In 2014, America's opioid painkiller and heroin epidemic led to nearly 29,000 opioid overdoses, causing nearly two-thirds of the record 47,000 drug overdoses that year. While there are already some measures in place to squash this rising epidemic, the Obama administration on Tuesday proposed a $1.1 billion plan to boost the fight.
The proposal would fund several programs over two years, with a focus on increasing access to opioid abuse treatment options, particularly in states like West Virginia and New Hampshire that have been hardest hit by the epidemic:
- $920 million to states, based on the severity of their epidemic and strength of their strategy, to help them expand medication-assisted treatment for opioid use disorders and make it more affordable (more on what medication-assisted treatment is below)
- $50 million to expand access to substance use treatment providers, which would help approximately 700 providers
- $30 million to evaluate the effectiveness of medication-assisted treatment under real-world conditions
- $90 million in new spending across the Department of Justice and Department of Health and Human Services for an array of programs that emphasize treatment and prevention
The spending plan will need approval from Congress, but administration officials said they're hopeful the opioid epidemic is an area where there's bipartisan agreement on the need for action.
In a call, White House officials emphasized that this is one part of a broader plan to combat opioid use, which includes other public health efforts and law enforcement programs that attempt to crack down on the illegal supply of painkillers and heroin.
The administration, for example, has stepped up general spending on treatment and prevention programs over the past few years. It dedicated $2.5 million in 2015 to fight heroin abuse. The Department of Health and Human Services (HHS) proposed $133 million in 2015 to fight opioid abuse. And the administration helped launch a combination of federal, state, local, and private efforts in 2015 to provide better prescriber training and improve access to addiction treatment.
But with the epidemic showing signs of worsening in the latest federal data, the White House is proposing additional steps.
The plan tries to fill a big gap in the health care system
HHS estimates that 2.5 million people have an opioid use disorder, yet fewer than 1 million get care.
This exemplifies a broader problem in the health care system: According to 2014 federal data, at least 89 percent of people who meet the definition for a drug abuse disorder don't get treatment. And that's likely an underestimate: Federal household surveys leave out incarcerated and homeless individuals, who are more likely to have serious, untreated drug problems.
There are lots of explanations for the low rates of treatment, including stigma against drug addicts. But one reason is there simply aren't enough treatment facilities: During President Barack Obama's visit to West Virginia to address the opioid epidemic, several families told Obama that they had to send their sons and daughters to other states for treatment or wait as much as three months for potentially lifesaving care.
With the rising number of drug overdose deaths, this long wait period is increasingly seen as unacceptable. So the White House is asking to boost funding for treatment options.
Medication-assisted treatments are a promising way to combat the epidemic
The opioid epidemic has largely inspired a public health response by lawmakers at the state and federal levels, but one area that's consistently lagged behind, according to several investigations by the Huffington Post, is medication-assisted treatment.
In these programs, opioid addicts replace their painkiller and heroin use with drugs like methadone and Suboxone. When used as prescribed, these generally safer opioids help suppress withdrawal symptoms without leading to the kind of euphoric high that can lead to more use and, therefore, overdose.
There's a lot of science behind methadone and Suboxone: Decades of research have deemed them effective. The Centers for Disease Control and Prevention, National Institute on Drug Abuse, and World Health Organization acknowledge their medical value.
But since methadone and Suboxone are, like heroin, opioids, many people view them as simply masking an addiction rather than treating it. And although this flies in the face of the accepted medical literature, it's a criticism that's widespread enough — even among doctors — to hinder access.
The White House's increased spending will also boost naloxone, a drug that reverses opioids' effects, including overdoses. Currently, many states limit access to naloxone, and the White House hopes its financial and regulatory incentives will help states relax these barriers. (Read more on naloxone here.)
On top of increased funding, the administration is publishing new guidelines through federal health care programs to better guide and educate doctors on when it's okay to prescribe opioid painkillers — to avoid the kind of overprescription that led to the epidemic in the first place. (For a comprehensive look at the causes of the epidemic, check out Vox's explainer.)
It's a lot of different steps. But the epidemic is now so widespread that administration officials — and drug policy experts — widely agree that more action is needed. Tens of thousands of lives potentially depend on it.