From student political newspapers to political ads, it seems everyone has devised a solution to the issue of the opioid epidemic. When it comes to legislation, evidence-based programs like drug therapies and rehabilitation programs seem to be the most numerous and effective, with most even backed by concrete examples of success. However, politics and policy surrounding the issue still move slowly, while the opioid crisis continues to intensify.
Recent developments, like a Senate bill (the Opioid Crisis Response Act of 2018) passed this September, come after various blocks, like a similar but ultimately rejected bill proposed in 2016. The new legislation includes language authorizing the Drug Enforcement Agency (DEA) to further limit opioid production, allows doctors to remotely prescribe addiction recovery drugs, like methadone and buprenorphine, and increases mail security to prevent illicit fentanyl from entering through imports. However, this bill does not include any increases to treatment spending within Medicaid, be it treatment for opioid addiction or non-narcotic alternatives for chronic pain management. The bill also fails to mention some of the more stigmatized damage control measures to the epidemic, like needle exchange programs or safe injection sites. Though it moves in the right direction and begins to address the crisis in meaningful ways, this new bill provides an interesting insight into the politics of the crisis: what works, what doesn’t, and what’s still missing.
The first and most obvious advantage of the bill is its near-total bipartisan support. Sponsored by two conservative and one liberal representative, this initiative was one of the largest collaborative congressional actions against a drug crisis. Titled the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) bill, it follows the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act (CARA). 21st Century Cures, in short, provided nearly a billion dollars in state grants to combat the crisis, while CARA was composed of 11 bills, covering everything from creating an opioid task-force to updating pain management practice guidelines for physicians.
In addition to legislative bills, state and local government are also turning to litigation against pharmaceutical manufacturers. Six state attorneys, from Nevada, Texas, Florida, North Carolina, North Dakota, and Texas, have headed lawsuits against Purdue Pharma, while Florida is also in the process of suing seven other large distributors as well. A total of sixteen states have filed suits against Purdue alone. These litigations stand to make large payouts to the communities that they have affected, similar to the series of big tobacco lawsuits from the 1990s, with payouts of almost $246 billion in total, across all fifty states (it is worth mentioning here that an additional $15 billion went to lawyer fees). The numbers for these cases are clearly staggering, and could pave the way for increases in treatment funding, alleviating the effects of previous funding crises that have stymied past attempts of expansion.
As far as large congressional initiatives go, legislation like CARA and 21st Century Cures has been supported by Democrats and Republicans alike, and the recent initiatives have even been endorsed by one rather controversial POTUS. However, public opinion on the opioid crisis and its solutions, outside the White House and the halls of the Capitol, is not nearly as unilateral. In an article from the Harvard School of Public Health, only 28 percent of Americans think the opioid epidemic is a national emergency. For context, President Trump declared the crisis a National Emergency approximately ten months after the study was published. Further, only about half of the population supports increasing treatment availability for addiction (this, however, has been demonstrably correctable via advocacy messages focusing on treatment efficacy). The public is also divided on methods of treatment delivery, both in government responsibility and insurance coverage. Additionally, only about half of the population even believes that any treatment is effective in the long run.
The best way to understand where these views arise from is to examine the stigma surrounding addiction. During the War on Drugs, addiction and drug abuse were portrayed as moral failings, problems that good, upstanding people not only simply do not face, but should fear and strive to protect their children from. This excluded drug addicts within communities, alienating them from their families and friends as well as any words of kindness that could have helped them on their journey. Though candidates like Chris Christie, Jeb Bush, and Al Gore have all told moving and warmly accepting tales of their families’ struggles with addiction, their language of healing is only the first of the steps necessary to change the tides of public stigma.
Despite the stigma, many public campaigns, like Stop the Stigma and the Lift the Label Campaign, are seeking to remove the negative connotations of opioid addiction. Bipartisan support for bills to alleviate the crisis, as well as open collaboration on these issues, is a hopeful sign of future progress. Considering the long history of addiction in America, the journey seems daunting, but armed with a world of solutions and more open doors to funding, the millions of citizens suffering from the opioid crisis can look to the future with optimism.