Columns » Jay Barth

The crisis

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In American history, it has been rare that life expectancies have dropped year to year. Even during wartime, when premature deaths occurred at high rates, medical advances have nudged this key marker of progress upward. Last year, however, for the second year in a row, American life expectancy dropped in the United States. While a variety of systemic forces related to diet, the omnipresence of guns and the patchwork of health care access are explainers of the flattening life expectancy rate, the distinctive force in driving down the number in recent years is deaths from drug overdoses fueled by the opioid epidemic.

That epidemic is, of course, hitting different parts of the country at different rates. Deaths by overdose has hit rural areas hardest because of the pervasiveness of the epidemic among white rural Americans and their lack of access to emergency treatments that can stop overdoses and ongoing services that combat addictions. Now, average life expectancies differ by as much as 20 years across America's counties.

With just over 400 overdoses recorded in 2016, Arkansas has not experienced the same impact as states in the eastern half of the United States. Partly this is because those parts of the state where that component of the epidemic fueled by heroin is most pronounced are sparsely populated. There are anecdotal signs, however, that the deadlier expressions of the epidemic are moving toward the state's population centers. Moreover, Arkansas faces a particular challenge with prescription opioids. While overprescription rates have dropped nationally in recent years, little change has shown itself in Arkansas. In 2016, Arkansas was second among states in the prescribed rate of opioid pain relievers, with 115 prescriptions per 100 persons, nearly double the national average, according to the Centers for Disease Control and Prevention. (Some argue, however, that the easy availability of prescription opioids in Arkansas actually slows the emergence of deadlier drugs, such as heroin.)

In his State of the State Address on Monday, Governor Hutchinson gave only a nod to the opioid crisis in the state. It merited part of a sentence listing challenges facing the state that will not be dealt with in the fiscal session starting this week. The reality is that the state budget could be altered during the session to shift resources to attack the boiling public health crisis. State leaders' choice appears to be otherwise.

To be clear, under Hutchinson, Arkansas has taken clear, positive steps when it comes to opioids. The state allows pharmacists to provide naloxone, an antidote to overdoses, without a prescription; provides training and access of naloxone to State Police and other first responders; makes victims of overdoses immune from prosecution if they seek help; enhances the use of "drug courts" that provide access to treatment rather than imprisonment for drug offenders; and allows the state's Department of Health to track problematic patterns in the dispensing of prescription opioids.

Still, while some new dollars for tackling opioids has come through federal grants in recent years, these projects have represented minimal new investment in state dollars to address the crisis.

What a best practices model would look like, however, does require new dollars. The work of Rhode Island, a small state hit particularly hard by the crisis, provides a strong guide. Particularly costly are investments in treatment and recovery programs that are a crucial component of any comprehensive opioid plan. For instance, Rhode Island has made a distinctive investment in "recovery coaches" who are certified and work with the addicted in communities across that state to support them in their recovery and help prevent relapses.

In a budget released this week that generally makes deep cuts across social services, the Trump administration would genuinely commit new resources to the opioid crisis, mostly by pushing federal dollars down to the states. (To be certain, other proposed cuts in the health care budget would counter these proposals, because so many individuals dealing with opioid addictions are Medicaid-eligible.) Still, even though it is an area of a great deal of bipartisan consensus, we do not know when, if ever, a major new federal investment in the crisis will actually come to be.

On the crisis burgeoning right before our eyes, Arkansas should not wait on Washington to make a major investment in programs known to work in attacking the opioid epidemic. Any additional delay puts more lives at risk and destroys the families of the thousands of Arkansans dealing with opioid addiction.

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