The magnitude of the tragedies—personal, family and neighborhood—engendered by the opioid crisis is so vast and so pervasive that words actually fail us. Each year, almost the same number of Americans die from opioid overdoses as were killed during the entire Vietnam conflict, which spanned a period of almost 15 years. And, much, much worse, we expect these chilling numbers to continue their deadly ascent this year.
What can we say to families who have lost cherished loved ones? What can we tell neighbors or colleagues who have lost a close friend? What can we tell communities that have lost vibrant members? What? Just what?
We must come to grips with this lethal epidemic, not just by bringing good intentions, but through positive actions that produce life-saving results. We must be open to whatever steps actually do work, and we must reach into all corners of American society to do so.
I know that most of you already are aware of the critical steps I will recount here, but I think it exceptionally important to put them together in a single place. To date, in my opinion, we do not yet have a fully systematic strategy to confront and defeat this major calamity.
First, we simply cannot permit the “war on drugs” to degenerate into the “war on people who use drugs." Threats from the Justice Department to get tough on drugs through lock-ups and jail time have already proven to be a dismal failure. Let’s not go there. Rather, let’s start by agreeing that opioid addiction is a terrible disease and one that is chronic and frequently relapsing. It demands immediate and effective treatment, not incarceration.
Second, we must recognize the fundamental and essential role of health insurance in providing resources for life-saving care. Both the state health insurance marketplaces and the state Medicaid expansions offer health insurance that includes coverage for substance use care that must be at parity with coverage for other health conditions. Large private plans that offer substance use care also have this same parity requirement. We need to expand such parity coverage, not contract it. There are storm clouds on the horizon, however. The “junk insurance” being promoted by the Trump administration will offer little or no benefits for substance use care. We must oppose this shallow tactic.
Third, we must move upstream and implement effective prevention strategies. We will never get ahead of this national epidemic if we focus solely on treatment. The sources of opioid addiction must be found in our communities and the generative role they play in structuring members’ social and physical determinants of health, potential life chances and well-being. Such preventive efforts must engage all sectors of government and all sectors of our communities, not just county and city substance use prevention and care programs.
Fourth, the Congressional leadership has presented us with a wonderful opportunity to make a large impact over the next two years. Up to $6 billion in new funds has been set aside for addiction and mental healthcare during 2018 and 2019. We must spend these funds very wisely. New funding mechanisms will be needed so that these funds actually can more effectively reach the counties, cities, and providers who are delivering prevention interventions and care in our communities.