How budget cuts will turn opioid addiction into the next AIDS epidemic
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In the next 24 hours, nearly one hundred Americans will die from a drug overdose. In 2015, more people died from drug-related causes than from vehicular crashes and gun homicides combined. Unprecedented overprescription of opioids ignited the epidemic, which has nearly quadrupled in the past 15 years despite reported levels of pain remaining constant. 

Today, West Virginia has the highest drug-related death rate in the country.

Between 2007 and 2012 in the state, drug wholesalers shipped enough hydrocodone and oxycodone for every resident in the state to receive 433 pills. West Virginia filed lawsuits against opioid distributers in federal court, reaching a settlement that will pay the state tens of millions of dollars to combat the crisis. Other states are pursuing similar cases. 

 

Injection of synthetic opioids like fentanyl and heroin — the cheaper alternative — has also led to skyrocketing rates of hepatitis infection, since sharing syringes is one of the most efficient routes for transmitting blood-borne diseases, like HIV.

Hepatitis C infections in America tripled from 2010 to 2015. In that same time frame, West Virginia had the highest annual incidence of hepatitis B and the second highest incidence of hepatitis C in the country.

A 2014 HIV and hepatitis C outbreak in Scott County, Indiana, left nearly 200 people infected from sharing needles. The outbreak may ultimately cost the state of Indiana nearly $60 million in long-term healthcare costs paid by Medicaid. Recognizing this risk, the CDC last year assessed every county in the United States vulnerable to a rapid spread of HIV and hepatitis C. An alarming 50 percent of the state of West Virginia was at high risk. More than one-quarter of Kentucky, Maine and Tennessee were considered vulnerable to an outbreak.

There are some promising signs of progress. In 2016, Congress partially lifted a longstanding ban on federal funding for syringe service programs. 

Last month, the CDC awarded thirteen states funds to strengthen disease surveillance for viral hepatitis. In West Virginia, Gov. Jim Justice’s administration enlisted the help of county and city officials, law enforcement, public health and community leaders to develop a harm reduction plan. Grant funding from the 21st Century Cures Act allowed West Virginia to support syringe service programs in seven sites. In February the state implemented a project aimed at increasing access to the overdose-reversing medication naloxone and expanding testing for viral hepatitis.

Yet amfAR, the Foundation for AIDS Research estimates that only 10 percent of West Virginia counties have syringe service programs, though many are in the planning process. Nationwide, young people with hepatitis C must travel a median of 37 miles to reach a syringe service program. Similarly, access to addiction treatment is limited and many facilities have long waiting lists. More than 88 percent of Americans experiencing drug addiction do not have access to treatment. 

Seemingly in defiance of this public health crisis, the White House released a budget proposal that includes a 19 percent cut to the CDC’s domestic HIV prevention budget, and a nearly 19 percent cut to the CDC program for sexually transmitted diseases.

Cuts of this magnitude would mean significant reductions in funding to state and local health departments, resulting in health department staff layoffs and limiting the capacity of states like West Virginia to respond to their public health needs. 

In parallel, the House-passed repeal of the Affordable Care Act threatens the future of Medicaid expansion for low-income adults.Medicaid plays a vital role in efforts to address the opioid epidemic and is the largest source of funding for behavioral health treatment in the country — one in three of the 2.5 million Americans addicted to opioids is covered by Medicaid and Children’s Health Insurance Program.

If passed by the Senate and signed into law, cuts to Medicaid would devastate efforts to end the opioid epidemic. Overall, nearly one-quarter of Americans receiving medication-assisted treatment for drug addiction are on Medicaid. In some of the hardest-hit states this number is considerably higher: in West Virginia, 45 percent of treatment is paid by Medicaid.

The expectation that the costs of drug addiction treatment will be absorbed by out-of-pocket payments is unrealistic and, ultimately, will prove deeply harmful to American public health. Most states will not be able to make up the lost funding, resulting in millions of people losing their coverage. For many states, Medicaid is the most powerful tool at their disposal to fight the opioid epidemic. 

The U.S. has finally turned the tide in the battle against HIV. In the past six years, new HIV infections in the U.S. have fallen 18 percent . Yet we need only look back at our country’s inaction at the beginning of the AIDS epidemic to remind ourselves that without the political will and financial commitment, it will be nearly impossible to stem the tide of the opioid epidemic in our country. Regrettably, we are poised to repeat history.

Dr. Rahul Gupta is the Commissioner and State Health Officer, Bureau of Public Health, Department of Health and Human Resources for the State of West Virginia. Alana Sharp is a Policy Associate for amfAR, The Foundation for AIDS Research.


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