Why Do Some States Have Bigger Drug Problems Than Others?

Washington D.C. is home to both the nation’s capitol and the nation’s largest drug problem, but why? As the country’s drug epidemic continues to grow, a new analysis by personal finance site WalletHub determined the states with a higher prevalence than others. Vermont, Colorado, Delaware, Rhode Island and Oregon followed the District of Columbia on the list of states with the largest drug problems.

To determine the rankings, WalletHub assessed states across several metrics. They measured drug use and addiction statistics, law enforcement response statistics and realities regarding the availability of treatment. The metrics used to calculate drug use and addiction received twice as much weight as the metrics used to assess law enforcement effectiveness and treatment availability in determining overall ranking.

It is important to note that because the federal government still considers marijuana an illegal drug, and WalletHub considered it as such for the purpose of the report. This was one of the factors that caused Colorado to be ranked so high.

The other states clearly are grappling with the nation’s opioid epidemic.

In an exclusive interview with Foundations Recovery Network, WalletHub analyst and regular NBC financial commentator Jill Gonzalez put the report into context. She noted that in states where high numbers of opioid pills are dispensed, drug problems tend to follow. The states with the most opioid prescriptions per 100 people include Alabama, Tennessee, West Virginia, Kentucky and Oklahoma.

“Often the numbers per 100 residents are at 120, 130, sometimes under 100, but really not very often,” Gonzalez said. “Some states have three times as many as others.”

The states with the fewest number of opioids prescribed per 100 people are Hawaii, California, New York, Minnesota and New Jersey.

People Dying While Politicians Debate Solutions

New Jersey’s lower numbers reflect a kept promise by its former governor, Chris Christie, who recently became the federal drug czar. In his final year as governor, Christie vowed to fight New Jersey’s opioid epidemic, and he made great strides. Christie represents half of the equation that is leaving the nation confused about what the Trump administration will mean for the addicted. The other half is Health and Human Services Director Tom Price.

Price recently said he does not believe opioid maintenance therapy, or medication-assisted treatment, is an effective treatment method. He specifically mentioned the use of methadone and buprenorphine, which are both opioids. Price almost stands alone in the medical community in terms of his remarks.2 His beliefs even contradict his own agency’s advice. Still, some opioid addicts have agreed that not using methadone, buprenorphine or other opioids is the only way they could get sober. Quitting opioids cold turkey is dangerous and always should occur in an inpatient facility.

“We’re Kind of Going in Circles”

Our nation appears to be spiraling out of control when it comes to the opioid epidemic, Gonzalez said.

“I think that the jury’s still out from state to state regarding alternatives to counteract overdoses and medication to wean people off [street drugs]. The is no federal mandate on these,” Gonzalez said. “States will be undecided on this for possibly another decade, when we have an epidemic on our hands now. That’s what our continuing dialogue continues to suggest. We’re kind of going in circles here,” he added.

Many have criticized the state of Indiana and then-Governor (now Vice President) Mike Pence for being behind the curve on needle exchanges. When the opioid epidemic hit Indiana, it was also accompanied by an unprecedented HIV and Hepatitis C outbreak. The state did participate in the Medicaid expansion, so everyone should be eligible for treatment.

Because many of those addicted also have a low-income wage, they bear the added burden of taking expensive HIV medications for the rest of their lives. It is unclear how many are being treated for Hepatitis C, which can be cured, but it takes time.

Where Treatment is Available, People Seek Help

Not surprisingly, states with the highest number of substance abuse treatment facilities per 100,000 drug users also ranked low for drug problems overall. Those who need help are getting it. Those states include Hawaii, Wyoming, North Dakota, Maine and South Dakota.

States with the lowest number of treatment centers? Washington D.C., not surprisingly, followed by California (which does seem surprising, but not when you consider per capita), South Carolina, Nevada and Texas.

All of this said, the report also noted our nation’s drug epidemic is rooted in states that lean toward the Democratic party and is far less prevalent in those that have a higher presence of Republicans. It has been widely reported that President Donald Trump won almost every county where the opioid problem is most severe, a majority of them in America’s Rust Belt.3

Expansion of Access to Quality Treatment Is the Only Way Out

A panel of experts who commented on the WalletHub analysis offered differing emphases on how to solve it. Hilary S. Connery, Clinical Director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital and Assistant Professor of Psychiatry at Harvard Medical School, offered a frank explanation of how the opioid epidemic came into being.

After “Pain as the fifth vital sign” became a well-intentioned mantra among physicians in the 1980s, “Pharma aggressively marketed opioid prescribing, at times unethically,” Connery said. “Patients learned it was their ‘right’ to get opioids and began to demand them routinely.”

“Prescribers are asked to treat high-risk, complex patients in 10 minutes, which is simply unrealistic for careful, thoughtful prescribing and monitoring practices,” she added.

Joseph R. Guydish, Professor of Medicine and Health Policy at University of California, San Francisco, was asked what the “most effective” measures state and local authorities can take to combat the opioid epidemic are.

“Authorities will look for strategies they know,” he said, listing solutions such as more methadone and buprenorphine clinics (even though Secretary Price said these treatments are not real solutions) and encouraging better usage of prescription drug monitoring programs.

“But the most effective measure is to expand substance abuse and mental health treatment, and to pay for these services on parity with other healthcare services. Then, both patients and physicians may have recourse to treatments that do not always come in a pill,” Guydish said.

1. Kiernan, J. and WalletHub researchers.“Drug Use by State: 2017’s Problem Areas.” WalletHub.
2. Harper, J. (2017, May 16). “Price’s Remarks on Opioid Treatment Were Unscientific and Damaging, Experts Say.” NPR.
3. Heitz, D. “What Kind of Addiction and Mental Health President Will Donald Trump Be?” (2017) Michael’s House.

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