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Obamacare did not cause the opioid epidemic

This argument has been popping up on social media. But it’s rebuked by the basic concept of time.

Did Obamacare cause the opioid painkiller and heroin epidemic?

That’s what Conn Carroll, communications director for Republican Utah Sen. Mike Lee, suggested on Wednesday night, tweeting that “expanded coverage helped CAUSE the opioid crisis” and “free pills means more addicts.” It’s not just Carroll; I have also seen this argument pop up more and more on social media as discussions about Obamacare repeal’s effect on the opioid epidemic have played out.

The argument: By expanding access to insurance, more people were able to go to doctors and obtain opioid painkillers. These painkillers, as we now know, are a big driver of overdoses by themselves, and the pills’ proliferation got people hooked on opioids, eventually leading them to other opioids like heroin and fentanyl.

There’s just one problem with this theory: the basic concept of time.

Obamacare was signed into law in 2010. But its major coverage provisions took years to kick in, with launching in 2013 and the Medicaid expansion officially starting in 2014.

But the opioid epidemic was well underway by 2010, starting in the late 1990s as doctors began prescribing opioids in droves. In fact, the year after Obamacare passed, opioid painkiller overdoses plateaued, and the rapid rise in heroin deaths began as people moved from painkillers to other opioids.

It’s certainly possible that easy access to opioid painkillers, perhaps driven in some way by insurance coverage, was a factor in the epidemic. After all, without the proliferation of these pills, the epidemic would have never started in the first place.

But the timeline just doesn’t fit the assertion that Obamacare helped cause the opioid epidemic.

There’s also a case to be made that better insurance coverage could have prevented the rise in opioid deaths. As Northeastern University drug policy expert Leo Beletsky pointed out and others have argued, one of the big reasons that doctors resorted to opioid painkillers to treat their patients’ pain in the first place is because painkillers offered a cheap, easy answer, particularly compared to other pain treatments, such as physical therapy, which would have been more work and perhaps too costly. Better insurance could have made the better solutions to pain more affordable, avoiding the move toward opioids in the first place. (Although this possibility needs more study.)

And at this point, it’s clear insurance coverage is crucial to helping fight the opioid epidemic. Without insurance, most Americans with drug use disorders are just not going to be able to afford the kind of rehabilitation and treatment they need to deal with their addictions. As Jessica Goense, who’s recovering from addiction at a New Jersey program with the help of Medicaid coverage, recently told me, “If it wasn’t for insurance, I wouldn’t be here.”

So Obamacare didn’t cause the opioid epidemic. And the coverage it provides is the one thing helping a lot of Americans — up to 2.8 million, by one estimate — finally treat their addiction.

For more on the opioid epidemic, read Vox’s explainer (or the abridged version).

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