U.S. Agriculture Secretary Tom Vilsack has steered a pragmatic course during his time in office between two powerful lobbies — production agriculture and increasingly influential organic producers. That balance has served the industry and country well.
In what are likely his waning days in Washington, D.C., it’s critical for the plain-spoken former Iowa governor to strike another carefully calibrated balance with his newest assignment: leading the effort to fight painkiller addiction in rural America. This is indeed a public health scourge, as Vilsack noted in a recent meeting with the Star Tribune Editorial Board to discuss the new White House initiative. With deaths linked to opioids and the street drug heroin now topping 28,000 a year in the U.S., coordinated, common-sense action is needed at the federal, state and local levels.
At the same time, access to these drugs must be preserved for those who truly need them. OxyContin, Vicodin and other so-called “opioid” drugs remain a vital part of medicine’s arsenal against acute and chronic pain. The pendulum shouldn’t swing so far that investigating the cause of a patient’s pain takes a back seat to investigating the patient as a potential drug abuser. Nor should patients relying on these drugs be cut off suddenly — a situation that can cause some to turn to cheaper, dangerous heroin.
An estimated 257 million prescriptions are dispensed for opioid medications each year, a staggering increase from the 174 million written in 2000, when drug companies began aggressively marketing them. But it’s a TV ad that aired during the Super Bowl this year that really drives home how prevalent their use is. There’s not only a lucrative market for these drugs, but the same holds true for treating a common side effect: constipation. The Super Bowl ad touted a remedy to prevent this.
Unfortunately, there’s no easy, take-a-pill solution for other far more dangerous side effects: overdoses and addiction. “Deaths from prescription drugs and an illegal opioids such as heroin have risen nearly sixfold since 2000, reaching 317” in 2014, according to a Nov. 28 Star Tribune story. Research strongly suggests that opioids, which provide a high similar to heroin, are a gateway to this street drug, said Carol Falkowski, one of Minnesota’s foremost drug abuse experts. Data also show that drug overdose rates are higher in rural areas than in cities, she said.
Why that’s the case is unclear, though the causes likely involve rural poverty and lack of access to health care, particularly doctors who can offer addiction treatment, or integrative medical care to treat pain (which includes mental health care along with pain-management alternatives such as physical therapy). Ian McLoone, an addiction and mental health therapist at Alltyr Clinic in the Twin Cities, said patients sometimes drive four hours each way to get care there.
The latest White House initiative builds on a previous effort to expand prescription monitoring databases at the state level. The latest $1 billion-plus measure proposes $500 million to increase access to addiction treatment and expand state-level strategies against abuse. Some of the funds would be directed at rural areas, with a key aim of improving access to what is known as “medication-assisted therapy.” Drugs to treat opioid or heroin addiction are more regulated than opioids, making it difficult to find a provider certified to prescribe them.
Experts such as McLoone argue that allowing nurse practitioners or physician assistants to prescribe them would help alleviate the shortage of treatment options. Expanding telemedicine’s use for this purpose and reimbursing medical providers better for care delivered this way would also help, said McLoone, a former high school baseball star from St. Louis Park who overcame his own opioid addiction.
Vilsack’s crusade will need to carried by whoever succeeds him under the next president. In the meantime, state policymakers should consider how to use additional federal resources that may become available. They should also consider taking advantage of in-the-trenches experts like Falkowski and McLoone to ensure that a necessary balance is struck between combating abuse and ensuring adequate pain treatment.