The Opioid Epidemic Rages in the Background
2019 set a new record for overdose deaths, and 2020 is primed to shatter it
For the last nine months, the attention of the American populace has been, understandably, centered on the Covid-19 pandemic. But the opioid epidemic, a ravaging crisis which has led to hundreds of thousands of overdose deaths since the turn of the century, continues to rage on in our periphery. Preliminary 2019 data from the Centers for Disease Control and Prevention reported 72,158 overdose deaths, which breaks the record of 70,237 deaths set in 2017.
In October of 2017, the Trump administration officially declared the opioid epidemic a public health emergency. In the declaration, the administration appeared to grasp the severity of the crisis citing that overdose deaths now outnumber auto accident and gun deaths, killing around 175 people a day in the United States. And the administration did increase funding, allotting an additional $1.8 billion in September of 2019. There was a moderate decrease in overdose deaths in 2018 with a total of 67,367, though it is uncertain this decline was the result of administrative action. Moreover, as the preliminary 2019 data above show, it didn’t last. And it didn’t last because we didn’t spend nearly enough money, and we didn’t spend it in the right places. We need large-scale, structural changes, and that certainly didn’t happen.
This is very much a healthcare crisis, and, much like the Covid-19 pandemic, it has shown us that our labyrinthine, for-profit system is not built to administer universal care. But, since single-payer healthcare is not supported by the incumbent or the president-elect, we must be aggressive in order to fight against the very design of our healthcare system and actually make an impact. Because the situation is dire.
40 states have reported a rise in overdose deaths during the pandemic, leading many to believe that the 2020 numbers will look worse than 2019, and set yet another fatality record—potentially by a large margin. This is not surprising as studies have shown economic distress increases the likelihood of opioid overdose deaths. And the pandemic has led to 40 million people losing their jobs, while pushing 8 million more people into poverty. We cannot afford to keep this crisis in the background.
An easy, no-brainer improvement that the Trump administration failed to do was to lift the DEA waiver on prescribing buprenorphine, a vital medication in treating opioid use disorder. Currently, to prescribe the medication, clinicians must meet a number of criteria and then complete a 24 hour online training. On the topic of the waiver, Karen Cropsey, a professor of psychiatry at The University of Alabama at Birmingham stated:
Frankly, the country’s rebound from the opioid crisis would have been much greater if Azar had announced that there is no longer a waiver required to prescribe buprenorphine. The fact that any doctor, with no extra training, can prescribe medications that caused this crisis, but doctors need several hours of training and a waiver on their DEA to prescribe buprenorphine, a medication that could curb this crisis, is ludicrous.
Buprenorphine is part of Medication Assisted Treatment (MAT) model, also referred to as Medications for Opioid Use Disorder (MOUD) which pairs counseling and behavioral and cognitive therapy with opioid agonists (buprenorphine, and methadone) and/or opioid antagonists (naltrexone). Opioid agonists alleviate cravings and withdrawal symptoms by activating the opioid receptors in the brain at a slower rate, and without producing the associated euphoria. Opioid antagonists alleviate cravings by blocking opioid receptors, also without euphoria. MAT/MOUD has consistently been shown to be the most effective mode of treatment for opioid use disorder, reducing overall use, relapse, and fatalities. But many people in America still do not currently have access to these treatments. A study completed in 2017—and, it should be noted, there may have been some modest improvements since then—found that only 60% of residential facilities throughout the country offered MAT/MOUD.
Biden’s plan is far more significant and addresses many of these issues. The plan calls for $125 billion to be spent over the next ten years in order to dramatically expand treatment with the goal of reaching universal access to MAT/MOUD by 2025, as well as lifting restrictions and barriers on buprenorphine prescribing.
It’s a solid plan, and one that might be large enough to make a serious impact. But oftentimes ambitious plans drawn up during campaigns are softened considerably, or forgotten entirely, when a candidate assumes office. They are really just documents of broad intent. But what is inevitably implemented needs to be as all-encompassing and significant as this plan. $125 billion over ten years is the type of serious investment that is needed to combat this crisis. But it’s troubling that the opioid crisis was rarely mentioned at all during the Democratic National Convention. We cannot forget about the epidemic looming and growing larger beneath the pandemic.
We need to act with urgency here. The opioid crisis was killing tens of thousands of people a year for two decades before Covid, and at the rate we’re going, it’s going to be killing far more people over the next two decades.
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