Dr. Adams: ‘Insanity of inaction’ adding to opioid overdose deaths
(WISH) — An often and overused saying is that the definition of insanity is doing the same things, but expecting different results. By any objective measure, opioid overdose deaths were a public health emergency long before our current pandemic started. With COVID-19 disrupting daily life, reducing access to treatment services, and exacerbating conditions that lead to opioid overdose, overdose deaths from opioids have reached unfathomable highs.
According to recently released data from the CDC, more than 100,000 Americans died from opioid overdose from April 2020 to April 2021, shattering the previous record of 93,145. As we contemplate a million lives lost to covid, we must also digest a million American lives lost over the past 20 years from opioid overdoses. If the loss of lives isn’t enough to shake you to your core, consider that the opioid crisis now costs the nation an estimated $1 trillion a year in lost productivity and higher health care spending.
Moreover, deaths from drug overdoses are rising faster among minority populations. Between 2019 and 2021, mortality rose a shameful 81% for Black and Native Americans, 65% for Hispanics, and 40% for whites.
To put it plainly, the status quo is unacceptable. That’s why I joined with former members of Congress, governors, cabinet secretaries, and policy experts from across the political spectrum to examine the problem and offer policy recommendations as part of the Bipartisan Policy Center’s Opioid Crisis Task Force.
We are at a pivotal moment. With the biggest increases in mortality among minority populations, we must disaggregate key data by race, ethnicity, and other demographic factors to craft an equitable response. And we must commit to bipartisan (and nonpartisan) efforts to support vulnerable Americans who face the highest risks of preventable suffering and death.
In our new report, the BPC task force offers recommendations in four areas: (1) leveraging mandatory funding from Medicare, Medicaid, and the Affordable Care Act marketplaces more fully; (2) focusing discretionary funding on “smarter” spending that is evidence-based and coordinated; (3) establishing data reporting and metrics that are more uniform, more frequently reported, and actionable; and (4) strengthening governance and leadership to ensure executive branch coordination and accountability.
Federal funding for substance use disorder (SUD) care comes disproportionately from mandatory (or entitlement) programs: Medicare, Medicaid, and Affordable Care Act marketplace resources. Of these, Medicaid is the largest source of opioid-related funding, allocating at least $23 billion a year and, in 2018, paying for 47 percent of emergency room visits and 38 percent of inpatient visits.
For mandatory programs, policymakers should expand coverage for SUD services and ensure parity with non-SUD services by, for instance, working with state insurance commissioners and Medicaid agencies so that they exercise their own authority to enforce parity rules for SUD treatment. Policymakers should increase Medicaid and Medicare reimbursements for OUD/SUD treatment by health care providers and ensure that all qualified providers can bill federal programs for such treatment.
Federal opioid-related discretionary funding, which the President and Congress fund each year through the appropriations process, tripled in 2018 to over $6 billion—after President Trump declared opioids a public health emergency. This funding provides grants to states for services that mandatory programs don’t cover. Such funding has essentially remained flat ever since (excluding additional funding from one-time COVID-19 legislation).
For discretionary programs, policymakers should update funding formulas so that grants respond to evolving problems such as synthetic opioids and methamphetamine, and needs beyond just treatment, such as housing, transportation, and food insecurity. We should provide two-year rather than annual grants so that states can plan better, and take steps to ensure that grants go to evidence-based OUD intervention and promising innovations. There are currently over 70 different funding streams- many overlapping. Policymakers should ensure that programs with similar objectives work together, and encourage states to coordinate their various federal funds to best meet their own state’s needs.
Policymakers lack good metrics to fully understand the scope of the opioid crisis and respond to it in a timely manner. Currently, our main outcome (and funding) measure is death–which doesn’t help the person who had died, and often is reported a year or more after it has occurred. We are driving down a dark road while looking only through the rear-view mirror. Datasets are too decentralized, use different metrics, and suffer from significant time lags in reporting. The data do not provide enough information disaggregated by race or ethnicity, and stigma associated with SUD raises issues related to data sharing.
As a result, policymakers should establish a set of real-time evidence-based metrics to measure the size of the opioid problem and the delivery of health services to address it. They should collect data more frequently, update their process for collecting it, and make it as accessible to the public as COVID-19 data now are.
The Office of National Drug Control Policy was created to coordinate our federal response, however, agencies that run opioid-related programs rarely work together or share information. Further, ONDCP, federal agencies, and Congress all lack a process and metrics to evaluate program effectiveness.
Policymakers should restore the ONDCP director to Cabinet status, and the director and Secretary of Health and Human Services should foster more collaboration within and across departments. The federal government should also provide technical assistance to states in directing the dollars they receive from opioid-related legal settlements to enhance state grant programs. We simply can’t afford the level of state waste and diversion that we saw with the tobacco settlements.
With so many preventable lives already lost to opioid overdoses, we must treat this crisis with the same urgency as we do COVID-19. This means using our most powerful tool–federal funding–to better deliver services in a coordinated and sustainable manner, and overcome regulatory and legislative barriers to address the evolving needs of vulnerable populations. Failing to do so is not only insanity, but will deliver more of the same heartbreaking result.
Dr. Jerome Adams is WISH-TV’s Medical Expert and served as the 20th Surgeon General of the United States. Adams also serves as a member of the Bipartisan Policy Center Opioid Task Force.