BOSTON — Among the records set over the past difficult year is the one for drug overdose deaths. Such deaths had been increasing before COVID-19 hit, but the latest numbers suggest that the pandemic made the problem worse: Isolation, depression, anxiety, job loss and disruptions to state budgets for services have had a devastating impact. Over 81,000 drug overdose deaths occurred in the United States in the year ending May 30, 2020 — the highest number ever recorded for any 12-month period. (In Cuyahoga County, the 69 suspected overdose deaths for March this year put the county on pace to eclipse its 2017 record of 727 overdose deaths.)
Hope — and a new challenge — is arriving with large sums of new money. The American Rescue Plan, the $1.9 trillion federal government response to the pandemic, increases block grants to state and local governments by $3 billion to address substance use disorders and mental illness, plus additional funding for workforce education and community services in behavioral health. The prior relief package and appropriations bill directed over $4 billion to most of those areas, not to mention the billions that might flow to the states from litigation against prescription opioid manufacturers and distributors. Together these monies raise federal spending in this area by around 25%.
Such a flood of cash is double-edged. It is a once-in-a-generation opportunity to improve our response to substance use disorders, but it also challenges us to spend the money wisely. It is vital that these new funds go towards evidence-based care. But federal guidelines can’t possibly account for the diversity of American communities in their needs, values, health care infrastructure, and resources.
That means state and local policymakers will have considerable discretion over where these dollars go. How can we be sure that so many decision-makers facing many different situations will be able to figure out how to get the best results possible for them?
They — and American taxpayers — face the classic dangers of spending on ineffective care, of reinventing the wheel, and of trade-offs among competing approaches and organizations. Around 70% of overdoses involve misuse of opioids like prescription painkillers, fentanyl and heroin, according to the federal Centers for Disease Control and Prevention, but other substance abuse needs attention as well.
The good news is that solutions are out there. More than 50 organizations combating addiction have endorsed guiding principles to ensure that money spent will save the most lives. An interdisciplinary team of experts has compiled a menu of proven interventions. This collection, entitled “Evidence-Based Strategies for Abatement of Harm from the Opioid Epidemic,” offers an array of potential actions and their costs that can be any community’s first step.
Policymakers will have myriad choices, and the report suggests some of the right questions to ask about the three big issues: prevention, treatments and costs. Is there existing capacity to deliver interventions that work, such as providers of medically assisted treatments? Are first responders like police and sheriffs educated and willing to initiate interventions that can prevent fatal overdoses? And are there ways to augment existing community resources such as syringe exchange programs or supportive care through homeless shelters?
With an eye to helping affected families, the report offers evidence for effective and affordable approaches to the full range of conditions facing our diverse communities. The compilation highlights the ways various types of care fit into different contexts, such as criminal justice settings or primary health care facilities, as well as how a state’s political, financial and infrastructure circumstances may make some packages of programs more practical than others.
The arrival of new funds offers a unique opportunity to begin a transformation of our approach to the persistent and vexing problem of addiction. The challenge is to invest in what works for the communities ravaged by the opioid epidemic. The evidence to guide a response is available, and policymakers must use it to make their decisions count.
Richard Frank is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School. This was written for The Plain Dealer and cleveland.com.