Minneapolis Star Tribune, Dec. 18
Minnesota is taking opioid abuse seriously
A glimmer of good news for Minnesota when it comes to opioid abuse turns out to be a grim testament to the toll taken by these powerful, addicting painkillers on the nation as a whole.
According to the latest national data, the North Star state rates fifth when it comes to an important metric on judicious use of these drugs - the number of prescriptions filled per 100 people per year. Only California; Washington, D.C.; Hawaii, and New York have a lower rate than Minnesota’s - 46.9.
And yet, at least one Minnesotan dies each day from opioid overdoses - a total of 376 people in 2016. If this is what fifth-best looks like, imagine the grief in other states where prescriptions flow more readily and the price in human life is even steeper. Nationally, more than 15,000 people die each year from opioid abuse.
A state that’s home to world-class medical providers has an obligation to jump into the trenches to combat this public health crisis. Minnesota, to its credit, recently took a leadership step with the draft release of new prescription guidelines for medical providers across the state.
States even harder hit by opioid deaths, which include a cluster of Appalachian and southern states, ought to give close scrutiny to this thoughtful new framework intended to educate medical providers about the drugs and reduce patients’ risks. It’s time to go from lamenting the problem to actually doing something about it.
The Minnesota plan, which strikes a reasonable balance between restraint and concern for pain treatment, is the result of two years of research by a state work group whose members included top medical experts and two legislators who lost children to drug overdoses. This group’s work stands in welcome contrast to the frustrating absence of leadership by the Trump administration, which has lacked follow-through after making big announcements about opioid dangers.
It’s commendable that the Minnesota work group took a deep dive into the data to understand opioid use in Minnesota and draw conclusions about how best to reduce the drugs’ risk. The analysis found that too many patients who began using the drugs over the short-term went on to become chronic users. Of those who received a 45-day supply, 80 percent went on to get a 90-day refill. Of those who received a 90-day refill, 65 percent continued opioid use at the three-year mark.
To stem this, the recommendations take a relatively novel focus - urging providers to do more to halt this transition from short-term to chronic use. Education is one of the strategies the report calls for to accomplish this, with recommendations crisply outlining time frames for usage after patient injuries.
But the report also calls for delivering confidential reports to medical providers on how their opioid prescribing practices compare to their peers, with further follow-up from state officials if prescribing practices do not change or have a reasonable explanation. Eventually, those who persist in prescribing outside the guidelines could be excluded from state medical assistance programs. That hopefully won’t be necessary, but it does give the recommendations some welcome teeth when opioid prescribing practices vary widely around the state.
Another noteworthy recommendation in the report - having legislators pass a “penny a pill” surcharge to fund treatment - merits support.
It is important to note that the work group’s recommendations are not meant to limit pain medication for patients in end-of-life situations or those who have serious conditions such as cancer. Members of the group are also admirably aware that they tackled only part of the problem. The vexing problem of how to effectively treat patients taking opioids for chronic pain remains. If not opioids, then what? As Minnesota patient pain advocate Jennifer Kane has argued on these pages, there’s not a confidence-inspiring “Plan B” for those whose pain causes them to seek out these drugs in the first place.
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Post Bulletin, Dec. 19
9 million children need Congress to act on CHIP
There’s a tendency, whenever Congress isn’t doing what we personally would like it to do, to say that the honorables have their priorities mixed up.
But when it comes to funding for the Children’s Health Insurance Program, which provides medical care for about 9 million children through Medicaid and other programs, we can say without fear of hyperbole that Congress indeed has its priorities messed up.
In the race to come up with a tax cut plan that lards gifts primarily on corporations and the wealthy, Congress is dragging its feet on renewing funding for a program that benefits the most vulnerable among us.
CHIP provides health coverage for 8.9 million children whose families don’t qualify for Medicaid but can’t afford insurance. The program is administered by the individual states, several of which are now on the verge of running out of money. That’s because the current round of funding for the program, which costs $16 billion a year, expired Sept. 30 and Congress hasn’t gotten around to passing an extension.
Some senators and House members have given lip service to renewing it, but nothing has happened yet.
Among the states hardest hit is Minnesota, which ran out of CHIP money last month and is keeping it going with state money. Oregon and Colorado will be the next to run out.
Lawmakers from both parties say they intend to pass an extension. But some Republicans want to tie it to an Obamacare repeal or other issues. Failing that, they warn, an extension for CHIP might have to wait until early 2018.
The United States already trails many other western countries when it comes to children’s health. Infant mortality rates are as much as 42 percent higher in the U.S. than in comparable developed countries. Early neo-natal deaths are as much as 66 percent higher, according to the Peterson-Kaiser Health System Tracker. And among 17 developed countries, a 2013 study found that American children are more at risk of dying before age 5 than children elsewhere.
Clearly, we’ve failed our children too many times in too many ways. Dragging out or, even worse, abandoning CHIP funding is just the latest example. It’s an especially egregious oversight in this season of celebrating the birth of a child who changed the world.
It’s not too late, and it’s the perfect season, for Congress to change course and put CHIP funding, and our children, at the top of the list of year-end priorities.
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Mankato Free Press, Dec. 20
Senate election: The DFL cedes the field to Smith
It appears that Gov. Mark Dayton and the Minnesota DFL have salvaged as solid a position as they could have hoped for after Sen. Al Franken’s electoral career imploded on misconduct allegations.
Dayton named his favored candidate, Lt. Gov. Tina Smith, as his appointee to Franken’s seat when the second-term senator makes his resignation official. And in the week since Dayton’s announcement, the rest of the party has essentially ceded the DFL line in the 2018 special election to Smith. None of the large, and perhaps growing, field of Democrats hoping to succeed Dayton as governor switched to the open Senate race.
Even on the Republican side, there appears relatively little appetite for the seat. Former Sen. Norm Coleman emphatically took himself out of the field soon after Smith’s appointment. Former Gov. Tim Pawlenty, while less definitive than Coleman, has hinted that he’s content with his current occupation. At one time or another a dozen names have put themselves in the running for the GOP nomination for governor; only one of those, an uncredentialed candidate, has shifted to the Senate special election.
Smith is clearly well-regarded in DFL circles. She has run campaigns for Walter Mondale, Ted Mondale and R.T. Rybak. Dayton as governor and Rybak as Minneapolis mayor leaned heavily on her. But her only elected position is her current one as lieutenant governor, and she is untested not only as a senator but as a candidate. One would think politicians of ambition would see an opportunity here.
It’s early, of course, and this week a Republican state senator from the Stillwater area, Karin Housely, announced her campaign for the Franken seat. Housely is the wife of hockey Hall of Famer Phil Housely, the coach of the NHL Buffalo Sabres. More important, she is a two-term legislator and committee chair who was part of a statewide campaign three years ago as running mate to Republican gubernatorial hopeful Scott Honour. Perhaps more Republicans will get into the race.
But there should be no doubt about the challenge. Franken spent years laying the groundwork for his first election; Smith, and anybody of either party seeking to challenge her, has less than a year to prepare for the special election. And then there will be the seat’s regular cycle in 2020. Two statewide campaigns in three years on short notice is a daunting proposition.
This is one explanation why there are 18 candidates, serious and frivolous, for the governor’s chair Dayton will vacate, and so few for the two U.S. Senate seats. (Only one Republican, state Rep. Jim Neuberger of Becker, has declared his candidate to challenge Sen. Amy Klobuchar). Another may be this: It’s easier to imagine oneself accomplishing something useful as governor than in the morass that is Washington these days.
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