{"id":13431,"date":"2016-12-21T13:10:34","date_gmt":"2016-12-21T18:10:34","guid":{"rendered":"http:\/\/philip.greenspun.com\/blog\/?p=13431"},"modified":"2016-12-21T13:10:34","modified_gmt":"2016-12-21T18:10:34","slug":"who-funded-americas-opiate-epidemic-you-did","status":"publish","type":"post","link":"https:\/\/philip.greenspun.com\/blog\/2016\/12\/21\/who-funded-americas-opiate-epidemic-you-did\/","title":{"rendered":"Who funded America’s opiate epidemic? You did."},"content":{"rendered":"

Dreamland<\/em> <\/a>by Sam Quinones talks a little about the economics of America’s opiate epidemic. On one side was the evil Purdue Pharma<\/a>, which collected tens of billions of dollars in revenue for OxyContin. But who was on the other side? Most drug addicts don’t have a lot of money. The answer turns out to be that you the taxpayer were on the other side:<\/p>\n

And so the Medicaid card entered our story. The card provides health insurance through Medicaid, and part of that insurance pays for medicine\u2014whatever pills a doctor deems that the insured patient needs. Among those who receive Medicaid cards are people on state welfare or on a federal disability program known as SSI (Supplemental Security Income). In Scioto County, annual SSI applicants almost doubled in the decade ending 2008\u2014from 870 to 1,600. An untrained observer of Portsmouth\u2019s bleak economic landscape might have understood; jobs, after all, were scarce. People needed money and that check helped. That was true, but by then pills and pain clinics had altered the classic welfare calculus: It wasn\u2019t the monthly SSI check people cared so much about; rather, they wanted the Medicaid card that came with it. If you could get a prescription from a willing doctor\u2014and Portsmouth had plenty of those\u2014the Medicaid health insurance cards paid for that prescription every month. For a three-dollar Medicaid co-pay, therefore, an addict got pills priced at a thousand dollars, with the difference paid for by U.S. and state taxpayers. A user could turn around and sell those pills, obtained for that three-dollar co-pay, for as much as ten thousand dollars on the street.<\/p>\n

Combined with pill mills, the Medicaid card scam allowed prolific quantities of prescription medication to hit the streets. The more pills that sloshed around the region, the more people grew addicted, and the bigger the business grew, and the more people died. The Oxy black market might never have spread and deepened so quickly had addicts been forced to pay for all those pills with cash at market prices.<\/p>\n

\u201cTwenty years ago they were drawing SSDI and full workers\u2019 comp\u2014say, eighteen hundred dollars a month,\u201d said Brent Turner, the commonwealth prosecutor for that part of eastern Kentucky, whose career began in 2000, just as OxyContin became a business for impoverished families across Appalachia. \u201cThe checks were higher because they\u2019d go work in the mines and pay into their [SSDI] disability. Now we\u2019ve got people who aren\u2019t working, who are drawing SSI, maybe five hundred dollars a month. We\u2019ve got people who have kids and wives and the whole family trying to survive on five hundred dollars. I\u2019m not making excuses for them. Many haven\u2019t had a job. But it is what it is. When you don\u2019t work, and never have had a job, or paid into the system, you don\u2019t qualify for much. We have boatloads of people who qualify only for SSI. You wouldn\u2019t believe the number of people we see, twenty or thirty years old, have never had a job and are drawing checks since they were teenagers. \u201cThat was one of the driving factors when pills exploded. We can talk morality all day long, but if you\u2019re drawing five hundred dollars a month and you have a Medicaid card that allows you to get a monthly supply of pills worth several thousand dollars, you\u2019re going to sell your pills.\u201d<\/p>\n

Other families, though, had been unemployed for generations and on government assistance. Up to then, they had resorted to small-time criminal activities, but remained minor irritants in holler life. When Oxy came along, however, the sorriest families were transformed into dominant and unruly forces.<\/p>\n

Back home, [the pill dealer] made a killing on the first of the month when the SSI checks arrived in Floyd County.<\/p>\n

He watched capable young people get themselves declared \u201csimple\u201d to get SSI and the Medicaid card, and thus access to pills.<\/p><\/blockquote>\n

The author elsewhere praises liberal Democrats and condemns conservative Republicans, so I don’t think the above passages were driven by a bias against government welfare programs. And in fact the author directly praises anyone working for the government as implicitly altruistic:<\/p>\n

As I tried to chart the spread of the opiate epidemic, one thing dawned on me: Other than addicts and traffickers, most of the people I was speaking to were government workers. They were the only ones I saw fighting this scourge. We\u2019ve seen a demonization of government and the exaltation of the free market in America over the previous thirty years. But here was a story where the battle against the free market\u2019s worst effects was taken on mostly by anonymous public employees. These were local cops like Dennis Chavez and Jes Sandoval, prosecutors like Kathleen Bickers, federal agents like Jim Kuykendall and Rock Stone, coroners like Terry Johnson, public nurses like Lisa Roberts, scientists at the Centers for Disease Control, judges like Seth Norman, state pharmacists like Jaymie Mai, and epidemiologists like Jennifer Sabel and Ed Socie<\/p><\/blockquote>\n

The author lives in California so he is presumably aware that government workers do get paid (examples<\/a>). He doesn’t explain why a police officer, DEA agent, prosecutor, judge, or prison guard\u00a0would be upset to have a job, steady paycheck, and pension due to the existence of opiate addicts.<\/p>\n

Related:<\/p>\n