When signing the Comprehensive Addiction and Recovery Act, or CARA, into law last month, President Barack Obama said, “Every day, 78 Americans die from opioid overdoses.” Indeed, the size of the epidemic is astounding: Currently, more than 2 million Americans suffer from an opioid abuse disorder. In 2014 alone, 47,055 people died from drug overdoses in the United States and 61 percent of those deaths were due to opioid overuse. This corresponds to approximately 28,700 opioid-related deaths annually and nearly 80 deaths per day. However, the problem has not always been this severe. According to the Centers for Disease Control and Prevention, the national number of opioid drug overdoses has nearly quadrupled in the past 15 years.
The facts on opioid addiction and treatment in the United States
A majority of opioid-related mortalities are caused by an overuse of prescription painkillers, such as morphine, oxycodone, and fentanyl. From 1997 to 2007, there was a 402 percent increase in the average sale of opioids per person in the United States. This is alarming, especially since those who take opioid painkillers are 40 times more likely to become addicted to heroin than those who do not. Given the extremely high potency of heroin—and the fact that it is much less expensive than prescribed opiate pills—this is an incredibly dangerous trend.
Furthermore, only 10 percent of Americans with addictions currently receive care, despite the fact that treatments exist for opioid-use disorders, including methadone and buprenorphine. Naloxone—a drug used to treat heroin overdose—is also available. However, only 2.2 percent of doctors were trained across the country to prescribe buprenorphine as of 2012. Such astonishingly low numbers of trained doctors further limit access to treatment, contributing to thousands of preventable deaths throughout the United States every year.
Fighting America’s opioid epidemic
As noted in a recent report from the Center for American Progress, Maryland, Florida, Rhode Island, and New York have passed a number of reforms to ameliorate their drug epidemics. These reforms include expanding the availability of naloxone; adding lessons on the consequences of painkiller overdose to school curricula; requiring physicians to receive opioid prescription training in order to earn their licenses; requiring practicing physicians to register for Prescription Drug Monitoring Programs, or PDMPs, that monitor their prescribing practices; and increasing penalties for physicians who overprescribe opioids. However, an April 2016 poll from the Kaiser Family Foundation found that more than 60 percent of Americans indicated that the federal government needs to do more to address the country’s soaring rate of drug overdoses.
On July 13, 2016, Congress passed CARA after a final 92–2 bipartisan vote in the U.S. Senate. The new law puts a spotlight on treating rather than incarcerating people addicted to opioids. It also contains a series of provisions meant to curb the rise of opioid abuse in the United States. These provisions include embracing the use of naloxone to treat heroin overdose; giving nurse practitioners and physician assistants who meet certain requirements the power to prescribe buprenorphine—which supplements the U.S. Department of Health and Human Services’ recent executive action to increase the number of patients to whom a physician can prescribe the drug from 100 to 275 per year; and incentivizing states to establish PDMPs or improve their existing PDMPs. Additionally, the act attempts to protect the babies of addicted mothers by requiring hospitals to “report, track, and assist drug-dependent newborns” and their withdrawal symptoms. Despite these positive steps to change attitudes toward opioid drug abusers and improve access to treatment, however, many policymakers, public health experts, and advocates are still unsatisfied with the bill.
Congress needs to provide additional funding
The White House believes that CARA is inadequate due to its lack of sufficient federal funding. Although President Obama recommended allotting at least $1.1 billion to address the epidemic, Congress passed the bill providing only $181 million in annual unappropriated funds for opioid programs. With this $1.1 billion, the federal government originally hoped to allot $920 million to states to help expand their treatment capacities, with each state receiving money depending on the severity of the epidemic in the state and the strength of the state’s response. With the remaining funding, President Obama’s request would have allocated $50 million to the National Health Service Corps to support providers in giving medication-assisted treatment to opioid abusers and $30 million to evaluate the effectiveness of these treatment programs. In addition, the Obama administration’s request would have increased funding by $90 million for existing opioid abuse treatment and response efforts by the U.S. Department of Justice and the U.S. Department of Health and Human Services. Although the House promised to appropriate another $581 million when Congress reconvenes in September, this money would only be accessible through grant applications. Given the widespread, acute suffering this funding is meant to address, time is of the essence.
As the American people wait for Congress to act, the White House continues to push forward in its efforts to address this epidemic. On August 12, Director of the Office of National Drug Control Policy Michael Botticelli announced that the federal government would offer free online buprenorphine trainings for health care providers across the country.
State actions inspire hope
On the same day that Congress passed CARA, 46 state governors signed the Compact to Fight Opioid Addiction, binding themselves to reinforce their efforts to fight the opioid epidemic. The compact’s promises include implementing stricter prescribing limitations for physicians; integrating education into schools to raise awareness and reduce the stigma of addiction; requiring PDMPs for opioid prescribers and dispensers; and increasing access to naloxone. As a part of this effort, states have pledged to support access to treatment by “reducing payment and administrative barriers in Medicaid and other health plans.” Although not included in the compact, states that have not yet accepted federal funding to expand Medicaid under the Affordable Care Act should do so to further connect people to treatment.
As an act of state unity, the Compact to Fight Opioid Addiction should inspire hope, particularly because state governments are taking an active role in fighting the opioid epidemic. Hopefully, the federal government will take further action to support them. To make a substantial impact on addressing the increase in opioid abuse in the country, Congress must redouble its efforts and allocate a larger budget to CARA.
Neil Davey is an intern with the Health Policy team at the Center for American Progress.
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