By Anne Woodbury
October 4, 2019 at 5:00 am ET
Another day, another debate without any discussion of how presidential candidates plan to end the opioid crisis. Ten Democratic candidates took the stage in Houston recently to debate solutions to some of the most pressing issues facing our nation, and not a single one offered their plan to fight the epidemic taking more than 130 American lives every day.
Despite lengthy conversations on health care and the war on drugs, candidates chose not to share specific policies to help those addicted to opioids. Vice President Joe Biden came closest by speaking about his previous support for drug courts.
Yet where was the conversation about the here and now? Policymakers at all levels must commit to rapidly increasing the availability of evidence-based treatment and support to the millions of Americans living with addiction to opioids or other drugs.
A message to all candidates for president: If the moderators at the next debate choose not to ask about the addiction and opioid crisis directly, here are a few points you can bring up.
Health care reform
A health care reform plan is not comprehensive and cannot be successful unless it explicitly addresses the systemic barriers to mental health and addiction care. From issues around insurance parity or workforce shortages to the underutilization of medication-assisted treatment, mental health and addiction are consistently placed on the backburner in these discussions.
The 2017 Surgeon General’s report on addiction found that every dollar spent on substance use disorder treatment saves $4 in health care costs and $7 in criminal justice costs. An IHS Markit report last year showed that doubling the use of MAT in the commercially insured population could not only save as many as 805,000 lives and prevent millions of overdoses, but would also have a significant financial benefit — as much as $645 billion in savings because of reduced medical expenses over the next 15 years.
A number of the candidates reinforced their support for “Medicare for All” in some form. But Medicare is far from a best practice for mental health and addiction care.
On the addiction front, Medicare won’t cover evidence-based, highly regulated opioid treatment programs, which provide methadone treatment, until 2020. It took until the SUPPORT Act last year for that provision to be passed. Buprenorphine, another recovery medication, is still underutilized by Medicare beneficiaries.
We know that recovery medications for opioid use disorder — buprenorphine, methadone and naltrexone — don’t work on their own. The gold standard for OUD treatment is a combination of these medications plus mental health counseling and social supports.
Unfortunately, Medicare has a number of shortfalls when it comes to mental health, as well. For example, the program doesn’t reimburse for clinical mental health counselors or marriage and family therapists.
Medicare covers more expensive practitioners, including psychologists and psychiatrists, but unfortunately, too few people have access to these providers, especially in rural areas. Medicare must expand its mental health services so that people in need have access to these life-saving supports.
Too many individuals living with addiction are on a pipeline straight into the criminal justice system. Rather than criminalizing addiction, which is by all accounts a brain disease, candidates need to share their plans for helping individuals avoid contact with the justice system in the first place.
Drug courts are proven effective for helping people recover and in reducing costs to the community, yet they’re only one piece of the puzzle. How will we ensure that people living with addiction get evidence-based care if and when they are incarcerated, and how will we ensure they have the appropriate, effective recovery supports and services when they re-enter their communities?
It’s time to take a stand
New research shows that a majority of voters (62 percent) would be more likely to vote for a candidate if he or she promised to do more to address mental health and addiction. All candidates on the last debate stage had the opportunity to address mental health and addiction this summer when they received a survey from Mental Health for US – but only 7 responded. One of the questions focused specifically on the opioid crisis, so I encourage you to read it.
If you’re running for president, regardless of your party affiliation, it’s time that you take a stand and proactively campaign on ending the opioid epidemic and addressing other mental health issues. Millions of Americans are waiting impatiently to hear from you about the most devastating public health crisis of our time — and I’m one of them.
Anne Woodbury is the executive director of Advocates for Opioid Recovery, a nonprofit organization breaking down the regulatory, legislative, and ideological barriers that prevent access to evidence-based treatment for opioid use disorder, and the CEO and co-founder of CURA Strategies, which manages the Mental Health for US initiative.
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