The Opioid Crisis is a National Emergency. What Now?
The numbers are staggering. Every day, 142 people die from a drug overdose. Every day, countless more are revived from near-fatal overdoses with the use of Narcan by emergency responders, family members, friends and even librarians. According to the New York Times, 59,000 Americans died from an overdose last year – more than the number of Americans who died over 20 years of fighting in the Vietnam War. NIDA’s latest survey, which evaluated opioid prescription use in 2015, found that 38% (92 million) of Americans had used opioids in the past year. Of those, 11.5 million misused the drug and 1.9 million had what was classified as an opioid use disorder. 41% of those who misused the drug got it for free from a friend or relative. A few weeks ago, the Chairperson of the Federal Reserve Bank, Janet Yellen, testified before Congress that the opioid crisis is a threat to the American economy.
We are in the midst of an addiction crisis that affects every generation, every demographic and every region of American society. What, then, are we to do?
The President's Commission on Combating Drug Addiction and the Opioid Crisis recently issued its interim report, which urged President Trump to declare a Public Health State of Emergency. This is entirely within the president's power and discretion to take immediate action. The president at first hinted there was no need to declare an emergency, that there were enough resources already available to fight the epidemic. Late last week, however, the president indicated that he changed his mind and was taking the first steps to declare the opioid crisis a national emergency.
This is an excellent start. Caron agrees with all the recommendations in the preliminary report from the commission. Declaring a state of emergency not only sounds the alarm about the seriousness of America’s crisis, but it also affords the president and his cabinet officials extra flexibility in responding to it. As the commission indicates, a state of emergency would empower Health and Human Services (HHS) Secretary Tom Price to issue Institutions for Mental Diseases (IMD) waivers to all 50 states, allowing Medicaid to fund inpatient substance abuse treatment programs at facilities with more than 16 beds — something it is currently barred from doing. The limitations imposed on Medicaid patients when searching for treatment is all too often an insurmountable obstacle on the road to recovery. By removing it, we will be able to get more people the quality, evidence-based treatment they need.
Declaring a national emergency also enables HHS to negotiate bulk purchase agreements for naloxone, a drug that many states and local governments have armed their police and EMT units with, which has revolutionized front-line opioid treatment.
But there are additional steps we need to take, which were not mentioned by the President’s Commission.
Improve the quality of addiction treatment. Time, money, and even lives are being lost in the use of ineffective treatments. It is essential that funds be directed to quality, evidence-based treatments for appropriate lengths of stay, which will likely include medications for addiction treatment (MAT), based on individualized, patient-centered treatment plans.
The length of time spent in treatment is critical to success. Too little time, and the cycle of addiction is just likely to repeat. It seems counter-intuitive, but we suggest that it will be cheaper in the long run to pay for longer treatment programs that work than rely on shorter programs that don’t.
Cookie-cutter approaches to treatment don’t work, either. What works for one person won’t necessarily work for another. Like cancer and heart disease, addiction is a category of disease that manifests differently in those fighting it. Addiction is complex and chronic, and every case is unique. Many people have co-occurring medical and mental health issues that drive the addiction, and these must also be addressed if treatment is to be successful. Treatment plans must be individualized.
Detox is just the start of recovery. Medically managed withdrawal takes time, but recovery requires even more commitment and guidance. Detox with just a prescription does not qualify as "treatment." There is no magic pill that people can take that will solve their problems. Instead, it takes time and effort to understand what drives the addictive behavior in the first place and then begin to retrain the brain to healthier ways to respond to the triggers. It takes time to stabilize patients, determine what, if any, medication-assisted therapy may be necessary and establish an ongoing therapy plan that will foster recovery. Treatment does not look the same for all.
End the fraud. Programs that enable the exploitation of those living with addiction often send patients on a backwards path, away from lifelong recovery. In fact, the current reimbursement program can work against long-term recovery when fraudsters view relapse as another opportunity to bill for a new round of treatment. The government needs to hold these swindlers accountable, and the addiction treatment field must develop standards for treatment that enable those suffering from addiction and their families to make wise choices for treatment that works.
Send our doctors back to school. Addiction to opioids often starts with a legitimate prescription from a doctor or a dentist. Doctors need to be retrained on how to manage pain safely, not just how to prescribe opioids safely. It is the height of irony that legitimate use of doctor-prescribed painkillers is one of the primary drivers behind the epidemic of opioid addiction.
With more than 60 years of successfully treating addiction and behavioral health issues, Caron believes that the addiction crisis has never been more urgent than it is today. The stakes could not be higher. Every day 142 families are burying sons, daughters, sisters, brothers, mothers and fathers. Every day, the list of those lost grows.
There is no silver-bullet solution, but we can continue to save tens of thousands from death, and we can offer hope to millions of families across the country watching their loved ones struggle with this disease. To do this, we need to make the most successful solutions available to as many people as possible. That means building our approach around improving the availability of proven, outcomes-driven, evidence-based treatments and making it possible for anyone facing addiction to get treatment for it.
The disaster declaration brings the weight of the presidency to fighting this epidemic, but the weight must be aimed at the right spots. Saving someone from an overdose, and getting them to treatment, is just the first step in a long road to recovery, not just for those suffering from addiction but also for us as a nation.