Opinion | The U.S. is facing its worst addiction crisis ever. Biden must step up his response. – The Washington Post

The United States is facing its worst addiction crisis in history — far worse than it’s ever seen before. That’s the takeaway from a recent report from the Commonwealth Fund, which shows a massive increase in overdoses last year. Overall, overdose deaths last year likely surpassed 90,000. By contrast, 2019 — the previous worst year on record — had 70,630 deaths.
The Biden administration is not ignoring the epidemic. Just this month, the White House released a report listing its priorities for drug policy, including ramping up addiction treatment drugs, increasing access to health care and exploring harm-reduction tactics, such as controversial needle-exchange programs that make sure people with addiction disorders are using sterile syringes. It’s also managed to get some funding to battle addiction in its rescue plan and in its budget proposal.
It’s a great start, but it’s not enough. Worse, the administration has missed some crucial opportunities to signal that it will give the crisis the attention it deserves as President Biden juggles fighting the pandemic with his other policy goals.
Let’s start with funding. The administration included nearly $4 billion in the American Rescue Plan for substance use and mental health programs, and it has proposed $10.7 billion in its budget to combat the opioid crisis, an increase from 2021 of $3.9 billion.
This is legitimately good. Still, the achievement is diminished by the fact that it’s far short of the $125 billion Biden promised during his campaign to combat addiction. That’s the scale of funding advocates have been saying for years is needed to seriously address the issue.
Given that Biden is so willing to push trillion-dollar spending sprees through Congress, why wasn’t that included in his rescue plan? The addiction crisis is a pandemic issue. The current surge in overdoses predates covid-19, but lockdowns, isolation and mass unemployment have exacerbated the addiction crisis to dramatic levels. If any people are in need of rescuing from pandemic restrictions, it is those suffering from addiction.
More important than funding is crafting policy that would expand access to treatment drugs, such as methadone and buprenorphine, that can stave off the withdrawal effects of opioid addiction. Such treatment is the gold standard for addressing opioid use disorder, which is driving the epidemic, but the vast majority of people who need it don’t have access to it, and most physicians eligible to prescribe those drugs aren’t able to because of federal drug-control regulations.
On this front, the administration has actually taken a step backward. It nixed a last-minute policy from the Trump administration that would have helped to expand access to addiction treatment. The policy, widely applauded by health experts, would have exempted physicians from an onerous training requirement, known as the X waiver, that would allow them to prescribe buprenorphine for those with opioid use disorder.
White House sources told The Post in January that the administration never opposed the Trump policy; it only killed the measure because it had failed to get the necessary clearance from the White House budget office, among other legal and operational hurdles. So the overwhelmingly popular measure has been sitting in limbo for months.
In response to a question on where the policy currently stands, the White House’s Office of National Drug Control Policy didn’t offer much clarity. The office is “working with the White House and federal partner agencies on the best way to remove barriers to access” for addiction treatment, said spokesman Alex Barriger. He noted that “the X waiver is an important piece of expanding treatment,” but stressed that the administration is seeking to expand other treatments beyond buprenorphine, including methadone.
Perhaps the ONDCP would have more freedom to offer more straightforward answers if it had a confirmed director. But that position remains unfilled. In fact, Biden chose not to elevate the “drug czar” position to Cabinet level, as was the case before President Barack Obama demoted it.
This isn’t to criticize the office’s acting director, Regina LaBelle, who gets high marks among addiction advocates. But Biden projected that he’s taking public health issues seriously by staffing up his covid-19 response team quickly. That he hasn’t done the same for the surge in addictions lends to the appearance that he views the overdose crisis as a side issue.
Reasonable people might conclude that it is a side issue; after all, there are so many problems to solve as the country recovers. But such a mind-set is particularly frustrating because that’s essentially how the Obama administration approached the overdose crisis. The mounting deaths and exploding opioid industry were largely ignored until it was too late.
The Trump administration gave much lip service to addressing overdoses; its failure to actually address them is evident in today’s death toll. Biden, given his own family’s history with addiction, is the perfect person to finally change the federal government’s course. He should get on with it already.
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