“‘Our findings suggest that both public and private insurers, at least unwittingly, have contributed importantly to the epidemic,’ said study senior author G. Caleb Alexander, M.D., M.S., associate professor in the Bloomberg School’s Department of Epidemiology and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness,” stated a press release from Johns Hopkins on the study, “Prescription Drug Coverage for Treatment of Low Back Pain Among U.S. Medicaid, Medicare Advantage, and Commercial Insurers,” which was published in the scientific journal JAMA Network Open.
The third-party payers make it too easy and inexpensive for people to procure opioid prescriptions, the researchers concluded.
Free Opioids Through Medicaid
Sen. Ron Johnson (R-WI), chairman of the U.S. Senate Homeland Security and Governmental Affairs Committee, was quoted in a January 2018 committee report saying Medicaid contributes to opioid abuse by providing patients with addictive and potentially dangerous drugs for free.
Johnson’s report found clear evidence Medicaid has fostered opioid abuse by making it enormously profitable to abuse and sell dangerous drugs, with Medicaid expansion making the problem worse.
In January, Johnson wrote an open letter to Eric Hargan, acting secretary of the U.S. Department of Health and Human Services, and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, and included a copy of his report, stating in the letter Medicaid plays a “perverse and unintentional role” in the rise of opioid abuse.
Johnson’s letter presented evidence Medicaid expansion had worsened the opioid problem.
“At least 1,072 people have been convicted or charged nationwide since 2010 for improperly using Medicaid to obtain prescription opioids, some of which were then resold on the nation’s streets,” Johnson said in the report. “The number of criminal defendants increased 18 percent in the four years after Medicaid expanded, 2014-2017, compared to the four years prior to Medicaid expansion. The criminal activities range from beneficiaries simply selling opioids they obtained through the Medicaid program to more attenuated health care fraud involving Medicaid reimbursement.”
Boon for ‘Third Party Sellers’
Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons, president of Doctors for Disaster Preparedness, and a policy advisor to The Heartland Institute, which publishes Health Care News, says doctors aren’t the only ones providing opioids to consumers. There are also third-party, illegal sellers, she says, to whom the sale of opioids is highly lucrative.
“Third party sellers pay for opioids as well, and opioids have a great resale value, so there is certainly an incentive to try to get prescriptions for diversion,” Orient says. “Third-party sellers do not pay for alternative treatments that might be of benefit to patients. Prescription opioids are more lucrative. Third-party sellers have no incentive to lower costs, because the more dollars that are amassed through the sale of opioids, the more dollars that stick to their fingers.”
Governments Focus on Prescribers
Orient says government agencies have focused more on prosecuting doctors who overprescribe opioids than on investigating why Medicaid and Medicare paid for the prescriptions. The crackdown results in a tragic situation in which patients who need the painkillers cannot get them, she says.
“Lawmakers and administrative agencies—including DEA, DOJ, and licensure boards—have been ‘cracking down’ on prescribers, criminalizing practices that were once promoted in seminars to combat under-treatment of pain,” Orient says. “Hundreds of thousands of pain patients nationwide were suddenly cut off from any doctors willing to see them, undergoing painful and occasionally fatal withdrawal. Some of the addicted committed suicide, some turned to the black market, some reverted back to disability.”
“Health Insurance Plans May Be Fueling Opioid Epidemic: Study of Coverage Policies Highlights Inadequate Effort to Reduce Opioid Overuse,” Johns Hopkins Bloomberg School of Public Health, June 22, 2018: https://www.jhsph.edu/news/news-releases/2018/health-insurance-plans-may-be-fueling-opioid-epidemic.html
“Drugs for Dollars: How Medicaid Helps Fuel The Opioid Epidemic,” Committee on Homeland Security and Governmental Affairs United States Senate, January 17, 2018: https://www.hsgac.senate.gov/imo/media/doc/2018-01-17%20Drugs%20for%20Dollars%20How%20Medicaid%20Helps%20Fuel%20the%20Opioid%20Epidemic.pdf