Editor’s Note: This is the second in a three-part series about Ohio’s heroin crisis. A symptom of a larger disease, opioid abuse and pharmaceutical abuse have ravaged the Midwest — and people are finally waking up to it.

Opioids have ravaged families and communities with increasing frequency over the past few years, as Southeast Ohio has witnessed first-hand. Ironically, one of the most powerful causes of this epidemic can be traced to the companies that are supposed to improve people’s health.

Data continue to show most opiate abuse begins with prescription painkillers, evolving into illegal drug use when the prescription runs out, becomes too expensive or is temporarily unavailable.

What, then, compels someone to enter the harrowing rabbit hole of opioid use?

The process is quite simple; patients who have legitimate problems, such as back pain or an injury sustained at work, visit their doctor and are prescribed medication. After taking the pills for days (sometimes weeks) a tolerance is developed, and addiction begins to form.

Finally, having either ran the length of their prescription or lacking money to purchase the more expensive pills, ordinary citizens now engulfed in a ceaseless craving for opiates take to the streets, searching for the illicit drugs to fuel their new addiction.

Perhaps the best explanation comes from the Massachusetts Medical Society: ‘“Doctors do not want to promote dependence, but they also want to provide the pain relief that many patients need.”

Providing treatment, however, has grown increasingly challenging in recent years. As some Ohio facilities have experienced, rehabilitation centers in particular have been struck by an ever-growing number of addicts seeking recovery assistance, with the pace of funding not necessarily increasing to match the surge in patients.

A large part of the funding used by hospitals and services such as Dr. Joe Gay’s, executive director of Health Recovery Services, an addiction services program in Athens, comes from Medicaid.

“(The expansion of Medicaid) had a tremendous positive benefit,” Gay said. “There was a point at which, before the expansion, we were turning away a third of the people who came to us for services because there simply wasn’t enough funding.”

Adults are eligible for Medicaid when their income goes up to 133 percent of the poverty rate, with greater access included for the likes of children or pregnant mothers. Ohio began the process of expanding Medicaid in 2013, receiving the majority of the funds to do so from the federal government.

Gov. John Kasich differentiated himself from his fellow Republicans during the 2016 presidential primary, in which he defended the expansion and praised its impact on addiction treatment services within the state.

Democratic Sen. Sherrod Brown has publicly opposed replacements to the Affordable Care Act, while Republican Sen. Rob Portman has similarly vowed to resist any replacement that doesn’t “include stability for Medicaid expansion populations.” Currently, Ohio’s Medicaid expansion alone offers coverage to some 700,000 residents.

Opposition to the American Health Care Act, a White House-backed legislation to repeal and replace the ACA, was so significant in Ohio and elsewhere that President Donald Trump and Speaker Paul Ryan failed to obtain enough votes to pass it.

Others have posited that the extraordinary cost of said expansion has led to problems. A fundamental aspect of health care is paying for treatment, and many funds have the potential to be wasted rather than used for useful services. In member states of the Organization for Economic Co-operation and Development, nearly 20 cents of every dollar spent on health care is wasted, the organization reported.

“We have to operate within a budget,” Dr. Douglas Teller, an internist specializing in addiction medicine at the Kettering Medical Center, said. “Our current system, it’s not people oriented; we need funds to treat people.”

Graph retrieved from https://media.nationalpriorities.org/uploads/mandatory_spending_pie%2C__2015_enacted.png

The United States far outpaces other developed nations in health care cost, spending nearly 50 percent more than the next closest nation, France, for a whopping $9,086 per capita. The OECD median? $3,661.      

Chart retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

Teller made it clear that the solution to rampant health care spending won’t be fixed until average citizens step up and demand more be done.

“When it comes to health care, personal responsibility is important.” Teller said. “We have to ask; are there clear guidelines? Do we know how we’re going to finance this?”

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