States facing massive pandemic-induced budget deficits could be forced to cut substance abuse treatment programs at a time when demand for them could surge.
States could suffer a drop in general fund revenues as high as 20% due to the pandemic, according to a report from the Foundation for Government Accountability. Most states have balanced budget requirements in their constitutions that require state politicians to cut budgets when deficits appear.
“We are dealing with a dual crisis, with the COVID pandemic and the opioid overdose crisis. [Cuts] would be terrible,” said Gretchen Bergman, co-founder and executive director of A New Path, a treatment advocacy organization based in San Diego. “We are particularly in need of services now during these troubling times. We’ve just gotten to a point where we understand the benefits of harm reduction strategies … but how do we get those services to people without funding?”
The coronavirus lockdown can result in isolation, which is particularly bad for recovering addicts.
“A common truism in recovery culture is that ‘addiction is a disease of isolation,’ so it stands to reason that social distancing — in every possible way — is counter to most efforts to engage in a recovery community,” wrote Dr. Peter Grinspoon, a primary care physician who treats addicts and is a recovering addict himself. Additionally, the lockdown disrupted most services and treatments, such as support group meetings and face-to-face counseling.
A lack of substance abuse treatment upfront often creates greater costs down the road.
“People with untreated substance use disorder end up costing the system more, even if you only look at healthcare and ignore the criminal justice costs,” said Phil Rutherford, chief operating officer with Faces and Voices of Recovery, a treatment advocacy organization based in Washington, D.C. “They often ignore their primary healthcare needs, and as those situations get worse, they get more expensive.”
The economic downturn only adds to the problem. Recessions are often associated with increases in substance abuse. A recent review revealed that most research found that drug use increases during a recession because unemployment increases psychological distress.
The U.S. economy shed 20.5 million jobs at the height of the pandemic in April. The jobs picture improved in May, with employers adding 2.5 million jobs. But that may not be enough to head off a rise in substance abuse cases.
About 1 in 3 Americans were more likely to drink alcohol during work hours while in lockdown, a survey by American Addiction Centers found. A survey from the Addiction Policy Center found that 20% of substance use disorder patients had increased substance use since the beginning of the pandemic. Finally, drug overdoses rose 16.6% from January to April when compared to the previous year, according to a National Office of National Drug Control Policy analysis. The analysis uses a mapping program based on data from six unnamed states with the most reliable data.
As the coronavirus began to spread through prisons, states released over 16,000 inmates in April, including ones who have substance use disorders. Cutting funding for substance abuse programs creates problems for that population too, said Bergman.
“Coming out, if they don’t have services they can get into immediately, you could lose people due to overdose,” she said.
In Georgia, the state legislature is considering cutting $4.3 million to “accountability courts” to help close its projected $3-$4 billion budget hole. Accountability courts allow about 1,900 drug offenders to finish out their sentences in work release programs. The cuts could send many of them back to prison to finish their terms.
New York was already facing a budget crunch in 2019 when the state cut $90,000 for each of 12 drug-user “health hubs,” clinics that provide healthcare to drug users. The Empire State faces a $13 billion budget deficit following the pandemic.
But some think that states have spent so much on substance abuse programs that there is room for some spending cuts.
“In Colorado, substance abuse counseling is all over the place, and the state keeps shoveling money at it,” said Linda Gorman, director of the Health Care Policy Center at the conservative Independence Institute in Denver. “And it keeps increasing the budget for so-called community based care.”
