More than 100,000 Americans died of a drug overdose last year, the second year in a row in which the death toll reached six figures. The trend is almost certain to continue. Drug overdose is the leading nonmedical cause of death in the U.S. and the leading cause outright among Americans under 50.
With the crisis growing, policymakers have taken only timid steps to respond. Marginally increasing the availability of medication-assisted treatment and providing more funding for harm reduction is, at best, a Band-Aid over a gaping wound. We need a comprehensive commitment to getting people off drugs and deterring them from starting drug use.
Accordingly, the federal government should move to expand the availability of evidence-based treatment for substance-use disorders. The Drug Enforcement Agency can make permanent pandemic-era rules permitting telehealth prescribing of buprenorphine. Congress can both confirm by statute and provide funding for mobile methadone programs, as well as encourage mobile distribution of buprenorphine. Where possible, federal health agencies—including the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Medicare and Medicaid Services—should encourage the use of longer-acting injectable or subdermal formulations that ease medication-compliance challenges. Given the high rate at which addicted people cycle through jails, Congress should prioritize funding for making all three FDA-approved addiction medications available in correctional settings.
By some estimates, as many as six in seven Americans with a substance-use disorder do not get the treatment they need. Efforts to close this “treatment gap” would benefit from federal coordination, particularly across the patchwork of state, local, and privately run treatment programs. Congress should charge SAMHSA with creating an easy resource for primary-care providers to link patients with substance-use disorders to treatment beds, even outside their local area. And SAMHSA should expand and increase the tempo of the National Survey of Substance Abuse Treatment Services so that it gives policymakers a near-real-time measure of treatment capacity nationwide.
At the same time, compulsory treatment is sometimes necessary to help a person before he takes his own life. While many states permit compelled outpatient or inpatient treatment, more evidence on efficacy is needed. Congress through statute, or the president through the Office of National Drug Control Policy, should create a blue-ribbon commission of addiction experts and physicians charged with articulating the best practices in humane, effective compulsory treatment. The Department of Health and Human Services should be tasked with studying civil commitment in application, particularly its expanded use in Massachusetts, and reporting the results to Congress.
Still, treating active addiction is no use if people continue to consume (increasingly) deadly drugs. Deterring casual drug use and more frequent consumption is of paramount importance when the risk of overdose death has risen by an order of magnitude.
Reducing drug use should start with primary prevention. Such programming is woefully underfunded, accounting for less than 6 percent of federal drug-related spending in FY 2022. Congress should invest in a nationwide public information campaign—far beyond the small steps that the DEA has taken—communicating that the drug supply is poisoned and that even casual use carries the risk of death. Given the dearth of randomized evidence on best practices in primary prevention, the National Institute on Drug Abuse should expand its research in this area.
Deterrence also means controlling the flow of deadly drugs. Precursor control—that is, of the chemicals required to manufacture such drugs—needs to be a top priority for American negotiators in bilateral and multilateral discussions with China. With Mexico, the focus should be on stepping up prosecution and disruption of drug-trafficking networks. The White House also should take aggressive steps to control the flow of drugs over the border, up to and including significantly slowing traffic or prohibiting carriers who have been found to transfer drugs over the border from returning. Domestically, the DEA should coordinate with local law enforcement to shut down open-air drug markets, reducing the availability and community harm of drugs.
Policymakers have not even begun to combat the nation’s drug crisis. They must take decisive action, and do it now—before tens of thousands more Americans lose their lives.
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