The United States is simultaneously experiencing two devastating public health crises—the COVID-19 pandemic and the overdose epidemic. As the rates of COVID-19 infections and deaths begin to decline nationally, the number of people dying from overdoses involving opioids and other drugs continues to escalate. Over the past decade, over 750,000 Americans have died from overdose. Preliminary data suggest that 2020 set a grim new record, with over 90,000 lives lost.
The federal government can and must take the same kind of urgent action to stem the tide of overdose deaths as it has to address the COVID-19 crisis.
As soon as the FDA approved the COVID-19 vaccines as safe and effective, there was an immediate mobilization of federal and state agencies to distribute them widely. Health care providers, public health entities, community organizations and corporations collaborated to get “shots in arms” quickly and with the least number of barriers. Messaging about vaccines’ safety and efficacy has been clear and consistent. The coordinated national response has worked—the most recent numbers show that more than 309 million vaccine doses have been administered.
The same coordinated national response could also work in the case of overdose. There are three extremely effective, FDA-approved medications for opioid use disorder (MOUD): methadone, buprenorphine and injectable naltrexone. A wealth of scientific evidence over the past 50 years has shown that these medications, combined with counseling, are the safest and most effective treatment for opioid use disorder and significantly reduce overdose.
So, why are penetration rates of MOUD so abysmally low?
In fact, all of the major medical, public health and health policy authorities—including the National Institute on Drug Abuse, US Surgeon General, Centers for Disease Control and Prevention, the US Food and Drug Administration, the American Medical Association, the National Academies of Science, Engineering and Medicine and the World Health Organization—recommend these medications as the “gold-standard” or “first-line” treatment for OUD.
And yet, despite the soaring rates of opioid addiction, a mere 10 percent of people affected currently receive one of the three FDA-approved medications, and only 4 percent of specialty addiction treatment programs offer all three.
So, why are penetration rates of MOUD so abysmally low? Largely because we have not diminished the legacy set of policy and practice barriers to MOUD—nor, in too many cases, the stigma that informed them.
Although there have been dramatic increases in federal spending to address the opioid-involved overdose crisis over the past few years, this funding has not been adequately focused on increasing access to MOUD. The result is that too few treatment centers offer MOUD, too few clinicians are trained to screen or treat opioid use disorder. Moreover, reimbursement rates are not aligned with the standard of care, creating a disincentive for all but the most knowledgeable and dedicated providers to offer these lifesaving medications.
There are, certainly, significant practical barriers to expanding access and availability of MOUD. But compared to the challenges created by COVID-19, these barriers seem diminutive. Over the past year, scientists developed effective vaccinations for a novel virus, the FDA approved three of them, and extensive and complex coordination among government, clinical and corporate entities produced the vaccines and made them available for free via a national network of providers to a massive percentage of the population.
Eradicating outdated federal, state and local barriers is imperative and—as we saw with the vaccination rollout—it is eminently possible.
We need to conduct the same type of high-profile and coordinated campaign to dramatically reduce the prevalence of opioid and other substance use disorders and overdose. We must increase funding—and target it at MOUD and other effective treatment, prevention, harm reduction and recovery supports. We must train health care professionals, provide sufficient reimbursement rates for care, and remove life-threatening prior authorization requirements, together with other barriers to private and public insurance that violate federal parity requirements. We must conduct public education campaigns to address stigma and communicate the effectiveness of MOUD.
Eradicating outdated federal, state and local policy and practice barriers to MOUD is imperative and—as we saw with the successful rollout of the vaccination strategy—it is eminently possible.
The stakes are high. Unless we act with the same focus and urgency as was applied to stemming the COVID crisis, deaths from overdose will continue to escalate. Like the COVID vaccines, medications for opioid use disorder demonstrably save lives. Expanding access is critical to ending the epidemic of opioid addiction and overdose.