A recent study out of Harvard that looks at rates of opioid overprescription by U.S Congressional district finds that while Texas overall has lower overprescription rates than the national average, Districts 4 and 1 greatly exceed that average.
According to the study, the rate of opioid overprescription nationally in 2016 was about 65 percent, meaning that two-thirds of Americans prescribed opioid drugs were prescribed more than they needed. In Texas, that rate was 58 percent overall.
But in Congressional Districts 4 and 1, which cover almost all of Northeast Texas, the rate of opioid overprescription was just shy of 90 percent – 89.67 percent and 89.35 percent, respective to Districts 4 and 1.
Those numbers rank Districts 4 and 1 72nd and 74th overall, respectively, among Congressional districts nationally. (See the listing of Texas' Congressional districts in the slideshow above.)
Lindsey Rolheiser, one of the authors of the Harvard study, calls the numbers in Northeast Texas “a statistical outlier.” More troublesome, though, is the fact that neither she nor her fellow researchers know why Northeast Texas' overprescription numbers are so much higher than the rest of the state.
U.S. Rep. John Ratcliffe, a Republican who represents District 4, said in a statement to KETR (see full statement below) that “this new information underscores the pressing need to continue the important work I’ve been doing in Congress to address the growing opioid crisis in Texas’ 4th District and around the country.”
His opponent for the District 4 seat this November is Democrat Catherine Krantz, who said in her own statement to KETR (see full statement below) that news of Northeast Texas' opioid problem was “shocking and sad but not surprising given the anecdotal evidence I have seen in the community.”
She added that she would “love to see more data and understand better why our rural southern (and especially rural East Texas) districts are so much more likely to see the overprescription of opioid drugs than other areas of the country.”
But more data as to why Northeast Texas has such high opioid prescription rates is currently lacking. Rolheiser says the study looked at reporting information from 135,000 U.S. retail pharmacies about how many opioid prescriptions were filled in 2016. All pharmacies reported under the same conditions, so “it's not an issue of reporting bias,” she says.
According to the National Institute of Health's National Institute on Drub Abuse, Texas doctors in 2015 wrote 15.9 million opioid prescriptions; and a year later, 1,375 Texans died from opioid-related overdoses. That's 4.9 people per 100,000, which is almost a third lower than the national average of 13.3 deaths per 100,000 in 2016.
Rolheiser says the Harvard study focuses on Congressional districts because doing so offers a level of accountability not possible at the county or local level. The authors, nevertheless, lay no blame on congressional representatives for the number of prescriptions written. No one goes to their Congressperson to get an opioid script, after all.
But the study does beg the question of what lawmakers can do.
“What has to happen and what Congress has a role in and can be very useful in,” says Marvin Ventrell, executive director of the National Association of Addiction Treatment Professionals, “is continuing to require addiction to be covered as a healthcare benefit.”
Addiction is recognized as a mental healthcare issue under the Affordable Care Act. Under the Mental Health Parity & Addiction Equity Act – passed under George W. Bush and enacted under Barack Obama – insurance payments for addiction treatment must be paid under the same rules as any other medical or surgical disorder.
Ventrell calls funding “the root source of all of the progress” when it comes to fighting opioid addiction through treatments.
What cannot be ignored, of course, is how overprescription of opioids leads to abuse. And the answer is not what you might think. According to Elizabeth Hermann, scientific director for surgical outcomes at the Mayo Clinic, a third of patients given opioids for pain actually never take any. And up to half only take a few pills, leaving most prescriptions with lots of leftovers.
The problem, Hermann says, is that “fewer than 10 percent get rid of pills” they don't use. Consequently, unused opioid pills sit around, inviting someone else to take them. Hermann says there are likely as many as 1 million unused opioid pills floating wound the country right now, in cabinets, on nightstands – all waiting for someone they were not intended for to grab them.
“These pills were prescribed with the best of intentions,” Hermann says. But, she adds, “75 percent of heroin users took opioids first.” And with a million pills sitting around, the already-big problem can certainly get worse.
Beyond the federal level, Ventrell says states like Texas could make a dent in at least the treatment of opioid abusers by expanding Medcaid.
“Poor people, people without coverage, are gonna die from opioid overdose and addiction if they don’t have this Medicaid expansion,” he said.
But Texas is not likely to take this route. Texas is one of 17 states to not have adopted Medicaid expansion, according to data from the Kaiser Family Foundation. It’s also one of 14 states not even considering it.
Last year, Gov. Greg Abbott referred to the Medicaid system as “broken.” Meanwhile, Lt. Gov. Dan Patrick has said the issue of expanding Medicaid in Texas is not even worth discussing.
Statement by John Ratcliffe (R, incumbent, TX-04):
“This new information underscores the pressing need to continue the important work I’ve been doing in Congress to address the growing opioid crisis in Texas’ 4th District and around the country. I’ve voted for the passage of dozens of bills to combat the opioid epidemic on behalf of the constituents I represent – including legislation (H.R. 5327) to establish comprehensive recovery centers in areas with the highest opioid mortality rates.
“I firmly agree with President Trump that opioid abuse is a national public health emergency that must be put to a stop. I’m grateful that he’s already signed opioid legislation I voted for to increase resources for stopping the illegal importation of opioids and other drugs (H.R. 2142) and to ensure safe opioid prescribing practices for veterans (S. 2372).
“In addition to the legislative efforts I’m working on in Congress, I’ve supported the work being done on the federal level to arrest drug traffickers who attempt to move addictive opioids through Northeast Texas. I’m also grateful for the expanded treatment options being offered by local healthcare providers to help promote recovery and early intervention for those at high risk for opioid use disorders in our region.”
Statement by Catherine Krantz (D, challenger, TX-04):
“That is shocking and sad but not surprising given the anecdotal evidence I have seen in the community. I would love to see more data and understand better why our rural southern (and especially rural East Texas) districts are so much more likely to see the over prescription of opioid drugs than other areas of the country. We have a true opioid crisis across America and it is playing out in force in our rural communities. It urgently needs to be addressed. I am a strong believer in Universal Healthcare and I know that any improvement in access to affordable healthcare would help. I also believe in legalizing medical marijuana, studies have shown areas that have medical marijuana dispensaries have lower incidence of opioid abuse. Legalizing medical marijuana would also have the added benefit of helping our veterans with non-opioid treatment of PTSD. Thirty-one percent of combat veterans suffer from PTSD and over 20 veterans a day are committing suicide in America. The opioid epidemic, according to the New York Times, led to over 72,000 overdose deaths last year alone.
“The over prescription of opioid drugs from our medical providers may be the 1st step toward opioid addiction for many of our citizens but to truly address the opioid crisis unfolding across America we need to tackle the underlying issues. I suspect any decent investigation on the opioid epidemic in America and especially in rural communities will conclude the main factors are health care related and poverty related. A population living so close to the poverty level (53 percent of the residents of TX-04 are considered low income, 13 percent below the poverty line) will be more affected by the lack of affordable healthcare and the lack of health insurance than higher income areas. These populations rely heavily on emergency room care over the preventative and maintenance care people with health insurance get from primary care doctors, which bring the added benefit of long term relationships with doctors that make wiser decisions about treatment and have a better understanding of their patients’ individual needs. Not to say that excellent care cannot be given in the emergency room, but with the continued underfunding or rural hospitals it makes it increasingly difficult.
“Any study of this would be of interest and any attempt to address the opioid epidemic should be welcomed by congressional leadership in the affected areas, but I suspect underlying economic issues will have an outsized impact and Progressive Democratic policies such as the ones I champion will most definitely be a step in the right direction. So many of the issues we are facing as a nation today are directly related to our lack of basic healthcare and health security for a large and growing segment of our population.”