Combatting the Opioid Epidemic

“Wisconsin is in the midst of a national health crisis. Opioid overdose deaths and opioid use disorder are at epidemic levels, and we must ensure those who are affected get the medical help they need. It’s time to hold big pharma accountable for its role for creating this crisis that is devastating the lives of too many in our communities.”

Expand healthcare access to ensure universal coverage. The opioid epidemic, and all substance use disorders, are healthcare problems first and foremost, and should be addressed when possible in the public health system rather than the criminal justice system. Statewide universal healthcare with parity for behavioral health services makes it easier to track and tackle public health crises, from infectious disease outbreaks to the opioid epidemic.This allows for equal access across the state and makes services less expensive as treatment providers don’t need to waste money navigating our complicated healthcare bureaucracy.. It also allows a nimble, efficient response as drug trends change. Until we have a national single-payer system, we must expand BadgerCare to allow anyone to buy in, making it a public option in a state-based exchange under the Affordable Care Act.

Ensure incarcerated people receive counseling and effective treatment. All incarcerated people should be eligible for BadgerCare to ensure that they can initiate or maintain medication assisted treatment for substance use disorder while they are incarcerated. Research shows this approach leads to decreased recidivism, decreased emergency room visits for overdose, and decreased overdose deaths. In addition to crucial gains in well-being, this approach leads to savings for Wisconsin taxpayers. The Department of Corrections has far more people who need behavioral health treatment, including drug treatment, than slots available – and once people are released, their coverage often ends and they leave with only a few days or weeks of medication. Unless other coverage is obtained, we should continue BadgerCare coverage during the period of extended supervision/release, to ensure that people can maintain medications to address their mental health needs, including substance use disorder. Among male prisoners, about 1/3 have mental health conditions, and among females, it’s about 2/3rds, so ensuring proper treatment can greatly reduce recidivism and the overuse of criminal justice/corrections resources for mental and behavioral health issues.

Use evidence-based practices to combat opioid addiction. For most people, effective opioid abuse treatment for most people includes medication assisted treatment and counseling — we need increased access to both. We should also increase the use of harm reduction strategies, which helps keep opioid users safe while making it easier to get them into treatment and recovery. Harm reduction can also help decrease the negative impact of drug use on communities by reducing disease and preventing overdose deaths. There are various effective strategies for harm reduction, ranging from safe sites, expanded access to naloxone (Narcan), fentanyl testing strips, and clean needle kits, among others. In addition to first responders, we should also enable family members who have a loved one at risk of an overdose to obtain training and access to naloxone, which reverses opioid overdoses and saves lives.

Continue building a statewide “Hub and Spoke” model. This is already under development based on a recommendation from Pew. States like Vermont who have enacted this evidence-based model for treatment and recovery are seeing better treatment outcomes and lower healthcare costs. The “hubs” provide intensive support for patients with serious addictions. The “spokes” include continuing and integrated care by healthcare providers and counselors to those in recovery, in local communities all around the state.

Increase the number of mental health and substance use disorder treatment providers. Wisconsin should create a grant program for those who want to work in the substance use disorder and mental health treatment fields. Wisconsin can replicate successful models for increasing providers in high-need areas by paying for graduate school in exchange for graduates agreeing to work in an underserved community for a period of time. Many areas of the state – both rural and urban – have a significantly greater need for services than providers available. Priority should be given to people with lived experience and cultural competence to serve underrepresented communities. We should also make it easier for existing prescribers to receive the buprenorphine waiver training and take a certain number of patients per year with substance use disorders through free Continued Medical Education or other reimbursement.

Create a Division of Prevention and Recovery within the Department of Health Services. This Department should be charged with preventing substance use disorder and supporting people and families affected by substance use disorder. It should use evidence-based practices and bring a trauma-informed care lens to address the opioid crisis. This department should also have a health equity focus to serve the needs of communities that have disproportionately poor health outcomes (for instance, African American, Latinx, Native American, rural Wisconsinites, and LGBTQ populations). One of the biggest areas of inequity is in the criminal justice system so these staff should work directly with Department Of Justice and Department Of Corrections to identify and implement practices to reduce inequities across the public health and criminal justice systems.

Make timely treatment a requirement for insurers. Many people suffering from substance use disorder struggle to get timely treatment, even if they have insurance, because there are not enough beds available at nearby health centers. If an insurer cannot provide timely treatment (within a week) of requested services, they must provide their insured with a single case agreement to an out of network provider at no additional cost. This would help increase availability and efficient use of scarce treatment resources.

Make it easier for those in recovery to access employment, housing, and community peer support. The State of Wisconsin should be a recovery-friendly employer and urge other businesses to do the same. People who have criminal records should not be disqualified or discriminated against in employment or housing, and Wisconsin should re-examine its many licensure prohibitions that makes it impossible for anyone with a felony conviction to obtain certain professional licenses. In addition, Wisconsin should encourage the creation of recovery-friendly housing, such as the sober living models in California and Florida, and make it easy to file a disabilities complaint if a person faces housing discrimination due to being in recovery. Finally, people in recovery often find it helpful to receive peer support/recovery coaching through a Recovery Community Organization (RCO), which can be overseen and funded by the Division of Prevention and Recovery. These RCOs can also be an important entry point into treatment, as it can be easier to reach out to someone with shared lived experiences, rather than calling a healthcare provider or someone in a formal system.

Expand our compassion and evidence-based treatment/recovery model to other drugs, to decrease racial injustice. While it is positive and important that the opioid crisis has sparked a national conversation about how we see and address drug use, unfortunately there are far too many individuals and communities still suffering from the effects of “tough on crime” approaches to previous drug epidemics like crack-cocaine. Wisconsin is the worst state in the nation for racial disparities in our criminal justice system, in significant part due to racist enforcement and sentencing under harsh drug laws, and lack of access to effective treatment. We must retroactively address the injustice created by decades of failed policies and unfair enforcement. While those struggling with opioid use disorder deserve high-quality treatment, so do those with any substance use disorder.

Sue Purdue Pharma and other pharmaceutical companies that lied about their opioid products. Heroin use is intertwined with prescription opioid use – national general population data shows that nearly 80 percent of heroin users reported using prescription opioids prior to heroin. Much like tobacco companies, pharmaceutical companies knew that their synthetic opioids were dangerous and addictive, yet they marketed them as safe, urging doctors to prescribe them for all manner of ailments and downplaying concerns about their addictiveness. I support Attorney General Kaul’s actions against these deceptive profiteers. 

Legalize, regulate, and tax marijuana, using the revenue to help to prevent and treat substance use disorder, and in particular to combat the opioid crisis. States with legal cannabis appear to have lower opioid addiction rates, because patients needing palliative care can get pain relief from cannabis without the danger of addiction from an opioid prescription.

Continue to address overprescribing. While Wisconsin now has a database to track prescriptions, overprescribing continues to be a problem. We can use academic detailing, which is face-to-face peer outreach for health care providers, and group education to reduce over-prescribing.