Since 1999, when the unconstrained prescription of painkillers was beginning to emerge as a public-health crisis, more than 535,000 lives have been lost to opioid overdoses. If that grim number seems familiar, it’s just a bit higher than COVID-19’s toll of 527,000 deaths so far.
COVID-19 and the opioid crisis are linked in other ways too. The pandemic has driven an alarming increase in overdose fatalities over the past year, as people struggling to recover from opioid dependence have been undone by isolation, job loss and the added difficulty of getting support and treatment with social distancing rules in effect. All this at a time when lethal illicit fentanyl is increasingly turning up in street narcotics, including counterfeit hydrocodone and oxycodone pills. The 12 months ending last July saw 61,000 deaths, a surge from the previous year — even though the period includes only the first five months of the pandemic.
To its credit, Congress has set aside billions of dollars in stimulus spending to address mental health and substance use disorders. But health providers say still more is needed — particularly since states have slashed their budgets for addiction treatment amid the pandemic. Policymakers at all levels of government need to wake up to this emergency and redouble efforts to tackle the problem.
It remains essential to continue to discourage doctors from overprescribing pharmaceutical opioids — a yearslong campaign that has led to a 40% drop from the 2011 peak. But the massive shift in the drug epidemic to illicit opioid abuse also calls for strengthened efforts to block the supply of street drugs and get users into effective treatment.
So far, the government has not taken the problem seriously enough. A federal audit released last year found it lacked “a strategic, coordinated and effective national response — with key sustained leadership from federal agencies.” It noted that the Drug Enforcement Administration had not yet crunched its own data well enough to spot emerging trends in drug misuse and distribution, and to enable law enforcement to quickly respond.
One big law enforcement challenge is to block the importation of fentanyl, which is sent to American dealers through the mail directly from China or carried over the southwest border from Mexico, and to find and dismantle fentanyl pill-pressing operations in the U.S. This means continuing to work with Chinese authorities to stop fentanyl manufacture and export, and reducing backlogs at Customs and Border Protection labs that test suspicious substances.
At the same time, harm-reduction efforts are needed. With a substance as lethal as fentanyl circulating, states, cities, doctors and pharmacies must see that users have access to naloxone, the overdose-reversal drug, and to test strips that can detect the presence of fentanyl. Users should be provided with treatment options at every encounter they have with emergency rooms, hospitals, clinics and prisons. People addicted to opioids require access to effective treatment with buprenorphine, a medication that can keep people in recovery from relapsing by reducing cravings without causing euphoria.
During the pandemic, federal and state agencies have made it easier for people with opioid-use disorder to obtain buprenorphine and methadone, a similar treatment, by loosening restrictions that had limited doctors’ ability to prescribe via telehealth and by allowing more take-home doses of methadone. These changes should be made permanent.
More important still, the federal requirement that doctors have special training before they are allowed to prescribe buprenorphine should be lifted. The Biden White House has reversed a Trump administration action intended to do this, over questions about its legality; it should quickly find a legitimate way to accomplish the same thing. Alternatively, Congress could take care of it, and at the same time require that doctors who prescribe opioid painkillers understand how to prevent, identify and treat addiction.
States, which are soon expected to receive tens of billions of dollars from drugmakers, distributors and others to settle claims that they were partly responsible for the opioid crisis, should make sure that money is spent to mitigate the crisis, including by expanding addiction treatment.
On the national level, President Joe Biden has promised greater spending to address drug abuse. It’s encouraging that he has already hired people to strengthen the Office of National Drug Control Policy. Now he should engage with Congress and the states to finally provide the policing and health care the U.S. needs to bring the opioid crisis under control.