The major new bipartisan budget deal Congress passed this week includes a $6 billion boost in funding for opioid abuse and mental health treatment. That sounds great until you understand the scale of the problem, what’s really needed to fix it, and how willing Congress is to throw money around at the moment.
Drug overdoses killed more than 64,000 people in 2016, with fentanyl and heroin accounting for the lion’s share of the toll, followed by other opioids, and cocaine and amphetamines bringing up the rear. That’s more deaths in 2016 alone than from the entire Vietnam War, and more than either AIDS or gun violence in their respective peak years. And as best as we can tell (the most rigorous data, unfortunately, reports with a lag), things got even worse in 2017. We’re looking at an entire Vietnam War’s worth of deaths each year, every year, indefinitely unless something big changes.
And while $6 billion over two years is better than nothing, it’s nowhere close to the “tens of billions” of dollars a year that experts tell Vox’s German Lopez would be needed to really meet the challenge. Indeed, even the most ambitious legislation pending in Congress — by New Hampshire Sens. Jeanne Shaheen and Maggie Hassan — calls for only $45 billion in total over 10 years.
Meanwhile, the budget deal provides a $160 billion boost to military spending over two years on top of a $549 billion annual baseline. So it’s not as if the tens of billions of dollars can’t be found or Congress is unwilling to appropriate it. They simply don’t take the issue seriously.
A major boost would be money well spent
There’s obviously no quick-fix silver bullet for drug abuse, but substitution therapies featuring methadone or buprenorphine are highly effective at saving lives — multiple studies show that this kind of therapy reduces all-cause mortality by half or more.
This is a proven, workable treatment that scales reasonably well. But it does require physical facilities that are reasonably convenient to where the patients live and work. They simply aren’t available throughout large swaths of the country. More money wouldn't ensure that everyone who needs treatment actually gets it, but it could ensure that everybody who wants treatment doesn’t face insurmountable logistical barriers.
And the return on investment would likely be high. A 2016 study estimated that the all-in economic cost of opioid abuse was $78.5 billion back in 2013, of which approximately a quarter was already being borne by the public sector through health care and the criminal justice system. The problem has gotten a lot larger in subsequent years, meaning the potential social returns on spending what Shaheen and Hassan are talking about — or even two or three or five times as much — would be commensurately higher.
The Pentagon’s boost shows what Congress does when it cares
I am not in a position to say whether spending $629 billion on the military rather than “only” $549 billion is going to solve any major problems in American life, though I will admit I am skeptical by instinct. But I’m struck by the logic key congressional leaders are using to justify the $80 billion-per-year increase. Roughly speaking, they are saying this is what military leaders say the military needs to meet its strategic goals.
With today’s vote, we’re finally going to get the military the budget they need to fulfill Secretary Mattis’ national defense strategy. That is by far the biggest achievement in this bill. https://t.co/NyXVptZR1a— Paul Ryan (@SpeakerRyan) February 8, 2018
At the same time, essentially everyone in Congress — and certainly Paul Ryan — says that the drug overdose crisis is a serious problem that they are serious about tackling.
Opioids are taking over our communities. Congress has made fighting this epidemic a top priority. https://t.co/4l6NYjMkMM— Paul Ryan (@SpeakerRyan) August 15, 2017
But listening to what public health leaders say they need in terms of monetary resources is precisely what is not happening here. Instead, everything is driven by the Pentagon.
The Pentagon says it needs $80 billion, and the old Budget Control Act bargain was that increases in defense spending should be matched by increases in non-defense spending. Republicans never liked that bargain, and they run the show in Washington so they are now demanding that the non-defense boost be smaller than the defense boost. Since the defense boost is large, Democrats are willing to accept less than parity because it’s still a lot of money for non-defense needs. That created a pool of about $64 billion in non-defense money to go around. A lot of that ended up claimed by urgent disaster relief needs, and then the remainder was parceled out across a few different priorities.
Relative to that backdrop, the $3 billion per year going to opioids is indeed a large block of money — more than the NIH, the Veterans Administration, or college affordability programs are getting.
But it isn’t nearly enough money to actually address an urgent problem. Making treatment widely available all across the country could save thousands of lives a year for years to come. If a foreign enemy were killing thousands of Americans per year and the Joint Chiefs of Staff said they needed $40 billion per year to stop them, we would obviously appropriate the money. In fact, even though there is no foreign enemy killing thousands of Americans per year, we are ponying up an extra $80 billion per year to achieve some fairly hazy “readiness” goals. Congress ought to take the drug overdose problem at least as seriously. But it doesn’t. And yet members would like credit for taking bold action.