The drumbeat of opioid overdose deaths goes on, none more tragic than the passing last July of a 9-month-old who accidentally swallowed a fentanyl-laced pill purchased by her 17-year-old mother and 43-year-old grandmother.
When police investigated their suburban home, they found more than 100 empty capsules, including some in the baby’s diaper bag. The two women have been charged with child abuse, manslaughter and reckless endangerment.
As we enter the home stretch of this holiday season, let us pause to reflect on the devastating human toll being taken by legal and illegal drugs, alcohol included. Addiction, substance use disorder—whatever you choose to call it—the disease affects an estimated 23 million Americans, only a tenth of whom are receiving treatment.
The death toll is staggering. Over 47,000 people died from opioid overdoses in 2017 and again in 2018, the most ever. The Centers for Disease Control and Prevention projects a similar number will die this year. The National Institute on Alcohol Abuse and Alcoholism estimates 88,000 people die each year from alcohol-related causes. That includes nearly 10,000 or 31% of auto fatalities.
America’s substance use disorder crisis is part of a much larger behavioral health crisis, which, despite the mental health parity law passed in 2008, continues to get short shrift from private and government payers. Among the half-million Americans who are homeless each night, a quarter have a serious mental illness and nearly half have some behavioral disorder.
The states hardest hit by the opioid epidemic are in northern New England and Appalachia, which helps explain why white people account for over two-thirds of fatalities. But no area is immune. Small cities and the near-in suburbs of large cities have the highest overdose death rates. What those areas have in common are declining economies marred by closed factories and mines. In their stead have come low-paying service jobs, often without benefits, or contingent work in the gig economy.
As a result, much of the workforce, even at this full employment moment, finds itself in a constant struggle to make ends meet. Millions of working people have become dependent on government aid programs like disability, Medicaid and food stamps, which the Trump administration is making more difficult to access. It’s hard to imagine a less hospitable environment for addressing the substance abuse epidemic.
In addition to a Marshall Plan for disinvested America, these communities need a comprehensive and well-funded program that screens for and identifies people with substance use disorder. They need more programs that provide prompt and effective medication-assisted treatment. The government must provide support for the long-term counseling and social services that are crucial to preventing relapse.
The administration’s ballyhooed opioid plan and Congress’ miserly support for treatment programs fall far short of those goals. HHS recently released $1.8 billion in funding for treatment programs, which brings the total to nearly $9 billion since Trump took office. Compare that to the $35 billion that the government will spend this year to combat HIV/AIDS, which claims about a third of the lives of the opioid epidemic.
Former Rhode Island Rep. Patrick Kennedy, primary author of the mental health parity law, documented his own struggles with drugs and alcohol in a recent book. He recently offered a simple explanation for the nation’s inability to come to grips with its substance abuse crisis. “The stigma is palpable,” he told a meeting of healthcare system practitioners working on developing better programs for fighting the substance abuse epidemic. “That’s why we don’t treat this … like a virus that you treat like a chronic disease.”
One way for healthcare leaders to help end that stigma is to expand their own programs for fighting substance use disorders and trust that at some point we’ll have a government that joins in the fight.