The United States is facing an overwhelming opioid crisis. Millions of Americans are suffering from its addiction, and a large percentage of death from drug overdose is associated with Opioid addiction. The Opioid epidemic has a devastating impact not just to individuals, families, and the community, but it is also dragging the economy as well as annihilating national security. Fortunately, in recent years, the U.S. government has developed numerous interventions to cut both foreign and local supply of Opioids while limiting the number of prescriptions in the country. Current government administration has increased its budget allocated towards this crisis. However, despite such allocation, addiction experts believe that the epidemic is not showing anysigns of slowing down. This paper aim is to examine how the federal government is tackling the opioid crisis in the United States, and why current interventions from the federal, state and local government are not working. In order to address the opioid crisis, the current interventions must be scaled by combined efforts from all stakeholders to improve the quality of life of million Americans throughout the country.
The Opioid epidemic has evolved, starting with the increased use of prescription to treat chronic pain. The Center for Disease Control and Prevention (CDC) initially offered a guideline to maximize pain treatment option. Part of this recommendation was the use of non-opioid medication. While CDC was not the cause of the epidemic, this recommendation prompted the first wave of the outbreak in the 1990s (Bipartisan Policy Center- BPC 7). At the time, deaths related to opioid started to rise after a steep increase in opioid-combined medications used to treat pain (Dasgupta et al. 183). The second wave of the crisis started in 2010 when there was a rapid increase in death related to heroin abuse. Dasgupta et al. attributed this transformation to rising dependency and tolerance of users (184). The third phase of the crisis began in 2013, a period associated with the rapid acceleration of the epidemic. According to Jones et al., between 2013 and 2016, death attributed to fentanyl analog increased by more than 540% nationwide (15). Such an increase in the used of Opioid prompted the present administration to declare the Opioid crisis a public health emergency.
Initially, when the epidemic emerged, the primary intervention from the federal government was to deter new users, especially those who were at risk of using Opioid. Precisely, the development of new abuse deterrence method by the FDA was created, and new public standards for pain treatment were created at the Joint Commission (Jones et al. 17). In addition, efforts to develop and offer medications to treat dependence began. Among the new policies was the re-examination of the risk-benefit model with a more strict emphasis of the ramification. Before 2002, Opioid addition was receptive to treatment, and there were numerous effective treatments (Dasgupta et al. 186). Since the epidemic was declared a public health emergency, the government has worked with Health Care institutions to improve medically-assisted treatments and improve access to different treatment options for Opioid. Besides, the federal government promoted the safety of Opioid prescriptions through prescription drug monitoring programs (PDMP) (Jones et al. 18). Other approaches used include increasing collaboration with law enforcement to deter those with a high risk of using Opioid. For instance, in 2015, discussions were held between China and Mexico to stop the flow of illicit fentanyl product, and the federal government pledged to prevent the flow using law enforcement programs (BPC 9). Despite these actions, ending this epidemic or reducing the rate seems impossible.
President Trump administration has taken decisive steps aimed to combat the current opioid crisis more than any previous administration. In 2017, the presidential commission on combating Opioid crisis was developed (BPC 9). The commission aimed to analyze federal programs designed to reduce the crisis. It analyzed federal programs to determine how they could be used to curb the epidemic. The president also directed the Department of Health and Human service (HHS) and other federal governments to assist states in identifying the source of funding to address the Opioid epidemic (BPC 10). At the first wave of Opioid epidemic, the primary intervention was prevention and public awareness aimed to deter users from addiction. At the second wave, President Obama’s administration focused on awareness campaign combined with the improvement of treatment programs.
Trump’s administration has invested more on treatment to reduce the harm of the epidemic compared to previous governments. For example, his administration has increased the federal funding of Opioid epidemic by more than $4 billion in FY 2018 from $3.3 billion to $7.4 billion in FY2018 (BPC 12). In 2017, the government proposed 10 billion in new funding allocated to the HHS, which amounts to $13 billion in new funding aimed to combat the epidemic. Federal financing across the country also doubled from $10 per capita in 2017 to more than $23 per capita (BPC 16). A large portion of the allocated fund is focused on treatment, recovery, research, and supply reduction efforts. Funding specifically targeted to treatment and recovery increased by $ 1.5 billion (BPC 13). With the available funding, the HHS and the commission established by Trump administration have announced effort to curt Opioid epidemic. Some of the most recent vigorous actions involve curbing the illegal supply of Opioid supply. Unlike other administrations in the past, Trump seemed to focus more on treatment than prevention and public awareness.
Funding dedicated to curbing opioid epidemic is allocated to the federal government who then distribute the resources to various agencies across the government. The most significant portion of the funding goes to the HHS and substance abuse and mental health service administration (SAMHSA). Federal appropriation is distributed to more than 57 federal programs aimed to address the opioid epidemic (BPC, 12). In turn, these federal programs distributed the fund to various States; they allocate fund based on the need of the state or local municipalities. For instance, SOR grant from SAMHSA was allocated more than $142 million, primarily allocated to States with the highest mortality rates associated with the Opioid addiction and drug-poisoning deaths (BPC 16). Grant increased in states with increasing rates of addiction and mortality rates. Particularly, Grant allocated to West Virginia was increased from $13 to $40 per capita (BPC, 16). Similarly, federal appropriation aimed to address the epidemic is based on the programs that address treatment more than those focused on prevention. Thereby, SAMHSA received more than $3.6 compared to CDC, which focuses on prevention of Opioid (BPC 12). Funding across the states also goes to the most affected population.
The federal government uses per capita and the mortality rates when appropriating the funding to different programs. The output data from the program is used to evaluate the success of an initiative. Also, since pharmacies can monitor the history of patients and detect the abuse of Opioid drug, the government also used the data from the health care to determine if the initiative is successful. Data collected from the health system is vital given that, presently, more data around social determinant of health are collected. These social determined are outside the health care system but often drive addiction. Recent statistics indicate that although the government has made a commendable effort in combating this epidemic, there is no apparent sign that the crisis is slowing down. Precisely, recent data from Substance Abuse and Mental Health Services Administration indicates that only one in ten people with Opioid used disorder seek treatment (140). As such, given that the current strategy is focused on treatment, the initiative is not working.
Notably, the health care system and other institutions such as the justice department are not prepared to meet the increased demands that result from Opioid crisis. Therefore, additional funding is needed to combat the Opioid crisis effectively. However, the scale of this epidemic today requires government involvement combined with efforts from all stakeholders. State official and local officials are increasingly serving as integrators in current intervention strategies; they understand the situation in their jurisdictions. As such, the government needs to collaborate with these officials and explore a better way of handling this epidemic. The success does not only depend on the effective intervention from the government but also on the intercession of other areas. A strong correlation exists between addiction and economic distress, and as such, additional funding and coordinated effort from all stakeholders is needed in order to handle the current epidemic. CDC plays an important role when a crisis is declared; however, the current allocation of funds does not seem to focus on CDC. As such, the prevention of Opioid is not a focus on various programs. Thus, CDC, HHS, and other federal departments need to work together to address this crisis.
Bipartisan Policy Center- BPC, “Tracking Federal Funding to Combat the Opioid Crisis.” March 26, 2019. https://bipartisanpolicy.org/wp-content/uploads/2019/03/Tracking-Federal-Funding-to-Combat-the-Opioid-Crisis.pdf
Dasgupta, Nabarun et al. “Opioid Crisis: No Easy Fix to Its Social and Economic Determinants.” American Journal of Public Health vol. 108,2 (2018): 182-186. doi:10.2105/AJPH.2017.304187
Jones, Mark R et al. “A Brief History of the Opioid Epidemic and Strategies for Pain Medicine.” Pain and Therapy vol. 7,1 (2018): 13-21. doi:10.1007/s40122-018-0097-6
Substance Abuse and Mental Health Services Administration. “Facing addiction in America: The surgeon general’s report on alcohol, drugs, and health.” US Department of Health and Human Services, Washington, DC, 2016. https://www.ncbi.nlm.nih.gov/books/NBK424859/
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