 25-year-old Bryan Grieco of Elmira, New York, who died of an opioid overdose in June 2017, is seemingly a perfect example. “Bryan was a really good guy,” his sister Danielle told The Ithaca Voice last year. “He has a heart of gold, but was just afraid to live,” she said of him.

The question confronting us is hopefully self-evident: How many more Bryan Griecos must our nation and the families and friends of these young men and women be forced to endure? Myrick would do well to focus on the causes and supply routes, and not simply the effects, of the opioid epidemic in the city. The mayor’s next letter, instead of an almost certainly illegal proposal, should focus on more reasonable solutions. First, New York’s public servants should support proactive measures to secure the border and tackle foreign drug importation, such as Chinese fentanyl, 80 percent of which enters the U.S. on the ground from Mexico. New York also should reform its Medicaid program, establishing opioid prescriptions as a last step in a pain management clinical protocol, including anti-inflammatories, muscle relaxants, physical therapy, biofeedback, cognitive behavioral therapy, and so on as appropriate, instead of simply approaching opioids as a first-line clinical solution to pain.

By addressing issues instead of advancing pet projects, New York will be more effectual as it seeks to reach and repair communities and stop the use and abuse of deadly drugs that take the lives of young people like Bryan Grieco.

Michael Johns is a junior in the College of Arts and Sciences. He can be reached at [email protected]. Athwart History appears every other Wednesday this semester.