A version of this article by Christine Durrance was published in the Milwaukee Journal Sentinel Ideas Lab as part of the Main Street Agenda.
Among the policy issues that concern Americans, especially during a presidential election year, health care is one of the most salient. Healthcare is also one of the most complex and evolving issues, as new technologies, public policies, and emerging concerns bring new challenges to the forefront.
Although the Affordable Care Act cut the number of uninsured Americans in half since it was signed into law fourteen years ago, the most significant piece of healthcare legislation in American history was far from a cure-all. We continue to spend more money on health care per person than any other developed nation, yet our health care outcomes lag and 45% of Americans struggle to pay for medical treatment or prescription drugs.
In Wisconsin, health care is the third most concerning issue, according to WisconSays survey data available through this year’s Main Street Agenda, which the La Follette School of Public Affairs at UW–Madison has used to highlight what matters to Wisconsin. In this state representative survey, 54% of respondents report health care as quite or an extremely big problem for Wisconsin; 69% feel this way about health care being a problem for the country. These sentiments are felt across the state with 58% of Democrats and 54% of Republicans viewing it as quite a problem or an extremely big problem for the state. There is also little divide between urban (54%) and rural (53%) residents.
One of the biggest issues of the last presidential election was the COVID-19 public health crisis. Today, what aspects of health care are concerns for Wisconsinites? The cost of health care? Access to (quality) health care? Or other aspects of health care policy, such as the cost of prescription drugs, hospital mergers, changes in legal cannabis markets, or changes in access to reproductive health care? One concern that many across the state share surrounds the ongoing opioid crisis.
An ongoing healthcare crisis
Although the causes are complex and multi-faceted, most experts agree that several of the largest drivers of the epidemic included a misunderstanding of the addictive potential of opioids, overprescribing of opioids, aggressive marketing, and other problematic actions by some pharmaceutical companies, distributors, pharmacies, and prescribers. FDA regulatory failures around Purdue Pharma’s opioid, OxyContin, compounded the problem.
Three decades and more than a million U.S. overdose deaths later, this full-blown crisis is on the minds of people across the state regardless of their situation, with widespread implications across demographics including gender, race, ethnicity, and geography.
Opioids release powerful endorphins into your brain’s reward centers, making them highly addictive. An opioid overdose can lead to respiratory depression and death if not treated in time with naloxone (Narcan) and additional medical attention. Most opioid overdoses occur from prescription opioids (e.g., oxycodone) or illicit opioids (e.g., heroin or fentanyl).
In 2022, more than 80,000 Americans died from opioids. It was the most deaths in a year due to the drug, and roughly four times the number of deaths attributed to opioids just a decade earlier. Nearly 1,500 Wisconsinites lost their lives to opioids in 2022, almost 20% more than just two years prior.
The effects of the epidemic on our communities and health care system reach far beyond overdose mortality. One understudied aspect of the opioid crisis is its impact on women, infants, and children.
Far-reaching effects on communities and public health
Use of opioids during pregnancy can lead to neonatal abstinence syndrome (NAS), a withdrawal condition at birth. The number of infants born with NAS increased more than fivefold from 2004 to 2016 in the U.S.
Some of the collaborative work I do with the La Follette School and the Institute for Research on Poverty investigates the prevalence of prenatal opioid exposure and its effects on infant outcomes, early childhood development, and involvement with child protective services.
Our research found that nearly two percent of births for Medicaid recipients in Wisconsin from 2010 to 2019 received an NAS diagnosis. We also found, using our broadest definition, that 20% of expectant mothers with Medicaid had some likely exposure to opioids.
Opioid exposure is also associated with worse infant health outcomes such as low birthweight, small for gestational age, placement in the neonatal intensive care unit, and referrals to child protective services. These effects are more pronounced for exposure from opioids used for the treatment of opioid use disorder and possible illicit opioids than for traditional prescription opioids.
We are also studying the relationship between prenatal opioid exposure and health and development among young children. Our preliminary results suggest that exposure to opioids of more than 90 days is associated with an increased risk of cognitive and intellectual disability diagnosis by age 5.
Beyond the impacts on infants and children, these data suggest that the opioid crisis is also stretching thin a health care system that is already overtaxed, not to mention burdens on the child welfare system, emergency response, law enforcement, and the judicial system. Policymakers and public health experts have introduced many promising approaches to combat the crisis, but like a game of Whac-a-Mole, new facets of the crisis emerge each time others begin to be addressed. Many of the latest concerns involve deadly illicit opioids.
Is help on its way?
Early data from the CDC indicate that opioid-related deaths may have slightly decreased in 2023, but these estimates are provisional and amount to more than 80,000 deaths in just one year. It is far too early to consider it a win.
At the same time, roughly $55 billion will be distributed to state and local governments as part of the high-profile opioid settlements with companies largely responsible for the crisis. Some of these funds have already made their way to governments, with the stipulation that they must spend at least 85% on treatment and prevention. Wisconsin will receive $750 million, with the 87 local governments involved in the lawsuit receiving 70% of the funds to help address the crisis.
With resources come hope. But the opioid crisis is an ever-evolving issue where increasingly dangerous opioids such as fentanyl have raised the stakes. Other deadly substances often combined with opioids, including Xylazine (“tranq”), a powerful non-opioid sedative, have made addressing the crisis even more difficult. There is not a one-size-fits-all solution. It is critical that we pair the funds being distributed with targeted solutions, based on sound, evidence-based research, that support distinct aspects of the crisis: prevention of opioid misuse and dependence, reduction in diversion, improved access to opioid use disorder treatment, and harm reduction, rightsized for different populations, including early intervention for pregnant populations with opioid use disorder.
Wisconsinites believe that health care is a significant problem for our state and country. If we cannot turn the tide on opioids, health care will figure even larger in the public’s consciousness as more of our communities are directly or indirectly affected by the opioid crisis.
What matters to Wisconsin
The La Follette School of Public Affairs and the Milwaukee Journal Sentinel are collaborating to share insights on how Wisconsinites feel about important policy topics through a yearlong project called the Main Street Agenda. Each month, the La Follette School and the Milwaukee Journal Sentinel will feature a different policy topic, analyzing new statewide survey data to highlight what matters to Wisconsin. The WisconSays/La Follette Survey being used for the Main Street Agenda is a subset of the new WisconSays opinion panel based out of the UW-Madison Survey Center. There are more than 3,500 Wisconsinites enrolled in this representative panel.