The current global health crisis has presented a complex set of intersecting challenges unlike any witnessed in the history of humankind. COVID-19 has shaken the pillars of our humanity and, in the United States, tested the boundaries of our political landscape as deep divisions about how best to mitigate the spread of the virus and provide economic relief lay in stark contrast.
Today, despite mask mandates, restrictions on social gatherings, and varying degrees of isolation ‒ both voluntary and involuntary ‒ for a number of individuals in many U.S. cities, an average of 1,133 Americans will lose their lives to COVID-19.
And today, according to data from the Centers for Disease Control and Prevention, an additional 220 Americans will also lose their lives due to an opioid overdose.
To put the current number of deaths by opioid overdose into perspective, a report on substance use amid COVID-19 indicates that opioid overdoses in the U.S. increased by 42% in May 2020 when compared to May 2019. Additionally, the American Medical Association reports that over 40 states have experienced higher rates of opioid overdoses resulting in death than before the onset of the pandemic.
So out of the COVID-19 pandemic, an opioid epidemic in our country has re-emerged with a vengeance ‒ one that data tells us has been raging for quite some time but seems to be progressively worse in light of the virus.
Now almost a year into the pandemic most individuals are aware of, or more likely have had firsthand experience with, the complex set of challenges born directly out of COVID-19, including isolation, loss of loved ones, economic hardship and loss of income, food insecurity, anxiety surrounding the future, improper medical care, loss of freedoms and so forth.
Data indicates that the intersecting challenges of COVID-19 have had profound impacts on our mental health. Case in point, a U.S. Census Bureau survey found that more than 42% of respondents reported feeling anxious or depressed in December 2020, a near-quadrupling from 11% the previous year. Outside of COVID-19, 2020 also saw Americans head to the polls in a federal election fraught with historic levels of division and tension, as well as an assortment of natural disasters with devastating impacts from coast to coast ‒ both events likely playing a role in the very make-up of these statistics.
What’s more, a survey from the National Council for Behavioral Health suggests that 52% of behavioral health organizations have seen an increase in demand for their services during the pandemic, further underlining the erosion of mental health across the board. At the very least, this statistic indicates that individuals are reaching out for help.
But opportunities to receive help are compromised in some areas. Fifty-four percent of organizations surveyed have ceased offering their behavioral health programs due to financial strains and/or limits on their capacity to deliver appropriate care. That statistic doesn’t even account for areas of the country, particularly rural towns and counties, that faced a shortage of mental health professionals and services to begin with, and lack broadband service that would make telemedicine connections possible.
These troubling statistics paint a picture not only of a population overwhelmed with mental health concerns, but a mental health system and structure that may not be positioned to sustain the ever-growing need for support. In some instances, individuals may be left up to their own devices to handle mental health difficulties and have turned to alcohol and drugs, particularly opioids, as a coping mechanism. In even more dire circumstances, individuals have turned to suicide.
It’s important to note that mental health difficulties do not automatically equate to substance use. Instead, we know that the relationship between mental health and substance use paves something of a two-way street, with the possibility of mental health difficulties contributing to substance use or substance use contributing to the development of mental health difficulties. Regardless of which side of that street an individual may find themself, the current opioid epidemic underscores the dire mental health impact that COVID-19 has had on Americans and, perhaps more importantly, that the situation must be addressed.
The good news is that despite the seemingly overwhelming nature of the situation and statistics, COVID-19 has highlighted a number of key areas where there are viable policy options to address the opioid epidemic and has presented opportunities for elected leadership on the state and federal levels to do so.
One of the most crucial, though sometimes overlooked, steps in addressing the pandemic is to weigh the impact that it has had on our mental health and the role it plays in the use of opioids. After all, we have found ourselves in a situation where we are essentially faced with weighing life versus life. We know that thousands of Americans are tragically dying of COVID-19, but various efforts to mitigate the spread, as well intentioned as some may be, have created additional situations that may also put Americans’ lives at risk.
Limiting non-COVID-19 related medical services has prevented individuals from receiving the care they need and has put some at risk. Isolation has prompted some to turn to dangerous levels of drinking, and as explored above, drug use. The shutdown or slowdown of industries and markets has resulted in an increase of suicides. Take, for example, agriculture. That industry has been hit particularly hard. According to the U.S. Centers for Disease Control and Prevention, farmers are experiencing 1.5 times higher rates of suicide than the national average.
The intention is not to turn this into a discussion about which mitigation strategies in some states are or are not preferable to others. Instead it is to simply highlight the fact that the situation we face is larger than COVID-19 on its own. Therefore, our response must also be larger than simply mitigating the spread of the virus.
American leadership should enact policy that works to rectify all of the crises born out of or made worse by COVID-19, including the opioid epidemic. If leadership is to truly “heal the nation,” which so many on both sides of the aisle insist they want to do, then their approach must be all-encompassing and unrestrictive. That means combating the opioid epidemic before it gets even worse, which it undoubtedly will if left unaddressed.
But what exactly can and should political leadership do? Several states have already started laying out a blueprint for how best to combat opioid use and other states would be wise to follow in their lead.
One effective method of preventing opioid overdose is to co-prescribe a drug known as naloxone with all opioid prescriptions, as is already required in seven states. Naloxone is unique in that it has a 75-100% efficacy in blocking or reversing the fatal effects of an opioid overdose. It does so by reversing the respiration of individuals who experience extremely delayed breathing or have stopped breathing altogether due to ingesting a lethal amount of prescription opioid pain medications.
All 50 states now have at least one law that expands access to naloxone, but each with varying degrees of efficacy to ensure that those who need it will have immediate access to it.
As states find themselves in the early stages of their legislative sessions, they should look to the precedent set by states that have a mandatory co-prescription plan currently in place, or follow the lead of California and Ohio where providing the option of a co-prescription is required for those who may want or feel they need it. Naloxone doesn’t come without the possibility of mild side effects and may even cause withdrawal. But those are both small prices to pay compared to the life-threatening nature of an opioid overdose.
Providing naloxone to those who take opioid pain medications is perhaps one of the most effective ways that we can prevent death by opioid overdose, though admittedly it does not prevent individuals from taking non-prescribed doses of opioids in the first place.
Beyond this, or at a bare minimum, states should ensure that naloxone is widely available to healthcare facilities and pharmacies, particularly in rural areas; an effective and comprehensive distribution plan is in place and that individuals are aware of its availability and uses, as studies have shown that awareness surrounding a state’s naloxone access laws have made individuals more likely to call 9-1-1 if they witness an overdose.
Federal and state governments, which have reached settlements with some opioid manufacturers and marketers, also must continue to hold companies accountable for their pervasive role in the opioid epidemic. Their early actions to distort the facts and mislead the medical community and the public about opioids’ dangers lit the fuse on this explosive epidemic and must not be forgotten.
Since the 1990s, manufacturers have launched mass marketing campaigns to downplay the addictive nature of opioids, paid medical professionals large sums to promote false claims to their peers and the public, and even sidestepped clinical trials to fast track Food and Drug Administration approval.
The culpability of opioid manufacturers has recently been at the forefront of public health litigation and made headlines as states rush to sue opioid manufacturers in a belated response to the epidemic. This month, high-profile consulting firm McKinsey & Company, which counts many drug companies among its clients, settled lawsuits for $573 million with 49 states for consulting practices that “turbocharged” the epidemic and for which the firm now claims to “deeply regret.”
Most states are putting the settlement money towards opioid education, prevention and treatment programs. These appropriations are especially important to deliver desperately needed opioid treatment services as the pandemic delivers a one-two body blow to states by slashing tax revenues while increasing expenditures.
While these lawsuits are a step in the right direction in holding opioid manufacturers accountable, they are a long-overdue reaction to a situation that was several decades in the making because of apparent governmental indifference. These suits should serve as a lesson that sparks lawmakers to develop proactive policy rather than a cause for state and federal officials’ self-congratulations.
Besides suing manufacturers for damages, states such as Maine now require opioid manufacturers to pay a licensing fee for doing business within the state, as well as an additional registration fee for large manufacturers. These new requirements allow for increased oversight of drugs and drug companies, while the fees, like compensation from settlements, are also put toward opioid education, prevention and treatment programs within the state. It also holds drug companies accountable, to an extent, for adverse effects their products create.
Federal leaders must also ensure that appropriate financial provisions for mental health and substance use are included in whichever version of the COVID-19 relief bill receives final approval and are included in any future packages. Currently, the Biden Administration’s $1.9 trillion COVID-19 relief bill includes a request that Congress appropriate $4 billion for mental health and substance abuse services. This portion of the proposal has received broad support from both Democrats and Republicans alike and will, presumably, be included in the final package.
This provision is a sufficient and critical first step. But alone it is simply not enough.
Ending the opioid crisis and expanding access to substance education, prevention and treatment was a key platform on which President Biden ran during his 2020 campaign. President Biden also has a fairly thorough plan laid out on his website for how his administration intends to combat the opioid epidemic. That plan includes a diverse range of policies, including an end to tax breaks for pharmaceutical companies on advertisement spending, and demanding that drug companies charge fair prices for overdose drugs like Naloxone. Fair pricing would allow for expanded access and prevent insurance companies from blocking access to medication-assisted treatment (MAT), a method that is considered by many to be the “gold standard” in opioid addiction treatment.
Since his inauguration, Americans have seen President Biden begin to lay the groundwork for much of his policy initiatives and outline his plans to confront the myriad of crises that Americans are currently facing. But outside of the inclusion of substance and opioid use provisions included in the COVID-19 relief bill, there has been little to no movement on enacting the President’s comprehensive plan to combat the opioid epidemic. Unsurprisingly, the president has received criticism for what some consider to be a glaring oversight in the initial days of his administration.
But, it is still early and we cannot expect that any new president, regardless of party, will be able to address every crisis a country faces at any given moment in a matter of mere weeks. This is even more true when one considers the sheer number of simultaneous crises that Americans currently face.
Furthermore, the federal government’s structure is cumbersome and rarely moves at the speed most would prefer. All of this should be taken into consideration when analyzing the speed of policy being carried surrounding the opioid epidemic or, quite frankly, any policy.
Still, we know that the coming months will be crucial in the effort to combat an opioid epidemic that many Americans have thought is already in the rear-view mirror. The actions taken by administration officials in the next few months will determine their level of seriousness in addressing the opioid epidemic in their policy initiatives.
Addressing this crisis simply cannot be relegated to the back half of the Biden presidency. In fairness, President Biden likely knows as much. Based on what the president himself has indicated and the policy points provided on his website, there should be real hope and optimism from the American people that timely action will occur.
The public has demanded action for far too long and that demand has only become justifiably heightened in the midst of the pandemic. The political leadership we trust to represent us must act on the demands of the American people and use their platforms to help end the opioid epidemic once and for all. It is possible.
Precedents have been set. What is required now is for leadership to act and to do so quickly.