The Opioid Epidemic in 2018: Where Do We Go from Here?

By Ian Goldstein, Government Affairs Specialist, NACCHO

The Centers for Disease Control and Prevention (CDC) estimates that 91 people die daily due to an opioid overdose. The Trump Administration has declared curbing the opioid epidemic a major priority. In March 2017, the White House created the Commission on Combating Drug Addiction and the Opioid Epidemic, headed by New Jersey Governor Chris Christie. The President proclaimed a public health emergency in late October 2017, however, such a declaration does not allocate any additional funding towards efforts to control the epidemic. On November 1, 2017, the Commission sent a report to the President with 56 recommendations the Administration can take to combat the growing opioid crisis. Some of those recommendations include an expanded drug court system, educational requirements for prescribers, and a media blitz to spread the word about preventive services and treatment availability for substance use disorder. Moreover, the Administration’s Council of Economic Advisors now puts the cost of the epidemic at $504 billion.

In 2016, Congress passed two major pieces of legislation. The 21st Century Cures Act and the Comprehensive Addiction and Recovery Act (CARA) allowed appropriations of roughly $1 billion in FY2017 to fight the epidemic. The funds appropriated to the Substance Abuse and Mental Health Administration (SAMHSA) were made available through the State Targeted Response to the Opioid Crisis Grants, and provided up to $970 million to states and territories for two years, beginning in fiscal year 2017. CDC received almost no additional funding through this legislation but receives $112 million currently through the annual appropriations process to work with the health care and public health systems to track the epidemic and implement prevention strategies.

NACCHO is focused on assisting local health departments battling the opioid epidemic by providing critical resources to localities hardest hit by the epidemic. NACCHO provides financial resources via sub awards, and technical assistance to local jurisdictions to build community capacity for harm reduction. NACCHO government affairs staff continue to educate elected officials about opioids and connect them with local health departments.

Estimates show that current funding of $1 billion is just a tiny fraction of what is needed. For comparison purposes, at the height of the AIDS epidemic in 1995, the US was spending $20-25 billion a year (today’s dollars) to combat the epidemic. Congress has held countless hearings; and public health organizations such as NACCHO have hosted briefings to educate Members of Congress. Local health departments continue to be on the front lines of this issue, responding to infectious disease outbreaks associated with the epidemic, as well as ensuring first responders have naloxone to reduce overdose deaths. I have personally been to over 50 meetings this year with congressional staff on this issue. The time for hearings and reports is over. The time for action is now.

In 2018, Congress and the Administration must begin to implement the recommendations of the Commission report, and follow the recommendations of dozens of witnesses that have appeared before Congress. Most importantly, the opioid epidemic needs increased funding through an emergency supplemental. In 2018, Congress must begin to focus on policy changes around the use of opioids and its consequences to infectious disease rates, and its impact on the workforce. The labor force in the United States continues to suffer due to the opioid epidemic. The cost in lost productivity was about $20 billion in 2015[1], and seven in 10 employers said they have felt effects in their workforce through absenteeism, positive drug tests, or decreased job performance.

Local health departments help to protect the public’s health through syndromic surveillance and cooperation with hospitals and medical first responders to gather data about the opioid crisis in their community. A robust health IT infrastructure in every state will allow for health departments and officials to track trends in the opioid crisis and help contain infectious disease outbreaks. Local health departments need additional funds to make sure they can engage in partnership efforts, educate the public and stop overdose deaths in their communities.

Infectious diseases such as Hepatitis B and C, and HIV have risen dramatically in the last five years due to intravenous drug use. Syringe Service Programs (SSP) are a proven effective way for local health departments to contain these outbreaks. Currently, the federal government can fund aspects of SSPs based on evidence of a demonstrated need, but are prohibited from purchasing sterile needles. The Administration and Congress must lift the federal ban on purchasing syringes for SSPs that have proven to be effective in spreading the outbreak of infectious disease.

Until emergency supplemental funding is provided by the Administration and Congress, the country will continue to have staggering overdose deaths and infectious disease outbreaks. A hypothetical job creation boom due to corporate tax cuts could benefit this country if there were workers ready and able to fill these jobs. Until we make the investment in these programs, those out of the workforce will continue to fail drug tests and in turn stay out of the labor force. Rep. Elijah Cummings (D-MD) recently summed it up best when he said, “We cannot fight this epidemic without funds equal to the challenges we face.” NACCHO and local health departments will continue to push policymakers to invest in public health so that the dedicated professionals in the field are up to the challenge.

Take action now! Go to NACCHO’s website to learn what you can do: https://www.naccho.org/advocacy

[1] http://www.nsc.org/NewsDocuments/2017/Media-Briefing-National-Employer-Drug-Survey-Results.pdf