Everyone in Washington agrees bold action to combat the opioid epidemic is long overdue. Yet the legislation advancing in Congress barely qualifies as a start.
The bipartisan Opioid Crisis Response Act, sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), would spend a paltry $6 billion over two years in more than two dozen programs. They include more support for research on non-addictive pain relievers; better FDA oversight of pain pill prescribing; and the creation of comprehensive opioid abuse recovery centers in targeted communities.
Most are worthy projects. But therein lies the problem. Entirely absent from the bill, besides enough money, is a comprehensive strategy for combating substance abuse. Such a strategy begins by recognizing that an effective program to reduce opioid addiction must include both public health and delivery system interventions.
There is no mystery behind the social conditions driving rampant drug abuse in our society. While the growing number of overdose deaths among middle-class youths pushed the epidemic into the spotlight, many of the hardest hit communities suffer from declining local economies. Hope left town when the last factory closed down.
Want to reduce opioid addiction? Create good-paying jobs in these areas.
America's massive incarceration rate—the highest in the world—is also a major contributor to the crisis. The U.S. jails people—mostly minorities—for minor drug offenses, denies them counseling while in jail and releases them without offering effective treatment. It's like giving ex-convicts a diploma to graduate into harder drugs.
Want to reduce opioid addiction? Reduce the incarceration rate and provide treatment after release.
Drug overdose deaths are concentrated among the young, and a majority of young opioid addicts experienced emotional, physical or sexual trauma as children. The U.S. has the highest rate of child abuse in the developed world, with over 7 million children affected in 2015.
Want to reduce opioid addiction? Invest in early childhood development and education.
Finally, the medical profession's misguided approach to pain management, aided and abetted by the drug industry, remains a major contributor to the epidemic.
Want to reduce opioid addiction? Re-educate and, if needed, restrict the professionals feeding the river of addiction flowing through many communities.
On the treatment side, the walls surrounding the substance abuse treatment ghetto must be torn down. Addiction is a disease. It should be treated like one.
The U.S. underuses proven, medication-assisted treatments. It's left the field wide open for abuse by unregulated operators who offer poor-performing counseling and inpatient programs until the insurance money runs out.
Last week, The Atlantic reported how France, beset by its own heroin epidemic in the 1980s and 1990s, dramatically cut overdose deaths simply by allowing any doctor to prescribe buprenorphine. The overdose death rate plunged by 79% in four years. The U.S., by contrast, not only limits the number of providers who can offer medication-assisted treatment, it restricts how many patients each can see. Communities also have to ration naloxone, the overdose antidote drug, because of its high price.
Want to cut the overdose death rate? Negotiate reasonable prices for buprenorphine and naloxone and make them widely available through physicians and first responders.
Last week, Sen. Elizabeth Warren (D-Mass.) and Rep. Elijah Cummings (D-Md.) introduced legislation that would earmark $100 billion over the next decade for battling the opioid epidemic. Modeled on the 1990 Ryan White Act for HIV/AIDS, it would create a targeted prevention and treatment program, which, if coupled with broader economic and criminal justice reforms, could make a real dent in the nation's addiction epidemic.
Congress just cut taxes by $1.1 trillion over the next decade. Is it too much to ask that they find a tenth of that to combat the scourge of opioid addiction?