In 2017, more than 70,000 people in the United States died from a drug overdose, with almost 50,000 of these deaths involving an opioid. The United States is facing a devastating opioid epidemic, and the federal government has responded by investing billions of dollars into prevention, treatment, and recovery efforts over the past two years. This includes efforts to curb the supply of both illicit opioids and unnecessary prescription opioids and to improve access to evidence-based treatment for opioid use disorder. Despite these actions, addiction policy experts believe that the end of the epidemic is not yet in sight.
Considerable attention has focused on the drivers of the opioid epidemic. However, less attention has been paid to whether the federal investments to address the issue are being effectively targeted to the communities most affected and to those with the highest overdose deaths. An effective response requires policymakers to know how resources are allocated and to use that information to minimize duplication and maximize the efficiency of limited resources. The federal government has not previously produced or made available a document that provides this information to the public or policymakers.
Thus, the Bipartisan Policy Center created this first-of-its-kind, comprehensive report that tracks federally funded opioid programs in fiscal year 2017 and FY2018, and examines how these appropriated funds are being directed to address the opioid epidemic.
Over the past six months, BPC conducted a detailed analysis of federal appropriations and identified 57 federal programs that, either entirely or significantly, fund efforts to curb the epidemic. In total, the federal government included nearly $11 billion for these programs in its FY2017 and FY2018 discretionary appropriations bills. This includes a 124 percent increase between FY2017 ($3.3 billion) and FY2018 ($7.4 billion). These programs span the continuum of care, including prevention, treatment, and recovery. In addition, funds are directed to research, criminal justice, public health surveillance, and supply reduction efforts. Between FY2017 and FY2018, funding specifically targeted to opioid use disorder treatment and recovery increased by $1.5 billion (from $599 million to $2.12 billion). Over three quarters (77 percent) of the appropriations to opioid programs are administered by the Department of Health and Human Services (HHS).
The report also examines how federal opioid investments are spent across five geographically diverse states: Arizona, Louisiana, New Hampshire, Ohio, and Tennessee. The average drug overdose death rate in the five case study states was nearly one and half times (144 percent) higher than the national average in 2017. Each state case study takes an in-depth look at how these states are allocating the two largest federal opioid grants, the State Targeted Response and State Opioid Response grants. BPC’s analysis also incorporates county-level maps of federal funding and drug overdose deaths from 2015 to 2017 for each of the selected states.
OPIOID APPROPRIATIONS FY2018: $22.73 Per Capita; $7,403 million
OPIOID APPROPRIATIONS FY2017: $10.16 Per Capita; $3,311 million
DEATH RATES IN 2017: 14.9 Opioid Overdose Death Rate
BPC’s five state case studies revealed:
- A statewide coordinating body, typically convened by the governor, is an essential part of developing a strategic opioid epidemic response. Each of the five states BPC studied has a coordinating body to facilitate data-sharing and communication.
- States are increasingly focused on building out treatment networks for individuals with opioid use disorder, using funds for direct payment supports for treatment in at-risk populations, providing trainings and technical assistance, distributing naloxone, and enhancing the treatment workforce.
- Federal funding in these states is flowing to areas with the highest number of deaths. When examining the per capita federal funding in rural and metropolitan areas, many rural counties receive relatively low levels of direct funding compared with the more populated cities. It is important to note that the recipient of funds may not necessarily correspond with the geographic service area.
- Ongoing evaluation is needed to help track all phases of progress in the state’s response to the opioid epidemic, including prevention, treatment, and recovery. Output data from these programs is only preliminary and more attention is needed to evaluate the effectiveness of this funding and its effect on longer-term outcomes.
- Medicaid (and Medicaid expansion in four of five case-study states) has been essential to providing services to individuals with opioid use disorder.
BPC conducted interviews with various state government officials and staff and collected information from the federal and state analyses. As a result of this examination, there are three essential steps that policymakers should take to improve the federal response to the opioid epidemic:
- HHS, other federal departments, and non-governmental organizations involved in the response should assist states in identifying sustainable sources of federal, state, and private-sector funding to address the opioid epidemic. The Substance Abuse and Mental Health Services Administration’s Prevention and Treatment block grant is one example of a critical federal source of long-term funding that has been level-funded at approximately $1.8 billion for the past 10 years, representing a 31 percent decrease in funding when adjusted for inflation.
- There is substantial need for improved coordination of grant programs at the federal level, particularly with the aid of the White House Office of National Drug Control Policy. Enhanced federal coordination of opioid funding programs across federal agencies will improve program coordination at the state level. This is critical given the sheer volume of grants going to states, the need for coordination across state agencies and local governments, and the multifaceted nature of the epidemic.
- Congress and the administration should build flexibility into federal grants to allow state agencies to adapt to quickly changing conditions on the ground. Flexibility in funding ensures that while states are responding to today’s opioid epidemic, they are also prepared for other emerging drug threats, such as methamphetamine and cocaine.
Further research and evaluation is necessary to ensure that states are delivering quality, evidence-based services and that federal funds support not only service delivery but also sustainable infrastructure to prevent and treat opioid use disorder. The critical role of other sources of funding—specifically Medicaid and private insurance—to address the opioid epidemic also need to be tracked.
Trajectory of our opioid work since 2017