Few issues have received as much bipartisan consensus in this Congress as the prescription opioid and heroin crisis. The House recently passed a package of 18 bills addressing a range of provisions, including opioid prescribing, medication-assisted treatment and access to the overdose reversal medication naloxone. These bills now move to a conference committee with legislation passed by the Senate earlier this spring.
But cracks in the bipartisan consensus are growing around that most partisan of issues: the call for more federal spending.
To date, Republicans have rejected pushes from their Democratic colleagues to add new funding and make greater federal investments in opioid and heroin programs included in the legislation. Last week, a White House statement asserted without additional funding, the House opioid bills “would do little to help the thousands of Americans struggling with addiction.”
The opioid crisis is not a partisan issue – Republicans, Democrats, Independents and the politically unaffiliated all across our nation are struggling with opioid addiction and too many lives have been tragically lost to preventable opioid overdose. With so much bipartisan agreement on the problem and the solutions, it would be exponentially tragic for the issue to get mired in partisan disagreement and inadequate investment. Indeed, experts agree that without a substantial new investment in our nation’s treatment and public health infrastructure, the impact of this legislation will be limited and inadequate. Congress’ opioid and heroin bills may provide some additional lifeboats, but we’re still on a collision course with the iceberg.
Thus far, the federal response to the opioid crisis has been characterized by an incrementalism in policies, programs and funding that has failed to keep pace with the scope and scale of the overdose epidemic. This does not mean we have not made progress. Indeed, there has been much-needed action at the federal, state and local levels on improving opioid prescribing practices and expanding access to naloxone.
Yet overdose deaths continue to climb, driven by an evolution to progressively riskier opioids – heroin and fentanyl. The overdose epidemic will persist until we reckon our greatest vulnerability: a weak and fragmented infrastructure for delivering effective treatment for opioid use disorders.
Medication-assisted treatment coupled with counseling and other supports, represents our best line of defense against opioid use disorders. Research demonstrates that medication-assisted treatment has the highest rates of retention and success and dramatically reduces rates of fatal overdose. But too many communities – particularly rural communities – lack treatment providers.
Too many Americans struggling with opioid use disorders are placed on waiting lists. This treatment gap is unacceptable at the height of an overdose epidemic: no American should be dying for lack of access to opioid use disorder treatment.
If we want to protect families and communities from overdose, we need to take a systematic approach to tackling the barriers to effective treatment. We need to train providers, increase workforce capacity, integrate medication-assisted treatment into more settings, improve screening for opioid use disorders in health care settings and utilize innovative telehealth and health IT tools to improve access and care coordination.
We have to increase awareness of effective treatment and reduce the stigma that keeps people from seeking care. We need to ensure that people in the criminal justice system have access to medications proven to prevent relapse, overdose and recidivism. We must address coverage and reimbursement barriers that leave medication-assisted treatment out of reach.
These efforts must be coupled with continued efforts to minimize excessive or inappropriate opioid prescribing and expand access to naloxone. Together, these strategies – with enough investment to bring them quickly to scale and to those communities most in need – would make a material difference and help turn the tide in the opioid and heroin crisis.
The White House has requested $1.1 billion over two years for these activities – a significant increase, but one clearly warranted by the magnitude of the overdose epidemic and the failure of incremental approaches and current funding levels to meet this public health crisis and national tragedy. If the rate of overdose deaths keeps pace with that reported in 2014, more than 10,000 Americans will have died from opioid overdoses since January 1 of this year and by December 31 another 20,000 will have lost their lives.
The Substance Abuse and Mental Health Services Administration estimates that 2.2 million Americans have an opioid use disorder, placing all of those individuals at risk for overdose. As Congress has realized, no family or community is immune.
We’ve long known that every $1 invested in drug treatment ultimately produces at least $4 – $7 in savings. A new study provides a bracing reminder of the costs of delayed action: the cost of hospitalizations related to opioid misuse and associated infections exceeded $15 billion in 2012, representing a quadrupling in costs over only a decade.
We urge Congress to meet the challenge of the opioid and heroin crisis. Congress needs to authorize and appropriate $1.1 billion to meet the President’s request and save thousands of lives. This is an investment we cannot afford not to make.
Ilisa Halpern Paul is President of the District Policy Group, a boutique health policy and government relations consulting practice within Drinker Biddle & Reath, LLP
Daniel Raymond is the Policy Director of the Harm Reduction Coalition, a national organization focused on the intersection of substance use and health. He leads advocacy efforts to prevent overdose deaths, improve access to drug treatment and health care, and prevent infectious diseases.
The views expressed are the author’s own.