It’s been a busy few months in the substance use disorder treatment community. It remains to be seen how productive that activity will end up being.
On Sept. 17, the president proclaimed Prescription Opioid and Heroin Epidemic Awareness Week to “raise awareness about the prescription opioid and heroin epidemic and to consider concrete follow up activities.”
The same week, the Senate finally passed its Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (or SUPPORT) Act, almost three months after the House of Representatives passed its version.
Following reconciliation negotiations, the House passed the new version less than two weeks later, and the Senate followed suit on Oct. 3. The final bill is said to be on the President’s desk, awaiting his signature, which he has said he will do.
On Sept. 24, the President also issued a Global Call to Action on the World Drug Problem before the United Nations, in conjunction with 130 other UN member states, pledging to work together to do pretty much the same thing but on a global scale.
Both plans call for stopping the supply of drugs, ending demand for drugs, improving treatment options for people who wish to stop using drugs, and better cooperation across state or national borders.
Neither plan includes much funding if any. SUPPORT authorizes Congress to seek appropriations, but with no guarantee that they will receive them. Most of the funds are designated for one-time grants or pilot programs, which ignores that addiction is a lifelong problem and that addicts often relapse, whether they want to get straight or not. Medication-assisted treatment (MAT) with buprenorphine and methadone are addressed, but perhaps not with the emphasis that the evidence for the effectiveness of these drugs warrants.
Completely missing from the plans are harm reduction programs such as supervised injection sites that can prevent accidental overdoses and deaths caused by black-market drugs tainted with fentanyl. Even a liberal governor such as California’s Jerry Brown opposes such measures despite the evidence that they work and even lead some addicts into recovery.
Ending the opioid crisis and the larger drug crisis will require more than the four-pronged approach the president has proposed. It also will require money. Some experts say that much more than the $8.5 billion Congress appropriated for opioid-related programs this year, and consistently over a period of years.
Stopping supplies isn’t enough. Addicts can switch from legally obtained opioids—oxycodone, hydrocodone—to the same drugs, illegally obtained, or more dangerous and stronger illegal opioids—heroin, fentanyl—or even different types of drugs—methamphetamine, benzodiazepine.
Stopping the supply is almost impossible anyway. Most of our heroin, fentanyl, and meth come from overseas across our borders, but through legal checkpoints, not the areas where the President wants a border wall. Even if the wall is built, they can tunnel under it or catapult drugs over it.
Ending addiction must emphasize drug treatment and prevention. Anything else is rearranging deck chairs on the Titanic.
