I was trying to avoid more discussions regarding the opioid crisis but we are seeing such increasing numbers of overdoses and how it is getting closer and closer to all of our lives. I just viewed an episode including a segment on an overdosed patient on the television program “Blue Bloods” and read the statistics on the increasing toll on communities and thought that we should spend more time searching for the answers.
Last week, President Donald Trump declared the opioid crisis a public health emergency — a move intended to expand access to treatment and loosen regulations to fight an ongoing epidemic of drug overdoses.
The declaration, however, doesn’t unlock significant new funding, and likely won’t be enough to solve an opioid crisis that kills tens of thousands of Americans each year. “My guess is that the states are going to feel like the resources that become available from today’s declaration, especially financial resources, are not necessarily enough to address the challenges that they’re facing,” says Lainie Rutkow, of Johns Hopkins Bloomberg School of Public Health. The declaration also falls short of what Trump had promised two months ago.
“ “WE CAN DO IT.” “
In August, the president announced that he intended to declare a national emergency on the opioid crisis but then didn’t take official action. A national emergency declaration (different from a public health emergency) would have quickly freed up federal money from the Disaster Relief Fund for states and cities to treat addiction and overdoses. That money is usually used to help states respond to natural disasters, not long-term public health crises. And the funds are “nearly exhausted” after a sweep of powerful hurricanes brought destruction to Texas, Florida, and Puerto Rico this summer, according to Reuters. So this week, the White House decided that declaring a public health emergency instead of a national emergency would be more appropriate, according to NPR. A public health emergency doesn’t give access to the Disaster Relief Fund; instead, it frees up money from the Public Health Emergency Fund, but that fund only contains $57,000, according to STAT.
Overdoses involving opioids has quadrupled since 1999, according to the US Centers for Disease Control and Prevention. In 2015, more than 52,000 people died of drug overdoses, most of them from opioids. And the number of overdose deaths keeps climbing. The opioid crisis is so bad that it’s driving down life expectancy in the US.
“This epidemic is a national health emergency,” President Trump said at a meeting today. “As Americans, we cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction, never been this way. We can be the generation that ends the opioid epidemic. We can do it.”
Trump announced a few steps the administration will be taking to fight the opioid crisis: a new policy, for instance, will waive a rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those suffering from drug addiction. The administration will also require federally employed prescribers to receive special training, in an effort to reduce the number of painkillers prescribed to patients. The government will also spearhead a “massive advertising campaign” aimed at discouraging people, especially children, from picking up drugs in the first place.
“ “I WILL BE PUSHING THE CONCEPT OF NON-ADDICTIVE PAINKILLERS.” “
The National Institutes of Health will be instructed to begin a new partnership with pharmaceutical companies to develop non-addictive painkillers, Trump said, although he didn’t specify how much money will be invested in the search for new addiction and overdose treatments. “I will be pushing the concept of non-addictive painkillers very very hard,” Trump said. “We’re going to be spending lots of money on coming up with a non-addictive solution.” Finally, Trump repeated his pledge to build a border wall with Mexico, which he claims will stop the flow of illegal drugs into the US, but experts don’t agree with him.
Today’s declaration is just the beginning: experts estimate that tens of billions of dollars are needed to truly solve the opioid epidemic in the US. And for all that money to be made available, Congress will have to step in. The Trump administration plans to work with Congress to set aside funding in a year-end spending package, according to The New York Times. But in the meantime, it’s likely that individual states will declare their own emergencies to redirect their own state-level funds to combating opioid use disorders, Rutkow tells The Verge. Six states, from Alaska to Florida to Virginia to Maryland, have already declared their own public health emergencies.
Lawmakers are also trying to stir action: this week, a group of Democrats called on the president to allow the government to negotiate lower prices for naloxone. The cost of the life-saving drug has skyrocketed in the past few years, with a naloxone injector costing $4,500, up from $690 in 2014. Making sure medications like naloxone is more accessible and more affordable, is one of the first steps that should be taken to address the opioid crisis, says Rutkow.
For now, the public health emergency designation will last only 90 days, according to CNN, but it could be extended afterward as needed.
“People are dying out here.”
As I mentioned President Donald Trump declared America’s opioid crisis a public health emergency on Thursday, after sending mixed signals on the issue for the past three months. But there’s one big thing missing: money.
Trump won’t direct any new federal money to the opioid crisis, per administration officials. The declaration will free up the federal Public Health Emergency Fund to be used to fight the drug epidemic, but Congress hasn’t replenished the fund in years. There’s just $57,000 left in it — and public health experts say that a serious response to the addiction crisis would cost $183 billion over the next decade.
For public health officials, doctors and treatment advocates on the ground in states hardest hit by the epidemic, the federal government – under both the Obama and Trump administrations – has been slow to respond to America’s deadliest drug crisis, which killed a record 64,000 Americans last year.
Trump’s Thursday declaration, though encouraging, wasn’t the decisive action that many were looking for.
“I think it was a step forward but it wasn’t the big step because it does not bring new money,” said Tym Rourke, chairman of the New Hampshire Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery and a longtime treatment advocate in the state. New Hampshire has the second highest rate of fatal drug overdoses in the nation, behind West Virginia.
There are unmet needs right now that this declaration, while welcome, does not address,” Rourke said. “If we don’t get additional resources on the ground, there is only so much positive impact we can have.”
In West Virginia, where the death toll from heroin, fentanyl, and prescription opioids is the worst in the United States, public health officials say they want help from the federal government matching the scale of the devastation they see every day.
“People are dying out here,” said Michael Brumage, executive director of the Kanawha Charleston Health Department in Charleston, West Virginia, in a recent interview. “We are having a Vietnam in America every single year from overdoses. If this is a war, why would we not apply the resources as we could?”
Brumage said he believes there’s a disconnect between government officials in Washington D.C. and people who are seeing the toll of the drug crisis play out every day in America’s communities.
“When you’re sitting in a position of power and you’re removed from the day to day misery of this epidemic, I believe it’s easy to dismiss,” Brumage said. “I think at an intellectual level they see the numbers of deaths from overdoses, but they’re abstractions because they’re figures on a piece of paper.”
“The public health hurricane of our generation”
Hard-hit states like New Hampshire and West Virginia have already had mixed experiences with the government’s response to the opioid crisis: they’ve gotten much less help than states with lower death rates.
The 21st Century Cures Act, passed last year, including $1 billion to be dispersed among states for drug treatment. The bill’s intent was for more federal money to go to states with the highest per capita drug death rates.
But after President Obama signed the bill into law, the Substance Abuse and Mental Health Services Administration changed the funding formula to take into account states with the biggest overall numbers of overdose deaths.
That meant more populous states like California, Florida, and Texas got the most money, even though their per capita death rates were much lower. New Hampshire, with the second-highest death rate in the nation, received about $6.2 million over two years. Texas, with the fourth-lowest per capita rate for drug fatalities in the US, received $27.4 million.
Michael Fraser, the executive director of the Association of State and Territorial Health Officials, called the 21st Century Cures money “the first downpayment in what’s going to be a long-term investment” fighting the crisis.
Trump’s declaration Thursday will do several things, including letting states shift federal funds dedicated for HIV to also deal with opioid addiction, allow the US Department of Health and Human Services dedicate more staff to the addiction crisis, and let patients use telemedicine to get medication-assisted treatment like methadone or buprenorphine.
Fraser says he’s optimistic the declaration will help federal agencies streamline their response to the crisis and work more efficiently with states. But it’s now up to Congress to appropriate more money to help combat the opioid epidemic.
Administration officials said Thursday that they expect Congress’s December spending bill to contain money for treatment, but gave no specific dollar amount. But any Congressional response is likely to fall far short of what some experts believe is needed to solve the crisis: close to $183 billion.
“If you’re going to actually do something, you’re going to have to put down some serious capacity building money,” said Richard G. Frank, a health economics professor at Harvard Medical School who has written extensively on the cost of treating addiction.
Every bit of money from the state and federal governments is helpful, said Gupta, the West Virginia health commissioner. Obamacare’s Medicaid expansion helped 50,000 people in the state get drug treatment, and the state received $5.8 million from the federal government this year as part of the 21st Century Cures Act.
“This is the public health hurricane of our generation,” Rourke said. “We are running against the clock.”
The epidemic goes beyond deaths
Why is the epidemic so expensive? Because while drug overdose deaths are often what gets the most attention, treatment advocates, doctors and public health officials say they are just the tip of the iceberg. The opioid crisis has turned into what Tufts University Assistant Professor Thomas Stopka called a “syndemic,” “multiple diseases feeding off each other.”
IV drug use, for example, led to rates of Hepatitis C infections tripling nationwide from 2010 to 2015. If untreated, the virus can liver cancer or cirrhosis years later; there is a cure, but it costs tens of thousands and many state Medicaid programs won’t cover it unless the patient’s liver is starting to fail.
In Kentucky, Dr. Jennifer Havens, a researcher at the University of Kentucky’s College of Medicine, says many of the drug users she sees who test positive for Hep C are young. And Havens describes the reaction she’s seen from many young drug users who test positive for Hepatitis C as “complete and utter apathy,” because drug use and disease has become a part of daily life.
“We’ve had very few people that have been upset by the news,” Havens said. “It’s kind of inevitable, and now it’s kind of endemic.”
Beyond Hepatitis C, many drug users develop abscesses and soft tissue infections from drug use. Some of these can be cleared up with antibiotics, but if infections become more serious and travel to a patient’s heart, they may need their heart valve replaced, a procedure that can cost between $100,000 to $200,000.
Then there’s the toll on children of addicted parents, including babies born dependent to drugs in the womb if their mothers are still using, and the thousands of children who have to go into foster care because their parents are dead from an overdose, or can’t take care of them due to active drug use.
“This is an epidemic like no other because it touches every fabric of society,” said Dr. Rahul Gupta, West Virginia’s state health commissioner.
A 2016 report found that prescription opioid abuse alone was costing America $78.5 billion, including $20 billion in lost productivity, $28 billion in health care costs, $21.5 billion in overdose deaths, and another $7.7 billion in criminal justice costs.“The cost is tremendous,” Gupta said. “It’s the Boeing 737 crashing every single day.”
“The cost is tremendous,” Gupta said. “It’s the Boeing 737 crashing every single day.” The U.S. opioid crisis, which President Donald Trump has declared “a public health emergency,” has ravaged some communities across the country. But it isn’t just killing people who have become addicted to these powerful pain medications and ravaging communities across the country, it’s taking a financial toll too.
When taking health-care bills, criminal justice costs and lost productivity, the opioid epidemic is costing Americans billions of dollars a year. “Nobody has seen anything like what is going on now,” Trump said in a speech this week. “As Americans, we cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction.”Opioids are killing tens of thousands of Americans every year. They include prescription pills (including Vicodin and Oxycontin), as well as heroin and fentanyl, a drug that can be injected or taken through a skin patch or as a lozenge. Last year 64,070 people died in the U.S. from opioid overdoses, even more than the number of Americans killed in the Vietnam War.
Opioids are killing tens of thousands of Americans every year. They include prescription pills (including Vicodin and Oxycontin), as well as heroin and fentanyl, a drug that can be injected or taken through a skin patch or as a lozenge. Last year 64,070 people died in the U.S. from opioid overdoses, even more than the number of Americans killed in the Vietnam War.
What is the cost of this epidemic? The cost of treating overdoses, abuse and dependence on prescription opioids alone costs American society some $78.5 billion per year, according to an analysis by the National Center for Injury Prevention and Control, published in the journal Medical Care in 2016. (Now, the costs are likely even higher, as the number of deaths each year from opioids has climbed.)
They crunched data from 2013 when some 2 million Americans met the criteria for prescription opioid abuse and dependence, and some 16,000 died from prescription opioid overdoses. In comparison, the U.S. spent $79.9 billion on the Supplemental Nutrition Assistance Program (SNAP) that same year, the researchers said.
Total spending for health care and substance abuse treatment for those abusing opioids was over $28 billion, with $26 billion being covered by insurance, they found. Patients with untreated opioid use disorders tend to incur $18,000 more in health-care costs annually than those without such a disorder, according to a 2011 study in the American Journal of Pharmacy Benefits.
One study from the Beth Israel Deaconess Medical Center in Boston found that the average cost of treating an opioid overdose victim in intensive care units jumped 58% between 2009 and 2015. As the addiction persists, patients arrive in a worse condition and require longer stays. In 2015, average cost among 162 academic hospitals was $92,400 per patient in intensive care.
The U.S. spent nearly $8 billion on criminal justice-related costs due to selling and consuming opioids, which was almost entirely a cost to state and local governments, according to the 2015 National Center for Injury Prevention and Control study published in the journal Medical Care. Worse, the recidivism rate for drug addicts is around 45% within three years of prison release.
The cost in lost productivity is about $20 billion, the 2015 study found. Some seven in 10 employers have felt some effect of prescription drug usage among their employees, including absenteeism or decreased job performance, according to the National Safety Council, a nonprofit based in Illinois. And fatal overdoses cost nearly $22 billion in health care and lost productivity costs.
Of course, these are just the costs researchers can actually measure, said Curtis Florence, one of the authors of the study published in Medical Care. It doesn’t even begin to touch the impact on quality of life or pain endured by those affected. As Trump said Thursday: “No part of our society, not young or old, rich or poor, urban or rural, has been spared this plague of drug addiction.”
Paige Winfield Cunningham explored the prognosis and possible solutions. What is the prognosis? There’s a quick and simple way President Trump could immediately help Americans addicted to opioids.
Here it is: allow Medicaid to start paying for treatment at large institutions for mental disease (known as IMDs). Under a current policy is known as the “IMD exclusion,” people on Medicaid can’t get substance abuse treatment at facilities with more than 16 beds.
This policy shift isn’t explicitly part of the emergency declaration Trump issued yesterday at the White House, but the president did make a brief mention of it in his address.
“As part of this emergency response, we will announce a new policy to overcome a restrictive 1970s-era rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those suffering from drug addiction,” Trump said. Treatment advocates, governors and medical providers have lobbied heavily to remove this exclusion, which has been in place since the Medicaid program was created half a century ago. Back then, there was a big push to deinstitutionalize mental-health patients in favor of integrating them into communities.
But now — as the nation grapples with an opioid abuse crisis that claims the lives of around 100 people every day — the overriding concern is how to help these patients break from their addictions, which often requires 24-hour monitoring over a period of several weeks, rendering residential settings crucial to the overall effort.
Trump’s opioid commission, led by New Jersey Gov. Chris Christie (R), identified removing the IMD exclusion as the top way to make treatment available to patients immediately. “This is the single fastest way to increase treatment availability across the nation,” the report said.
Yesterday, the president declared opioid abuse a public health emergency — a move that allows the federal government to more quickly direct resources toward the effort by giving states more flexibility in how they use federal funds and expanding the use of telemedicine treatment, my colleagues Jenna Johnson and John Wagner reported.
“Addressing it will require all of our efforts, and it will require us to confront the crisis in all of its real complexity,” Trump said during a speech in the East Room of the White House. “As Americans, we cannot allow this to continue. It is time to liberate our communities from the scourge.” But “liberating” residential facilities from Medicaid’s bed limits is, to the people who run them, a no-brainer way to combat the opioid abuse epidemic. Even before the Affordable Care Act expanded Medicaid, the federal health insurance program for the poor was the country’s single largest source of coverage for those with substance abuse disorders. For example, the Gateway Foundation, which bills itself as the country’s largest nonprofit provider of addiction treatment, could treat opioid abusers at its chain of clinics across Illinois and Delaware if the exclusion were lifted. Right now, none of its 43 clinics meet the bed limitations; its smallest center has 44 beds and its largest has 125 beds. “The type of person who needs to go residential is too sick to do [treatment] in the community,” the group’s president, Tom Britton, told me.
Trump couldn’t erase the exclusion because it’s written into law. But he could direct the Department of Health and Human Services to issue all 50 states waivers from it. West Virginia obtained just such a waiver this month, and New Jersey, Illinois, Indiana, Kentucky, and Michigan are still awaiting word on their applications. Of course, Congress could also vote to repeal the IMD exclusion — although the Congressional Budget Office has estimated it would cost an additional $40 billion to $60 billion over a decade. A bipartisan group of eight senators — led by Sen. Dick Durbin (D-Ill.) introduced legislation in May that would somewhat ease it by raising the 16-bed limit to a 40-bed limit.
“By maximizing Medicaid coverage gains and offering treatment for people suffering from addiction — rather than simply arresting them or turning them away from help — we can reduce crime, save money, improve health, and save lives,” the senators wrote.
But we still don’t understand the true problem and we just throw money at the “problem”. As long as the opioids are so inexpensive and the police can’t do their job this epidemic and will continue “suck” millions and billions to control this crisis and probably spread to Europe. Oh, and why is this epidemic such a problem in the U.S.A.?
Is the problem really the result of pharmaceutical companies pushing the use of string narcotics and the to have the physicians of this country responsible for 82% of addictions. I’m not sure that I believe this theory. Excuses???
We might want to look more carefully at this epidemic, the history, and other possible solutions.