Two hundred thousand Pennsylvanians suffer from "substance use disorder," a broad medical term for drug abuse. Fifteen died from their overdoses every day in 2021 — one every two hours; more than 5,000 in 2021 alone. Alcohol abuse is also a big problem in the commonwealth, though far less talked about by the candidates for political office, despite even higher numbers of Pennsylvanians dying from this disorder and the diseases it makes more deadly, such as diabetes (www.cdc.gov/ARDI).
Before you vote for Pennsylvania's next U.S. Senator, consider the kinds of people who show up every day in our medical practices.
A 45-year-old sober man came in with back pain and a long history of alcoholism. When asked what made it possible for him to stop drinking — was it a job, a new partner, family? — he answered, without skipping a beat, that good health insurance allowed him to go through an effective treatment program. He has been sober ever since. But nearly seven of every 100 Pennsylvanians have no health insurance.
Alcoholism is a medical condition, as are other substance use disorders. It is more familiar to most people than drug abuse and it typically kills slowly. It's not brought into the country by drug cartels, and sufferers aren't revived by naloxone, the nasal spray that can reverse a fentanyl or other opiate overdose.
Naloxone is not the answer to all of our problems with drug abuse, though it was used to reverse opioid overdoses more than 60,000 times in Pennsylvania between 2018 and 2021. Consider another patient, a 32-year-old woman suffering from cocaine addiction, recently discharged from hospital where she went after she threatened to jump off a bridge. Her father committed suicide when she was 10. Her 48-year-old mother died of a drug overdose on her mother's birthday.
What do John Fetterman and Mehmet Oz offer voters to address our worsening problem of substance use disorders? Oz hasn't put forth a program and has clearly stated that he is against expanding the Affordable Care Act (ACA) that has paid for and/or subsidized 35 million people who needed health insurance. In fact, he now states that he would not have voted in favor of the ACA at all. This doesn't mean he doesn't care about people with substance use disorder, but he hasn't told us what he would do to address this key connection between health insurance and substance abuse treatment. He sticks to general statements on the need for rehab and about going after the drug cartels, which is what politicians have said since Nixon launched the "war on drugs” in 1971.
Just as importantly, Oz has a long and troubling history of promoting vitamins, supplements, and foods to address other serious health conditions, when there is little or no evidence to support them. For example, he promoted selenium supplements — a mineral found in foods such as Brazil nuts — in 2012, calling them the “holy grail of cancer prevention." Several medical reviews, including by the National Institutes of Health, said there's no evidence that selenium could stop cancer. A research study reported that evidence supported less than half of Oz's TV show recommendations (https://www.bmj.com/content/349/bmj.g7346).
Senate candidates need to be clear on both supporting medically sound practices and how people can get affordable health insurance — and only one has. Fetterman supports the Democratic actions and proposals to address health insurance and to continue the efforts to slow the flow of drugs into the country. Specifically, he is in favor of the Affordable Care Act, supports lowering the Medicare eligibility age to 60, and favors permitting Medicare to negotiate for lower pharmaceutical costs, which is especially timely in this era of skyrocketing drug costs. The cost of insulin will be capped at $35 a month in 2023 for millions of Medicare recipients. That is unless a Republican-dominated Congress reverses this new policy as they've promised to do and have already introduced legislation to do just that.
While it is true that there are no simple solutions to the problems of substance use disorders in Pennsylvania or anywhere in the country, you can weigh in with your vote on what's most likely to help now and going forward.
If you sit out the vote, the effect will be to increase the flood of patients — too many of whom are uninsured, underinsured or their insurance is too expensive — when we are already struggling to help prevent, treat, and overcome addictions.