Why you should care
Because partisanship should not matter in public health.
Elizabeth Brico is a freelance writer from the Pacific Northwest who often focuses on addiction.
By now, we’ve all heard politicians tout the opioid addiction crisis as a nonpartisan issue. After all, does it matter whom you vote for when your daughter comes home loaded on heroin or you find your brother on the bathroom floor? Unfortunately, while the crisis may affect both sides of the political divide, the treatment of people who are addicted varies greatly depending on location. Evidence suggests that it is far better to be addicted to pills and heroin in blue states than in red states.
All Democratic states (defined here by the dominant legislative party) offer coverage for methadone — the gold standard of treatment for opioid use disorders — either through Medicaid or other state funds. Only around half of Republican states offer coverage for methadone. And states where clinics are few or far between — such as Wyoming, which has zero methadone clinics — tend to be Republican.
In general, people in Republican states face harsher sentences for drug crimes and receive worse treatment.
While all 50 states offer buprenorphine coverage, patients across the country report weaselly tactics that cost them hundreds of dollars a month, even while having insurance. Many buprenorphine providers will charge patients out of pocket for the recurring doctor’s visits the programs require, for example. I experienced this myself in Sunrise, Florida. When I enrolled in a buprenorphine detox program, my medication was covered, but I had to pay between $100 and $300 per doctor’s visit, depending on the frequency of visits required. In my observations, other patients paying these extra charges also tend to report from red states.
It’s not just the cost of care that is problematic. In general, people in Republican states face harsher sentences for drug crimes and receive worse treatment. If someone is incarcerated while taking methadone or buprenorphine, he is unlikely to have access to his medication while in jail or prison — even though treatment is available for other chronic conditions. It’s an issue across the country, but blue states lead the reform campaign by a wide margin. For example, Rikers Island Correctional Facility in New York state has the longest-running methadone treatment program, and Seattle’s King County Correctional Facility later followed suit. This year in New Jersey, Alan Oberman is heading a pilot mobile methadone program for Atlantic County Jail. Other methadone programs are sprinkled across United States correctional facilities, mostly in blue states. Of the approximately 5,000 correctional facilities in the U.S., fewer than 40 offer opioid-assisted treatments for inmates who are not pregnant. Of those that do, only eight are in Republican states: four in Pennsylvania, three in Arizona and one in Florida.
The issue touches every aspect of care. I spoke with a health unit coordinator from an emergency department in Dayton, Ohio, who asked to remain anonymous for professional reasons. She told me that she sees at least one overdose per shift, which is not surprising as Ohio leads the nation in overdose deaths. Even with so much experience, though, the patient care she describes is far from best practice: Patients are regularly restrained upon awakening from an overdose, then searched by armed police officers. Metal detectors are stationed at the public entrance. “We’re working on getting wands for people who come in by ambulance,” the coordinator said. Staff members regularly refuse to administer appropriate pain medication if overdose patients return for other reasons that would normally warrant narcotic pain control.
“They want to be addicted and they don’t care about anything or anyone else,” she added, reflecting the general attitude that dominates these areas, if news reports and social media interactions are to be believed.
A shift may be underway. Ohio Gov. John Kasich signed a bill this year that will allow for-profit methadone clinics to open in the state, as well as allowing wider availability for naloxone, the drug that can reverse an overdose. Georgia recently expanded the Medicaid approval guidelines for methadone so that more clinics will be able to bill Medicaid should they choose to do so. Federal funds dispensed across the country this year by the Trump administration from the bipartisan 21st Century Cures Act may lead to similar changes in other red states, but those data are not yet available.
The dynamic “is being recalibrated,” says Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. “I think it’s safe to say that when a large number of your state’s residents are dying, that moves the political calculus in a different direction. No elected official wants to appear complacent to the electorate when their sons and daughters and friends are dying.”
It will be at least a few months before we know the real-world results of these policy changes — and whether national momentum is growing. It’s difficult to imagine that these legislative moves will alter attitudes about addiction espoused in red states, at least not any time soon. In the meantime, statistics and on-the-ground reports available today continue to suggest that, for patients, the opioid addiction crisis is very much affected by partisan politics.