The opioid crisis is a national health emergency, but some states are hit harder than others.
California, Rhode Island, West Virginia, Kentucky and Florida suffer the most from opioid abuse, according to Fair Health, a New York-based nonprofit market research firm that analyzed 26 billion privately-billed medical and dental insurance claims from 2002 until 2017.
“Using that database, the national heat map represents opioid abuse and dependence [insurance] claim lines as a percentage of total medical claim lines by state in 2017,” the researchers said. The darker colors have the higher percentages of claims.
The firm mapped out how each state was affected by opioids, as well as the medical help residents received, the total cost of those procedures, plus the age and socio-economic background of patients. West Virginia had most opioid-related claims last year, according to the report.
The kind of treatments varied by state:
• “Methadone administration was particularly associated with the Northeast, while another medication, naltrexone injection, was more closely associated with the Midwest.”
• “Outpatient rehabilitative services were linked more to the South and West than to other regions.”
• “The South relied more on testing than on therapeutic procedures, while the West had a strong emphasis on treatment.”
• “Only New York had group counseling as one of its five most common procedures by utilization and cost.”
• “Only five states—Delaware, Nebraska, North Dakota, South Dakota and Wisconsin—included psychotherapy, 45 minutes, as one of their five most common procedures by utilization.
Source: Fair Health
West Virginia had a rate of 43.4 deaths per 100,000 in 2016, up from 1.8 deaths per 100,000 in 1999, according to a separate report from the National Institute on Drug Abuse. In the U.S., opioid-related deaths rose from 1.8 per 100,000 in 1999 to 13.3 per 100,000 in 2016.
In West Virginia, the number of overdose deaths peaked at 733 deaths in 2016 “with the majority of deaths attributed to synthetic opioids and heroin,” according to the National Institute on Drug Abuse. The rate of opioid prescriptions were 42% higher in West Virginia (110 per 100 people) than the rest of the U.S. (70 per 100 people) in 2013.
There was a shift away from pharmaceuticals and prescriptions to illicit drugs like fentanyl and heroin between 2012 and 2014, according to a state government proposal from January responding to the opioid crisis. Officials also said more should be done to stop medical professionals from prescribing certain opioid-related pain medications and expand law enforcement-driven programs.
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Why do some states have a higher opioid use than others? Figures differ on the rate of opioid use and misuse in various states, but experts say the causes relate to the rate of prescribed opioids and the public-health infrastructure in place to deal with opioid addiction. Some states had significant increases in death rates involving prescription opioids: West Virginia, Maryland, Maine, and Utah, according to the Centers for Disease Control and Prevention.
That, plus an influx of illegal opioids, has contributed to abuse in some areas, experts say. “Effective, synchronized programs to prevent drug overdoses will require coordination of law enforcement, first responders, mental health/substance-abuse providers, public health agencies, and community partners,” said Puja Seth, lead author of the CDC report on opioid abuse by state, which was published in March.
In addition to the proliferation of prescriptions by physicians, residents in states with lower household incomes may be more prone to opioid abuse. Americans on a low income may not be able to afford alternative care or surgery, which effectively means they would have more need for opioid prescriptions to deal with chronic pain. Another problem: Some people may not be able to take time off work and/or may not be able to pay to travel to clinics for regular care.
The dearth of appropriate treatment centers may also play a major part in the rate of deaths by state. Methadone, buprenorphine, and naltrexone are the three drugs used to combat the effects of opioid addiction, and treatment centers need at least three specific treatments to deal with opioid addicts, according to the journal HealthAffairs.org.
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Treatments for opioid abuse varied considerably by state. In some states, including New York, Hawaii, Rhode Island, Wisconsin and Arizona, patients were more likely to receive behavioral treatments (like psychotherapy). Others, primarily in Delaware, Maine, Oregon and Connecticut, used a mixture of behavioral treatment and medication. The top five states that used inpatient treatment were California, Missouri, Utah, Kansas and Illinois.
Opioid abuse is getting worse. There was an estimated 71,500 drug overdose deaths in the 12-month period ending in January, up from 67,000 predicted deaths for the previous 12-month period, according to the Centers for Disease Control and Prevention. Even more deaths are being investigated. Nebraska saw the largest jump in overdoses (33%), though it was still among the least affected states according to the Fair Health study.
The crisis is estimated to cost the country more than $500 billion a year, as of 2015, according to a report from the Council of Economic Advisers. President Trump declared said he would consider bringing lawsuits against “bad actors,” including companies.
In March, the president called for more ways to combat the opioid epidemic, including instructing the Justice Department to seek more death-penalty cases against drug traffickers and asking for more federal support of overdose-reversal medications, including naloxone.
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