At the outset of the coronavirus lockdowns last year, public health experts warned that social isolation, lack of access to treatment and the increasing lethality of the nation’s street drugs could lead to a massive surge in overdose deaths—a potential epidemic within an epidemic.
Nevertheless, 100,000 people have died in a single 12-month period, according to data recently released by the Centers for Disease Control and Prevention, an increase of 28.5 percent from the previous year, leading health-care providers, treatment advocates, and addiction experts to question whether the crisis is being taken seriously enough on the federal level.
“If a person was a diabetic, we’d never wait to treat them until they were in a coma or having a limb removed,” said Dr. Shawn Ryan, chief medical officer of BrightView Health, one of the largest providers of addiction treatment services in the Midwest. “That’s how far along we generally get to substance-use disorder before we do anything about it. People just need to realize how grossly under-budgeted our treatment field is.”
“Don’t act like you’re going to change something of this magnitude with these responses that are grossly underwhelming,” Ryan said.
The Biden administration has committed from the outset to addressing the nation’s addiction crisis, from earmarking $4 billion in the American Rescue Plan for expanding treatment access to pushing for an increase in the availability of naloxone—essentially an antidote to opioid overdose—nationwide. The president’s “Build Back Better” framework includes $11 billion in additional funding to prevent drug trafficking and to address inequities in treatment.
In a statement acknowledging the grim milestone, President Joe Biden pledged not to “overlook this epidemic of loss, which has touched families and communities across the country.”
“To all those families who have mourned a loved one and to all those people who are facing addiction or are in recovery: you are in our hearts, and you are not alone,” Biden added, in a likely nod to his own family’s struggles with substance use. “Together, we will turn the tide on this epidemic.”
Kevin Roy, chief policy officer of Shatterproof, a nonprofit that works to expand access to addiction treatment nationwide, put the poll in even starker terms.
“This is just a tragic growth in the overdose deaths,” Roy said. “To put it in perspective, just think about the 20-year trajectory: As recently as 2000, 17,000 people died per year of overdoses, and now we’re at 100,000.”
“Thinking we’re going to stop this because we stop it from coming in, that’s not how it works. That’s not how humans work. If the demand remains up, the supply will find its way.”
— Dr. Shawn Ryan, chief medical officer of BrightView Health
The barriers to adequately addressing the substance-use crisis are higher than simple financial resources, however. Experts say that a morass of regulatory obstacles to providing treatment, poor access to medical insurance, restrictive treatment limits for people who do have insurance, and patchwork laws on naloxone availability have all made proper response to the epidemic nearly impossible.
“Access to treatment is still being subjected to too many non-quantitative treatment limits, pre-authorization, concurrent review, retroactive review—people have been kicked out of treatment too early,” said Patrick Kennedy, a former congressman from Rhode Island and founder of the Kennedy Forum, which works to advance mental health and addiction care.
Kennedy, whose past substance use led him to becoming a prominent advocate for addiction treatment, pointed to Biden’s decision not to put the director of the Office of National Drug Control Policy in the cabinet—and the failure to even confirm a director until last week—as evidence that the White House is not taking the issue as seriously as it should.
“We just don’t have leadership,” Kennedy said, noting other key priorities for addiction treatment advocates, including more rapid approval for drugs that treat opioid dependence. “I mean, if we can get emergency-status COVID vaccinations, why in the world are we taking so damn long?”
Experts have lauded some aspects of the administration’s approach to the crisis, particularly its focus on harm reduction for Americans already struggling with substance use. The White House has particularly emphasized that component of its overall drug response as its most urgent priority in addressing the overdose epidemic, pointing to the Build Back Better framework as the best next step.
“Addressing addiction and the overdose epidemic is an urgent priority of his administration—that’s why we have taken significant steps to address it, including removing barriers to prescription medication for opioid use disorder, providing funding for harm reduction services, announcing a new overdose prevention strategy last month that will build on this progress,” White House deputy press secretary Chris Meagher told reporters last week upon the release of the CDC data.
Meagher also noted Biden’s proposed $41 billion investment in national drug program agencies, a $670 million increase over the previous year, as “a good example of how this is a priority for the administration.”
But without access, the efforts may be steering precious resources into a dead end, said Dr. Lawrence Weinstein, chief medical officer of American Addiction Centers.
“While the concentrated efforts made to quell the growing number of overdose deaths should be applauded, it seems as though some approaches are not directly focused towards the part of the problem that requires the most attention,” Weinstein said. “For example, while increasing the availability of naloxone is a great idea and can make a difference, those with a substance use disorder typically do not access the facilities that would benefit from such an approach. Those purchasing substances of any kind on the street—which is where these fentanyl-laced substances are the issue—are likely not patrons of libraries, health care providers, social services organizations, and other areas in which naloxone availability would be increased.”
Preventing addiction and overdose in the first place is an even taller order, experts told The Daily Beast, as evidenced by the quintupling of overdose deaths over the past two decades despite vast resources devoted to thwarting drug trafficking.
“If you look at the history of supply and demand and drugs in the U.S., not too many of the interdiction or stemming the supply side efforts have worked,” said Ryan. “Thinking we’re going to stop this because we stop it from coming in, that’s not how it works. That’s not how humans work. If the demand remains up, the supply will find its way, period.”
While addiction services and treatment are critical to preventing long-term substance use disorders, experts say that the administration hasn’t devoted nearly enough energy or resources to educating Americans about the danger of fentanyl, which was present in nearly 60 percent of the overdose deaths reported by the CDC. The drug, which is vastly more potent than morphine, is increasingly being cut into other illicit drugs, from cocaine and methamphetamine to MDMA and counterfeit pharmaceuticals—meaning that even casual drug users now face the risk of accidental overdose.
“A 20-year heroin addict would never have the tolerance to deal with this stuff, let alone these kids who are taking whatever pills… everything’s being cut with this stuff,” Kennedy said. “The single biggest change in the fatality numbers that we’re seeing is directly driven by the lethality of the new drug that’s on the market.”
But beyond increasingly common word-of-mouth rumors about cocaine laced with fentanyl in major cities, treatment experts say that too many Americans remain ignorant of the risk—and that the government needs to educate them.
“We do need to be doing educational campaigns on fentanyl exposure in every other drug,” said Ryan, who has seen numerous cases of non-addicted drug users who were unintentionally exposed to fentanyl and died.
“They were seeking no opioids whatsoever,” Ryan said. “There needs to be a public information campaign to say, ‘hey, if you’re going to choose to use drugs, understand that this compound is likely to be in them.’”
The education efforts that do exist largely focus on preventing teens from using drugs, said Lindsey Vuolo, vice president of health law and policy, the Partnership to End Addiction, which ignores both adults—who are more likely to be exposed to “hard” drugs than adolescents—and younger children, who can be influenced more easily.
“Substance use prevention has been too narrowly focused and concentrated in the adolescent years,” Vuolo said. “Substance use prevention needs to start much earlier in a child’s life and be more broadly focused on healthy youth development by reducing risk factors, including social determinants of health and adverse childhood experiences, and bolstering protective factors, such as resilience.”
Experts are the first to admit that in a field where the understanding of addiction and substance use disorders changes rapidly, there’s no single silver bullet to solving the overdose crisis.
“A lot of what we’ve been doing in the field, which we think is important, has not changed our trajectory,” said Roy. “In fact, it’s gotten worse.”
But in comparison to other public health concerns, many of them equally difficult to address, substance use is still getting “short shrift” by the federal government, Ryan said.
“If you compare substance use disorder to everything else—cardiology, diabetes, it doesn’t matter—we are grossly underspending by about probably 100 times in comparison,” Ryan said. “And then there’s some sort of level of surprise when these reports keep coming out as bad as they are. Honestly, it’s just embarrassing and asinine for people to say, ‘well, I don’t know why we’re not going to make any progress.’”