The 118th Congress has clearly signaled its commitment to addressing the growing availability of illicitly manufactured fentanyl in the United States. Already, the House Energy and Commerce Health Subcommittee held a roundtable and a hearing on the topic.
With overdose deaths in the U.S. surpassing 100,000 in 2021, primarily driven by illicit fentanyl, the stakes could not be higher. While the mood on the Hill appears prime for partisan posturing, the shared interest in saving lives calls for finding common ground. After the successful inclusion of significant addiction-related legislation in the 2022 end-of-year omnibus spending bill, more can be done to pursue real solutions that will decrease overdose deaths and curb international drug trafficking networks.
As the former acting director of the Office of National Drug Control Policy in the Biden administration, I believe bipartisan action can be taken to curb overdose deaths and improve the nation’s approach to substance use disorder. This bipartisan approach would have three prongs: expand quality treatment, invest in mental health care, and disrupt international criminal networks.
Invest in quality treatment: The omnibus legislation, signed into law by President Biden in December, contains provisions that will reduce unnecessary barriers to substance use disorder treatment. The bill included a provision that removes onerous training requirements for buprenorphine prescribing; one of three FDA-approved medications to treat opioid use disorder. This provision, coupled with the recently proposed rule that will increase access to methadone treatment, will increase the chance that individuals in need of treatment will get it.
Reducing barriers to quality care will help close the treatment gap, a gap that remains at 94 percent. However, stigma, racial inequities and other barriers to quality care remain. Congress can take additional steps, including amending the “inmate exclusion” that limits the use of federal Medicaid funds during incarceration. An estimated 65 percent of individuals who are incarcerated have a substance use disorder. Therefore, limiting Medicaid funding for health care during incarceration is not only unconscionable, it also does not make economic sense.
Improving mental health care access: We have recently seen startling increases in overdose death in the adolescent population, even while substance use among adolescents has remained stable. These increases in adolescent overdose deaths stem from the availability of illicit fentanyl. This comes at a time when the latest National Survey on Drug Use and Health highlights that 1 in 5 adolescents had a major depressive episode in the last year. There is an urgent call for us to look after our youth to make sure the early signs of mental health concerns are recognized and to get the support they need. This will take federal funding, as well as parents, schools and communities working together to identify mental health concerns, monitor social media and prioritize the mental health of our young people.
Illicit Finance, Reducing Corruption and Supporting Democracy: Lastly, there are steps that we as a nation can take, together with our international partners, to disrupt drug trafficking networks. These actions go beyond the border of the U.S. and Mexico — tackling international criminal networks is essential to a functioning society. Taking steps to reduce money laundering and illicit finance practices by freezing assets and other enforcement actions will help stem the fuel that drives transnational criminal organizations. The Biden administration took steps to advance efforts to address money laundering through a 2021 executive order. This executive order was just one part of the U.S. Treasury Department’s overall efforts to counter illicit finance. The U.S. must work together with its international partners to counter this growing issue.
As with many public health issues, this is a complex, multi-faceted challenge to our nation that calls for serious policy solutions. The 117th Congress took significant steps forward by expanding access to treatment for substance use disorder in the omnibus spending bill. This Congress also has an opportunity to build on those responses in a bipartisan way, and implement policies that will make a difference in this national concern.
Regina LaBelle is the Director of the Addiction and Public Policy Initiative at Georgetown University Law Center’s O’Neill Institute. LaBelle also directs and teaches in the Addiction Policy and Practice Master of Science program at Georgetown University’s Graduate School of Arts & Sciences.