In December 2016, President Obama presided over his last official bill signing ceremony. The bill before him was the 21st Century Cures Act, a bill that authorized $1 billion to tackle the opioid epidemic. At the time, the figure was an unprecedented sum.
In February 2018, over a year and almost 100,000 overdose deaths later, Congress has called the $1 billion and raised it. The U.S. Senate announced that it reached a budget agreement, which includes $6 billion over a two-year period for the opioid epidemic.
Considering this important step taken by Congress, I offer some suggestions to consider when determining how these funds should be spent.
First, examine the issue across a continuum. That is, how do we prevent substance use disorders, effectively treat them, and support people in recovery? Reducing rates of opioid overprescribing is important, but it is not the only step that must be taken to decrease overdose deaths.
What steps can be taken to intervene before an opioid use disorder becomes a chronic condition and more challenging to treat? In addition to changing opioid prescribing behaviors, we must increase identification and treatment of opioid use disorders.
The addiction treatment field grew separate and apart from mainstream health care. This phenomenon was driven by various factors, including the payment system for coverage and the belief that addiction was a moral failing and not a disease.
Health-care providers therefore, sometimes view the disease of addiction as separate from their everyday practice, when in fact, they treat people with the disease of addiction regularly.
A survey of primary care physicians found that 98 percent of them failed to diagnose a possible substance use disorder when presented with early symptoms of alcohol abuse in an adult patient. We still expect people with substance use disorders to diagnose themselves.
One way to improve early intervention and treatment in mainstream healthcare is by requiring every health-care provider with a license to dispense controlled substances to take a continuing education course in addiction. While 2 million people in the U.S. have an opioid use disorder, there are 21 million people with substance use disorders in this country.
Health-care providers, including doctors and nurses, should therefore understand the disease of addiction, how to screen for it, and how to treat it. Medical specialty societies could develop the course best suited for their specialty, and Congress could waive the fee associated with the Controlled Substances license for two years as an incentive to prescribers.
Second, Congress should make certain that treatment programs receiving federal funds are evidence based and provide supports in keeping with a chronic condition. We know, for example, that medication assisted treatment, coupled with behavioral treatment, is the “gold standard” for treating an opioid use disorder.
Yet there are far too many treatment facilities that do not offer medication assisted treatment. Further, out of almost one million providers who hold a controlled substances license from the Drug Enforcement Administration, there are less than 50,000 certified to prescribe buprenorphine, one of three FDA approved medications to treat opioid use disorders.
The other two FDA approved medications, methadone and naltrexone, also have limited availability. And methadone is often stigmatized despite numerous studies showing its effectiveness at sustaining recovery and reducing overdose deaths.
Congress, along with Health and Human Services, could identify the counties in the country with the highest rates of overdose death and where there is limited access to treatment providers.
Incentives such as forgiving student loans could be given to health-care providers to relocate to these counties. In addition, funds could be spent in targeted counties to build the workforce needed for a comprehensive approach to addiction, including behavioral health-care providers and recovery coaches.
Congress should also increase funding to the Substance Abuse and Mental Health Services Administration (SAMHSA) prevention and treatment block grant. This block grant, the primary source of funding for state treatment and prevention programs, has not kept pace with inflation and states badly need increased resources.
In addition, Congress should increase funds for HHS programs for pregnant and parenting women with substance use disorders. As we experience increases in infants born with neonatal abstinence syndrome and increased rates of foster care, appropriate treatment for women with substance use disorders is sorely needed.
States and local governments have been devastated by this epidemic. By including $6 billion in the budget the federal government is heeding the call for action.
These funds will be a significant investment and can make a difference in the epidemic, but only if the funds are spent in a deliberate fashion. We know how to stop this epidemic, states and local governments just need financial resources and support to implement these policies.
Regina LaBelle J.D. served as Chief of Staff and policy advisor at the Office of National Drug Control Policy in the Obama administration. She is currently a public policy consultant and Visiting Fellow at the Duke Margolis Center for Health Policy.