Introduction & Keynote
On June 22, the Brookings Institution launched a wide-ranging new paper series: “The opioid crisis in America: Domestic and international dimensions.” In the first of two public webinars, experts discussed the project’s findings on prevention, treatment, and regulation of the opioid epidemic.
Brookings President John R. Allen outlined the gravity of the crisis: as the death toll in the United States from the COVID-19 pandemic has surpassed 125,000, nearly 400,000 Americans have died from opioids overdoses since 2000. In 2018, at least 2.35 million Americans were found to suffer from opioid use disorder (OUD), a number that is likely a significant underestimate. The economic, social, and well-being costs of the opioid epidemic have been enormous.
Congressman David Trone (D-MD), Chair of the bipartisan House Freshman Working Group on Addiction and a member of the Commission on Combating Synthetic Opioid Trafficking, provided the keynote remarks. He highlighted that the Freshman Working Group on Addiction has now sponsored over 35 bills. Rep. Trone further outlined his work to secure funding for State Opioid Response grants, provide support services to families affected by OUD sufferers, standardize OUD trainings for opioid prescribers, and institute continued mental health care for incarcerated individuals as they re-enter society.
“The area of mental health [is] so directly tied to addiction,” he explained. “We can’t tackle them separately.” Rep. Trone emphasized that responses to COVID-19 should also include adequate funding for mental and behavioral health services. The $425 million provided to the Substance Abuse and Mental Health Services Administration (SAMHSA) via the Coronavirus Aid, Relief and Economic Security (CARES) Act was a good start, but nowhere near enough funding to meet increased needs caused by the pandemic, he said. The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act passed by the House in May called for $1 billion for Community Mental Health Services Block Grants, $1.5 billion for Substance Abuse Prevention and Treatment Block Grants, and $10 million for the National Child Traumatic Stress Network.
Asked by Brookings Senior Fellow Vanda Felbab-Brown about the lack of treatment options for those who suffer from OUD and are incarcerated, Rep. Trone indicated that Medicaid is key to expanding treatment. He also emphasized the importance of better utilizing Medication-Assisted Treatment (MAT) within prisons. “Addiction has to be the disease,” he said. “It’s certainly not a reason to incarcerate somebody — that’s just dead wrong.”
In the panel discussion that followed, moderated by National Public Radio correspondent Brian Mann, Brookings Senior Fellow Carol Graham spoke about preventing root causes of drug use disorder. She explained that even prior to COVID-19, the United States was the world’s only rich country where mortality rates were going up due to so-called “deaths of despair” among primarily middle-aged white people without a college degree — with many of those deaths related to opioid misuse. Such deaths of despair have been most prevalent in places where manufacturing and other blue-collar jobs have hollowed out, she said.
Carnegie Mellon University Professor Jonathan P. Caulkins outlined several ways to prevent the misuse of opioids by reducing the availability or demand of opioids. Rogue doctors who grossly overprescribe opioids can be arrested and incarcerated, he said. Well-intentioned, undertrained clinicians over-prescribing opioids should be sent letters stating when their patients have died of overdoses, as this has been seen to change behavior. And more pharmacist counseling to patients and drug take-back programs would also help.
University of Southern California Professor Rosalie Liccardo Pacula detailed state response to the opioid epidemic. She explained that the substance abuse treatment system has largely existed separately from the rest of the health care system. States have addressed this deficiency through multiple strategies to increase insurance coverage and payment for substance abuse disorders in general, increase capacity to treat more people, and improve quality of care for those in treatment and recovery.
Comparing how other countries have responded to opioid misuse, Director of the RAND Drug Policy Research Center Beau Kilmer outlined three insights for U.S. federal policymakers to consider. They could invest in clinical trials of medications not currently used in the U.S. for treating OUD; make it easier for states and localities to pilot programs to supervise opioid consumption and reduce the risk that an overdose becomes fatal; and support large-scale waste-water testing to both detect when synthetic opioids or other substances have entered a local market and better evaluate the effectiveness of interventions targeting drug use.
Brookings’s second webinar on opioids, forthcoming in July, will discuss vulnerable groups, international supply control measures, and domestic law enforcement.
H. Guyford Stever University Professor Of Operations Research And Public Policy - Heinz College, Carnegie Mellon University
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