In 1999, there were just under 20,000 fatal overdoses. Now, overdose deaths are five times higher—over 100,000 in the 12 months ending May 2021, according to the CDC’s most recent, tragically delayed, data.
As a member of the 2017 President’s Commission on Combating Drug Addiction and the Opioid Crisis and a national addiction recovery advocate who worked hard to elect the Biden/Harris ticket, respectively, we had front-row seats to the Trump administration’s failure to properly address this crisis. When Joe Biden took office, our hopes were high. But nearly a year after the administration change, things have not improved. Not by a long shot.
What we’re lacking is a strategic coordinated response across the federal government that doesn’t just tout small incremental changes as “progress.” Biden must urgently set ambitious goals to reverse the trend of fatal overdoses, invoke every power of the executive branch, and use a powerful bully pulpit to drive change. A new strategy should focus on four key areas.
The first is emergency actions and declarations. Our streets are being flooded with a poisoned drug supply. Consequently, President Biden and his administration should also be flooding streets with needed overdose response resources and taking aggressive action to shut down illicit fentanyl mills here at home and abroad.
While the Trump administration declared a Public Health Emergency for opioids (which has since been renewed multiple times), prior to COVID-19, the Public Health Emergency Fund had almost no resources the federal government could use to fund a response. Now, however, the fund has significant resources the Biden administration could swiftly utilize. Leaders should also broaden this declaration to apply to, at minimum, all substance use disorders, given that the overdose crisis extends well beyond opioids. We would recommend expanding the emergency to all mental health and substance use disorders, due to very high comorbidity rates and the devastating mental health crisis currently facing our youth.
The most powerful tool would be triggering emergency declarations for states under the Stafford Disaster Relief and Emergency Assistance Act, an action that was recommended to President Trump by the Opioid Commission in 2017. Though the Act has historically been summoned for natural disasters, its authority has also been used to great effect during the pandemic. In fact, FEMA has already provided tens of billions of dollars of emergency COVID aid to states. These same mechanisms could be used to immediately get money to state and local governments to respond to the overdose crisis with fentanyl test strips, sterile syringe programs, mobile crisis response teams, recovery community and harm reduction organizations, and more.
President Biden should also facilitate naloxone in all public places—just like first aid kits and AEDs—and press the FDA to make the drug available over the counter. After all, the agency expressed support for doing this nearly three years ago.
The second focus area must be insurance parity for mental health and substance use disorders. It is essential that we decrease our reliance on short-term, band-aid “solutions” and think big picture. Case in point: the recently announced “unprecedented” harm reduction grant program to “address the nation’s substance use and overdose epidemic.” The program only offers $30 million to be distributed over three years—nowhere near what it would take to truly address a public health crisis of this magnitude.
We don’t rely on cumbersome grant programs to treat cancer or COVID-19. Instead, we make sure our health care financing systems reimburse for providing needed treatment services. For mental health and addiction, this means fully enforcing the Mental Health Parity and Addiction Equity Act of 2008 to eliminate wrongful denials of coverage that too often stop people from getting help. Labor Secretary Marty Walsh has been taking aggressive action to do just that in employer-sponsored plans. We look forward to the administration following suit for Medicaid and marketplace plans, which disproportionately cover individuals at higher risk of overdose.
The third focus area must be increasing access to medication-assisted treatment (MAT). While the administration has taken steps to loosen a requirement that limits the prescribing of buprenorphine, a lifesaving medication to treat opioid addiction, the president has not forcefully declared his support for bills in Congress to eliminate the requirement entirely—despite campaign promises.
The fourth and final focus area must be strong leadership at the federal level. The president should take decisive action to cut across agency siloes, pressure Congress to make necessary statutory changes, and guide state and local governments.
We desperately need a primetime address on mental health and addiction—and a firm personal commitment to take charge. When the overdose death rate crossed 100,000 for the first time in November, Biden missed a critical opportunity by only issuing a written statement.
The administration must also walk the talk when it comes to public health updates and the dissemination of information. Dr. Anthony Fauci should be discussing the mental health and addiction fallout from COVID-19 on a regular basis, and mental health experts such as Dr. Raul Gupta, director of the Office of National Drug Control Policy, should be known to the American public. Visibility matters.
Every day that passes, we sacrifice more and more Americans to the highly treatable brain disease of addiction. Too many families are burying their loved ones due to a lack of a coordinated response from our elected leaders. The roadmap to confront this crisis is clear. President Biden, we implore you to use it.
Former U.S. Rep. Patrick J. Kennedy, founder of The Kennedy Forum, was lead author of the Mental Health Parity and Addiction Equity Act. He currently co-chairs the National Action Alliance for Suicide Prevention’s Mental Health & Suicide Prevention National Response to COVID-19 (National Response) and the Bipartisan Policy Center’s Behavioral Health Integration Task Force. Ryan Hampton is a nationally recognized recovery advocate, community organizer, and person in long-term recovery from addiction. He is the author of “Unsettled: How the Purdue Pharma Bankruptcy Failed the Victims of the American Overdose Crisis.”