Washington, DC—As the United States enters its third decade of the opioid epidemic while enduring a pandemic, the Bipartisan Policy Center releases a new report today that shows overdose death rates are rising and exacerbated by COVID-19, federal funding to states is not meeting the need nor properly evaluated, and treatment remains out of reach for the vast majority of people with substance use disorders. To address this public health crisis, BPC offers recommendations for Congress and the administration on ways to build and sustain a national addiction treatment system that not only focuses on today’s overdose epidemic but America’s ongoing addiction epidemic to save lives.
“Currently, we have no proper mechanism for evaluating the effectiveness of federal investments, the opioid crisis is getting worse, and only about 10% of people with a substance use disorder receive any type of treatment,” said Dr. Anand Parekh, BPC chief medical advisor. “Many individuals with opioid use disorders are still not receiving evidence-based treatment, such as at-risk populations like those who are incarcerated or recently released from jails and prisons.”
Preliminary 2019 data from the Centers for Disease Control and Prevention show that overdose death rates climbed nearly 5% compared to 2018, with more than 50,000 deaths involving opioids. Illicitly manufactured fentanyl continues to drive these increases.
BPC’s report tracked federal funding to states in fiscal year 2019 to curb the opioid epidemic and identified $7.6 billion in spending from 60 separate federal programs—a 3.2% increase in funding from FY2018. The report also shows that three-quarters of FY19 funding went to treatment, recovery, and prevention efforts, with the remaining dollars directed to research, interdiction, law enforcement, and other criminal justice activities. Strikingly, interdiction funding dedicated to disrupting the trafficking of opioids, particularly illicitly manufactured fentanyl, nearly doubled from 5% in FY18 to 9% in FY19.
The report also looked at how these investments were spent in six geographically diverse states with higher than average overdose death rates in 2018: Arizona, Louisiana, New Hampshire, Ohio, Tennessee, and Washington.
“The current situation is creating a cascade of effects in communities nationwide causing tens of thousands of preventable overdose deaths,” added Parekh. “Relying on annual congressional appropriations to fund ongoing addiction services prevents states from making the long-term investments that are necessary to tackle America’s addiction epidemic and build a much-needed national treatment system. This is particularly important in states without Medicaid expansion, since Medicaid is a primary source of funding for addiction treatment.”
“What started out as a prescription opioid fueled overdose epidemic primarily affecting middle-aged men in Appalachia, is now one that is being driven by illicitly manufactured fentanyl, increasingly affecting Black and Latinx communities,” said Regina LaBelle, former chief of staff of the White House Office of National Drug Control Policy and BPC consultant. “America must address the changing complexion—and complexity—of the addiction epidemic.”
BPC’s report offers the following recommendations for policymakers at the federal, state, and local levels on how to build a national treatment system that improves outcomes:
- Increase the Substance Abuse and Mental Health Services Administration (SAMHSA) Substance Abuse Prevention and Treatment Block Grant funding for evidence-based programs. This grant has been level-funded at $1.85 billion since FY2016 and has not kept pace with inflation.
- Evaluate grant programs and provide feedback to states based on these evaluations so federal funds support programs that will effectively reduce opioid use disorder and overdose rates. Federal evaluations are also key to assess prevention, treatment, and recovery support system shortfalls in communities of color, if funding is going to evidence-based treatment, and how the absence of Medicaid expansion affects outcomes.
- Coordinate federal government harm reduction services. The CDC provides ongoing support for syringe services programs, however, there remains a lack of funding coordination at the state and federal levels. In addition to enhanced coordination, BPC recommends Congress remove the funding restrictions on syringes in federal appropriations language.
- Increase access to treatment through state Medicaid programs. This is particularly important given that nearly four in 10 individuals with opioid use disorders are Medicaid beneficiaries.
- Revise burdensome laws and regulations that too often prevent access to treatment. This can include extending the revisions made to telehealth and opioid treatment restrictions during the COVID-19 pandemic. These revisions have allowed people in need of treatment for opioid use disorders better access to life-saving treatment. In addition, remove the waiver process that requires prescribers to receive a special certification before prescribing buprenorphine, one of three forms of FDA-approved medications to treat opioid use disorder.
- Require grant programs to focus on cultural competency to reduce treatment gaps in communities of color.
This new FY2019 effort builds on BPC’s FY2017 and 2018 study released last year. These reports are the only comprehensive, transparent analysis of federal funding to support states in tackling the nation’s opioid epidemic.