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The Cost of Wisconsin’s Opioid Crisis

Ike Brannon and Devorah Goldman

The entire country is in thrall to a large and growing opioid
crisis. From celebrity deaths to the ever-growing number of
individuals struggling with addiction, everyone, it seems, has been
affected in some way. Wisconsin politicians have reacted admirably
to the crisis, but to truly arrest this epidemic — here and
elsewhere — requires a more concerted effort from the federal
government.

By most accounts, the opioid epidemic began with the 1996
introduction of the painkiller OxyContin, which contains a chemical
cousin of heroin. Within a few years, OxyContin was being massively
overprescribed and abused. In 2010, OxyContin maker Purdue Pharma
replaced the drug with a reformulated version that is harder to
abuse. But this perversely gave addicts reason to look elsewhere
for more potent opioids. This resulted in a burgeoning market for
heroin, often supplied by Mexican drug cartels.

Wisconsin is on a good
path for treating those already afflicted, but reducing the demand
for opioids must be done nationwide.

Heroin is much more dangerous than OxyContin, and on the black
market, its potency and quality are vastly less predictable. Worse,
producers have taken to mixing heroin with fentanyl, a lethal
synthetic opioid roughly 100 times more potent than heroin. As the
nation learned after the death of the musician Prince, a small
amount of fentanyl can kill.

Beyond the lives lost and countless other tragedies related to
addiction, the opioid epidemic imposes a heavy monetary cost in
Wisconsin. Many addicts have lost employment and insurance and thus
have their myriad health crises paid for by Medicaid. A substantial
number of addicts end up in jail, with their health care and other
expenses falling upon the state.

Drug-company shenanigans also have increased the state’s
cost of treating opioid addiction. For instance, Indivior, the
maker of Suboxone — which is used to reduce opioid cravings
— took advantage of its exclusivity period granted by the
Food and Drug Administration by voluntarily recalling its product,
in tablet form, and replacing it with a medically unchanged product
in strip form. The FDA granted Indivior additional years of
exclusivity.

The higher price that resulted from the patent extension
continues to cost the state millions of dollars in higher Medicaid
expenses, and the Suboxone strip is now a popular contraband in
Wisconsin prisons, which has led to increased personnel costs.

The Wisconsin Medicaid Pharmacy Prior Authorization Advisory
Committee, scheduled to meet May 10 in Madison, can change the
current preferred drug list for buprenorphine, which now lists
Suboxone as the sole preferred drug covered by state Medicaid,
without the need to fund pilot programs or any other new state
initiative. By doing so, the committee would likely ease the burden
on law enforcement while expanding access to new, innovative
treatments for addiction.

To Gov. Scott Walker’s credit, he has acknowledged the
epidemic’s complexity. The state Senate on May 2 approved
legislation to expand opioid treatment and other initiatives, and
the governor has said he would sign the bills.

Walker’s Task Force on Opioid Abuse has, among other
things, addressed the state’s rural opioid crisis by creating
“addiction fellowships” for rural medical-training
programs. It moved to allow school nurses to administer opioid
blockers, which can reverse the effects of an overdose.

Unfortunately, the opioid epidemic isn’t going away soon.
No matter how big a wall we build on the Mexican border, as long as
the demand for drugs remains, a supplier will exist. Facile slogans
or stiffer penalties on drug abusers or their sellers will not be
enough to reverse the epidemic.

Wisconsin is on a good path for treating those already
afflicted, but reducing the demand for opioids must be done
nationwide, and it will require original thinking both about how to
revive the economy as well as how to renew faith in our
institutions and communities.

Ike Brannon is
a visiting fellow at the Cato Institute and president of Capital
Policy Analytics. Devorah Goldman is an assistant editor at
National Affairs.