Categories: Editorial, OpinionLast month, President Donald Trump’s bipartisan commission on opioid abuse released its long-awaited report on the crisis, and requested Congress provide funding to implement its recommendations.President Trump even called the opioid epidemic a public health emergency. This declaration is years overdue.A total of 64,000 Americans died as a result of drug overdoses last year — up from 52,400 the previous year.The most recent estimates indicate that our state saw 3,650 fatal overdoses in 2016, 29 of which took place in Schenectady County.These are depressing statistics amidst a tragic story with no end in sight. This would be paid for via a small tax hike that would replace the need for costly premiums and other health care expenses.What is medically necessary would be up to patients and doctors – not private insurance or the size of your wallet. This is a complex situation, and there is no silver bullet. Sometimes opioids are needed, and sometimes alternatives are more appropriate.What’s medically necessary is ultimately a question for patients and doctors.The Legislature should remove the profit motives of insurance companies from the equation – by regulation or by providing comprehensive public health insurance for all New Yorkers.Steve Keller is a regular contributor to the Sunday Opinion section. He works as an unpaid volunteer with the Campaign for New York Health, which is advocating for this bill’s passage.More from The Daily Gazette:EDITORIAL: Thruway tax unfair to working motoristsEDITORIAL: Beware of voter intimidationEDITORIAL: Urgent: Today is the last day to complete the censusEDITORIAL: Find a way to get family members into nursing homesFoss: Should main downtown branch of the Schenectady County Public Library reopen? Governor Andrew Cuomo signed a bill last year that removed many of the barriers preventing or delaying individuals from getting addiction treatment or overdose-reversing drugs that save lives.Now it’s time to go further.The Legislature should require insurance companies to automatically cover a wider range of non-opioid pain treatments — no questions asked. There is, of course, one snag.Access is great, but there’s still an economic barrier: If patients can’t afford exorbitant deductibles, co-pays and out-of-pocket payments, the cheaper and more dangerous opioid option might still be the only choice.We can remedy this by passing the New York Health Act in the new year.This bill, which has already passed the Assembly, would set up a public health insurance system similar to Medicare for All, under which treatment would simply be provided if you need it. So how did we get here? Most experts agree the current epidemic began in the 1990s, when pharmaceutical companies increasingly marketed opioids for pain relief, and doctors became more willing to prescribe them.Now, an astounding 289 million opioid prescriptions are issued each year. Of course, these prescriptions are not exclusively used by those for whom they’re written.The U.S. Centers for Disease Control and Prevention (CDC) states that while about a quarter of people abusing opioids use their own medication, half acquire the drugs from someone they know. Regardless of who is ultimately getting the opioids, when the prescription runs out, some percentage of people are left with an addiction.Rather than getting a new script from a doctor, it can be easier and cheaper to turn to illegal drugs, including heroin. Sometimes, insurance companies add unnecessary complication — or even block the best treatment altogether. In September, The New York Times and ProPublica published a piece revealing how health insurance companies often encourage prescription of dangerous opioids over safer, albeit more expensive, alternatives.Instead of immediately paying for safer drugs, they require prior authorization, barely recompense plan holders or don’t cover alternatives at all.Some insurance companies even require patients to go through the more dangerous drugs before they get to the non-opioids – just because the dangerous ones are cheap. This means that when patients need pain medication urgently, it can be easier to go straight to opioids. None of this is surprising.Insurance companies have a single mission, and it’s not to provide the best care – it’s to take in as much money and pay out as little in benefits as possible. Good for you if your insurer says they’ll pay for the safer but more expensive drugs your doctor recommends. But if your insurer is cheap, it’ll be opioids or nothing — unless you want to put your life-altering pain aside, hold off on medication and try to shop around for a better insurance company.Though the president’s commission has identified these insurance practices as part of the opioid problem, New York shouldn’t wait on the federal government to do something about it. When street dealers add in extremely toxic compounds like fentanyl, it makes an already dangerous situation even more addictive and even more deadly.This, experts say, is the root of the current crisis: proliferation of legal drugs acting as a gateway to harder, more dangerous ones.Clearly, in combination with increased access to treatment and rehabilitation, we must curb prescription of unnecessary opioids as much as possible. Yes, there will obviously always be a need for pain treatment.But sometimes opioids are more than is necessary — or they’re simply ineffective. In such cases, it’s better to seek alternatives like buprenorphine (a safer opioid), lidocaine, acetaminophen/ibuprofen combinations or even physical therapy. It’s a multifaceted decision that’s different for each person. Doctors and patients need to have serious conversations about the appropriate treatments for each individual’s pain. But it’s not always that simple.