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Going back to the pre-Covid “normal” isn’t enough

American policymakers should look beyond defeating the coronavirus.

A door is painted with the message to stop selling heroin, on a street in a neighborhood with a high rate of poverty and illegal drug use in 2016, in New York City.
Spencer Platt/Getty Images

Throughout the Covid-19 pandemic, there’s been a lot of talk about going back to “normal.” And while going back to a pre-coronavirus era would be a tremendous improvement for everyone, there are reminders all around us that it also wouldn’t be good enough.

A clear example is America’s opioid epidemic. Before Covid-19, the US suffered a record 70,630 drug overdose deaths in 2019. That amounted to a 5 percent increase from 2018, and erased the entire drop in overdose deaths reported from 2017 to 2018.

Based on data from the Centers for Disease Control and Prevention, the crisis further worsened in 2020 — with an estimated 86,000 overdose deaths over the 12 months ending with July 2020. Experts say that’s partly due to Covid-19: As much of society shut down, so did places that can help people struggling with drugs, and more people were thrust into isolated conditions that may have pushed them to drug use and addiction.

But as the increase in overdose deaths from 2018 to 2019 shows, the crisis was once again on an upward trajectory before Covid-19. There are many possible reasons. But most notably, the highly potent synthetic opioid fentanyl has continued to supplant heroin in illicit markets, and with its greater potency, fentanyl brings a greater risk of overdose and death. Couple that with America’s inadequate addiction treatment system — which is very expensive and frequently offers substandard care — and you get an uncontrolled, worsening public health crisis.

One thing I really want to emphasize: this isn’t because, as I often hear from readers, the opioid crisis is an impossible problem to solve. A solution isn’t easy — addiction is a complex medical condition, for one — but it’s not impossible.

For opioids, there are very effective treatments: medications like methadone and buprenorphine (commonly known as Suboxone). These medications have decades of evidence behind them, showing they reduce all-cause mortality among opioid addiction patients by half or more and do a better job keeping people in treatment than non-medication approaches. In France, an expansion of access to buprenorphine in particular was tied to a big drop in overdoses.

Yet the majority of addiction treatment facilities don’t offer any of the federally approved medications. Many of these facilities are instead built around approaches that have little to no evidence behind them — or, in the case of some, actually have evidence against them.

Policymakers could address this. They could boost support for addiction treatment facilities but tie that support to truly evidence-based care, as Vermont has done. They could integrate addiction treatment into the health care system, therefore tying treatment to more accountability and higher quality standards — as Virginia has moved toward through its Medicaid program.

The problem, though, is that policymakers across the country by and large haven’t taken the crisis seriously enough. They haven’t spent the money; even as the crisis became a truly national story during the Trump administration, Republicans resisted spending much. Many lawmakers still hold stigmatizing views of those suffering from drug addiction, fostering apathy toward the problem.

In other words, we know this crisis is happening, we know there are policy solutions to address it, and yet we haven’t. This was true before Covid-19, and it’ll be true after, too.

This is just one example. From gun violence to the racial wealth gap to climate change, there are many problems that were going largely unaddressed in the “normal” pre-Covid times.

The good news, with opioids, is that President Biden has a good plan to address the crisis — it was one of his few plans, in fact, that was actually more ambitious than the rest of the Democratic primary field.

But to get action on the opioid epidemic and other issues, the American public and lawmakers can’t settle for “normal” — we’ll have to go bigger than that.

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