Americans were divided as to their choice for president, but much less so on their support for ballot propositions that legalized previously prohibited drugs.
In 2018, the leading cause of death under age 45 was accidental overdose. Even so, Arizonans voted to legalize recreational marijuana. Montana, New Jersey, and South Dakota voted to legalize the use and possession of recreational marijuana for those over 21 years of age. Washington, D.C., residents legalized the use of magic mushrooms and other psychedelic substances. Oregonians voted to decriminalize all drugs, including heroin.
According to the Closing the Treatment Gap initiative, nearly 24 million Americans are battling substance use disorders today. Only 1 in 10 of these Americans receive the treatment they need to address their addiction, largely due to cost and lack of insurance.
None of these ballot propositions addressed the need for insurance companies to fund proper addiction treatment. Nor did they address the shortage of treatment slots available for those seeking treatment. Americans have set themselves up for a crisis of seismic proportions.
Americans should look no further than to the nation’s homelessness crisis to understand what is likely to follow. Approximately 75% of the homeless struggle with substance abuse disorders, according to a recent study by the UCLA Policy Lab. One might thus expect that the treatment plan for the homeless would emphasize sobriety.
Think again.
In our new book, Answers behind the Red Door: Battling the Homeless Epidemic, we share that our nation’s homeless policy — Housing First — completely ignores the underlying problem of addiction. In a caustic twist, it actually deepens the wounds of substance abuse by placing the homeless in housing where continued drug abuse is permitted and where they can choose whether or not to address their addiction.
Before Housing First policies had been fully instituted in 2013, the national homeless population had been relatively stable for years at just over 800,000, according to data from the United States Interagency Council on Homelessness. Between 2013 and 2019, it swelled to nearly 1.2 million despite significant economic and employment growth during that stretch. In Honolulu, drug and alcohol abuse were the leading causes of death for the city’s unsheltered homeless in 2019. Today in San Francisco, the homeless are four times more likely to die from overdose than they are from COVID-19.
It should go without saying that drugs like marijuana, mushrooms, and heroin have been illegal for good reason. Illicit drug use killed 17,000 Americans in 2017. According to the National Institute of Health, heroin overdoses alone kill over 15,000 — roughly the same number who die from brain cancer.
The societal implications, however, extend well beyond individual deaths. According to the National Institute of Corrections Adam II data for 2013, between 63% and 83% of those arrested for committing crimes, including harm to individuals or businesses, tested positive for drugs. During a period when many jurisdictions across the country are intentionally reducing policing resources, the risk to society is even further exacerbated.
Societal costs will grow as well. According to the National Council on Alcoholism and Drug Dependence, U.S. employers spent $81 billion in 2017 on addiction-related issues, including lost productivity, absenteeism, and health care costs. These expenses are not absorbed by the companies but are passed along to customers or the general public in the form of higher prices.
The average life expectancy in the U.S. actually declined in 2015-2017 due to opioid-related deaths. In a rare bipartisan effort initiated by the Trump administration in 2018, the federal government allocated $5.5 billion annually to address this crisis. In 2019, an almost 6% decline in opioid-related deaths resulted — the first such decline since 1990, according to the Centers for Disease Control.
The consequences of ignoring the underlying issue of addiction have devastated those struggling with homelessness by locking them into virtual straight-jacket versus helping them emerge from addiction. With so few treatment options available to those who struggle with addiction today, with the likelihood that many more Americans will be struggling with addiction tomorrow, and with no plans nor resources in place to ameliorate treatment availability, America’s ride is about to get much rougher. Brace yourselves.
Michele Steeb and David Flanagan are co-authors of Answers Behind the Red Door: Battling the Homeless Epidemic.
