Drug policy experts are urging President Joe Biden to overhaul the addiction treatment system that they argue cannot be fixed with funding alone, as opioid overdose rates increase dramatically in the United States.
“More money by itself will not solve the problem,” said Thomas McLellan, founder of drug policy reform organization the Treatment Research Institute. “The existing treatment infrastructure simply cannot provide the necessary evidence-based, modern treatments that work. They don’t have the resources.”
After declining in 2018 for the first time in 25 years, opioid overdose rates have skyrocketed since 2019. Nearly 72,000 died from drug overdoses that year, a 5% increase from 2018. The Centers for Disease Control and Prevention announced that 2020 figures are expected to be even worse. In December, the agency reported that fatal overdoses in the 12 months leading up to May 2020 reached 81,000, the highest number of deaths due to overdoses ever recorded in 12 months.
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Public health experts posited that nearly a year of isolation meant to stem coronavirus transmission had exacerbated the increase in overdoses. As the COVID-19 pandemic shows signs of receding, the Biden administration has indicated that the federal government will resume stalled efforts to deal with the growing rates of substance abuse. For instance, Biden included a provision in his 2022 budget request to Congress to spend $10.7 billion on addiction research, prevention, treatment, and recovery support services.
Past appropriations meant to reform the addiction treatment system have fallen short of ensuring equitable access to affordable counseling and medications to alleviate withdrawal symptoms, such as buprenorphine. This is according to McLellan, who also served as deputy director of the White House Office of National Drug Control Policy during President Barack Obama’s first term.
“If you don’t understand the problem and you don’t understand what’s necessary for the solution, your money is going to waste,” McLellan said. “We know that this is a public health problem, and we know that we have the potential for a first-class public health solution.”
The patchwork of health insurance plans has been an obstacle to getting affordable care for mental illness and substance use disorders, despite efforts from Congress over the past two decades to improve coverage parity so that those services are covered the same as medical and surgical services. Obamacare has made it mandatory for health insurers to provide substance abuse benefits. Still, the National Alliance for Model State Drug Laws has reported instances of payers circumventing the law in exchange for financial benefits gained by exploiting the increased access to insurance coverage under Obamacare.
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“What is broadly referred to as mental health parity is creating policies that require and facilitate payers … private insurance companies especially, to make sure that they have the same level of resources flowing to treat substance use disorder and opioid use disorder as they do for diabetes or heart disease,” said Mike Abrams, a drug policy researcher at the left-leaning advocacy organization Public Citizen.
The Biden administration has already introduced improvements to the medication services people can receive with the recent policy change to widen the pool of providers eligible to prescribe buprenorphine in outpatient settings. Physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives who are authorized to prescribe other medications will be exempt from the certification requirements related to training and counseling known as the “X waiver.”
The “only downside” to the change in policy, Abrams said, “is that maybe, it won’t emphasize enough the need for good solid psychotherapy that needs to go along with any kind of addictive disorder treatment.”
