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“We have a big challenge in our state.”
That’s the way U.S. Senator Claire McCaskill approached a problem in Missouri that is mirrored throughout the United States.
It’s an election year. Congress took their summer break early so that all the senators and representatives up for reelection could go home to talk about building walls or making America great again. But Claire isn’t up for election this year, so she and U.S. Department of Agriculture Secretary Tom Vilsack are using the time to talk positively about real problems of rural America that will likely be ignored by mainstream candidates looking to score a few quick points.
McCaskill and Vilsack were at Stephens College in Columbia Missouri speaking to a group who received emailed invitations to the event from the White House Rural Council’s Town Hall Meeting on the Opioid Abuse Epidemic.
The USDA and Appalachian Regional Commission held a similar event in Southwest Virginia earlier this month.
At first I was puzzled about why USDA is involved instead of the Food and Drug Administration or the Department of Health and Human Services. Then it occurred to me that out of all the federal departments and agencies, USDA is solely responsible for rural America.
Vilsack said that from 1993 to 2000 there was a 400% increase in the use of opioid drugs. Most of that increase came about initially through prescribed treatments leading to addiction. He said he once met a man who had 35 drug offenses on his rap sheet who told Vilsack his first experience with opioids came through a legitimate prescription.
“Eighty percent of new heroin users in this country get the introduction down that road using an opioid,” he said.
In Missouri that problem is compounded by the fact that we are the only state in America that does not have or participate in some sort of monitoring to prevent people from getting access to opioids through multiple doctors and prescriptions. In most states that type of monitoring is mandatory.
For a lot of people who abuse opioid prescription drugs (80% of them according to Vilsack), prescribed opioid pain killers lead to illegal heroin use, research shows. That in turn causes additional unnecessary annual health care costs of about $25 billion.
Vilsack said the White House Rural Council, which he charis, has set a goal of educating 540,000 doctors in a new way of prescribing drugs that will prevent abuse and addiction by patients who may not even be aware of risks, or realize their problem until it’s too late. He said he takes this problem personally because as a child he witnessed his mother’s struggle with addiction and mental illness when he once saw her try, unsuccessfully, to take her own life. Eventually he came to understand that opioid addiction is not a character flaw; it is a disease that he saw his mother triumph over.
“She offered her family an incredible example of faith and never losing faith,” he said.
Senator McCaskill, with a background as a county prosecutor who fought drug addiction, pointed to one success already achieved in Missouri with the establishment of a prescription drug monitoring program in St Louis County. She hopes to repeat that success in other communities across Missouri where our state Legislature has failed to act as every other state has to make drug abuse easier to detect.
In Missouri they say it’s about money, but the federal government has made available enough additional Medicaid funding to pay 90% of the cost for monitoring and treatment. Missouri has been one of a small handful of states where state lawmakers have shunned additional support.
In the past, our governor, Jay Nixon, has said accepting additional Medicaid funding is a no brainier that would benefit thousands of Missourians.
One of the leading reasons for opioid prescriptions stems from people going to emergency rooms seeking help with dental pain. Someone who earns $10 an hour in a convenience store doesn’t have enough money for regular medical treatment, rent, or food, let alone dental care. They’re called working poor, and Missouri has more than its share.
In the past, the Missouri General Assembly has opposed local control by communities working in their own best interests. McCaskill hopes this will lead to something positive out of Jefferson City once enough Missouri communities have adopted their own prescription monitoring programs.
That’s why, for now, at least, they are pursuing voluntary registration over mandatory.
Here in Langdon we build fences to keep livestock in. Like most rural communities, it’s a tempting idea to do the same thing with people, because our populations keep dropping as opportunity and health care become ever growing challenges to life in general and the tax base in particular. As populations fall the few jobs we have may be filled by commuters who bypass underserved rural areas to live in bigger towns. It’s a kind of no brainier choice driven by personal need and real estate values.
Who wants to own a house in a dying town?
Maybe that’s why the population here in Atchison County is less than half what it was in 1950 when I was born. The problem here isn’t fences or stolen jobs. It’s about the economy, opportunity, and getting ahead.
“We are focused on rebuilding and revitalizing the rural economy,” Vilsack said. “Everybody’s tomorrow needs to be better than their today.”
People who see themselves as going nowhere tend to make bad choices – like substance abuse – he said.
We have more than our share of problems here.
It’s reasonable to say there is no one-size-fits-all prescription for success in rural America.
Just the same it’s nice to know somebody in Washington gets it.
Richard Oswald, president the Missouri Farmers Union, is a fifth-generation farmer from Langdon, Missouri.