How is Congress handling opioids? We followed the money

Nearly 50,000 people died from an opioid overdose in 2017. Today, Americans are more likely to die from opioid overdoses than car accidents. While the United States is beginning to see a few positive signs that overdose deaths are leveling off, this doesn’t mean we’re even close to ending the epidemic.

Untreated opioid use disorder has numerous consequences, including neonatal abstinence syndrome, the spread of infectious diseases and family separations. These consequences will be with us for years to come. So too should federal investments to address the epidemic, and they should be transparent to policymakers and the public.

Imagine trying to build a national treatment support system almost from scratch. How much would it cost? A billion dollars? Ten billion dollars? To put things in perspective, only 10 percent of people with a substance use disorder, and only 30 percent of those who specifically have an opioid use disorder, receive treatment. This shows we are far from closing the gap. While a precise dollar figure has not yet been determined, Congress has begun to invest in programs to build a treatment system to address the epidemic.

Over the past six months, the Bipartisan Policy Center analyzed the congressionally appropriated opioid funding distributed to states in fiscal years 2017 and 2018. We also took a closer look at how five states — Arizona, Louisiana, Ohio, New Hampshire and Tennessee — are spending these resources. BPC’s newly released study shows that funding is reaching areas in these states with the highest number of deaths. However, when examining the per capita funding in rural and metropolitan areas of these states, many rural counties receive relatively low levels of direct funding compared to more populated cities.

This type of large-scale examination has never been done before or made publicly available. This study was necessary to determine where Congress’ significant investments are being made and to provide recommendations for future opioid funding.

Our analysis identified 57 federal grant programs across five departments and multiple agencies, including the White House Office of National Drug Control Policy that, either entirely or substantially, support programs that seek to end the opioid epidemic. These programs span the continuum of care, including prevention, treatment and recovery. In addition, funds have been directed toward research, criminal justice, law enforcement and interdiction efforts. These grants account for $3.3 billion in opioid funding for fiscal 2017 and $7.4 billion in fiscal 2018 — a 124 percent increase in discretionary spending.

Between these two years, funding specifically targeted to opioid use disorder treatment and recovery increased by $1.5 billion (from $599 million to $2.12 billion), a testament to the urgent need to reduce overdose deaths. Though the report did not focus on mandatory spending, it does acknowledge the critical role of Medicaid and Medicare in supporting treatment of opioid use disorder.

Based on BPC’s analysis as well as interviews with state officials, the report recommends that federal funding must be more sustainable, flexible and coordinated.

First, while funding for treatment and prevention of opioid use disorder is unprecedented, the epidemic is part of a larger problem of addiction in the United States. Providing one-time funding is treating addiction as if it were an acute condition, instead of a chronic one. Funding must be provided with a longer-term horizon rather than in annual budget cycles.

Second, federal funds going to states must be flexible enough to allow states to address all types of substance use disorders, including alcohol and the emerging problem of methamphetamines. Drug trends morph over time. We have seen this with the opioid epidemic. What began in the 1990s with prescription opioids has evolved into an epidemic driven by heroin and now fentanyl.

Lastly, there must be greater coordination of funding at the federal level. The opioid epidemic is multifaceted and demands the same response. The silos created by numerous funding sources require the federal government to provide greater oversight and coordination to help states tackle this problem. We agree with the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which called on the administration to provide ONDCP with a greater role in coordinating the federal response.

It is too soon to evaluate whether federal funds are entirely investing in evidence-based treatment programs and are leading to the desired health outcomes. However, we are encouraged to see that some large federal grants, such as the Substance Abuse and Mental Health Services Administration’s State Opioid Response grant, now require funds to be spent only on evidence-based treatment, often referred to as medication-assisted treatment, or MAT.

Transparency is critical in making sure our current resources are being spent properly. This will ensure future congressional investments in the opioid crisis help build the type of prevention, treatment and recovery support system that our nation sorely needs.

Anand Parekh is chief medical adviser at the Bipartisan Policy Center. He was previously deputy assistant secretary for health (science and medicine) at the Department of Health and Human Services. Regina LaBelle is a BPC consultant and former chief of staff of the White House Office of National Drug Control Policy.