A solution to the opioid epidemic from the urban and rural America perspective

Today, we face the deadliest public health crisis of our lifetime — the opioid epidemic. To combat this catastrophe, Congress reviewed dozens of bills aiming to address this issue. Most of these bills were bipartisan, and many proposed reasonable solutions to real problems. But they were, by and large, small fixes.

Last Friday, the House passed a massive package containing 58 individual bills that will prioritize training, support recovery centers, and expand research on several fronts. However, we’re in the midst of an epidemic, and Congress’ proposed solutions are tinkering around the edges of this crisis.

{mosads}Each year, more Americans are dying of overdose than have ever been killed from car accidents, guns, or HIV/AIDS. An American under 50 is now more likely to die of an overdose than from any other cause.

And the numbers continue to climb. In fact, in the next 12 minutes, another American will fall victim. Not only this constitutes a public health emergency but is also unweaving the very fabric of our society.

It is hard to accept that this has happened to our country, especially to family, friends, neighbors and community members that we love. It does not have to be this way. One bill in particular could put us, finally, on the path out of this crisis: the Comprehensive Addiction Resources Emergency (CARE) Act, introduced by Elizabeth Warren in the Senate and Elijah Cummings in the House.

The CARE Act recognizes a truth often obscured in conversations about the opioid epidemic: we know how to prevent overdose deaths. The problem, simply put, is that we don’t have money to pay for it. The CARE Act makes that money available: it would deliver sustained funding, in an amount commensurate with the scope of the crisis, directly to areas hardest hit by addiction and overdose.

Addiction is a disease. Treatment for that disease exists, and it works. When people are dying from overdose, naloxone — the antidote medication — can save their lives in a matter of moments.

In Baltimore, we issued a blanket prescription for naloxone to all 620,000 residents in 2015, and since then we’ve trained nearly 40,000 of our residents to use the medication. These residents have used naloxone to save more than 2,000 lives. That number should be far higher, yet lack of funding forces us to ration. We lost more than 1,400 people to overdose in 2016 and 2017. How many of them could have been saved?

Rural areas also are in need of naloxone. In West Virginia, we have mandated emergency first responders across the state to carry overdose reversal kits and have initiated distribution of naloxone. Since finding immediate access to a health-care facility is often difficult in rural areas across the United States, administering naloxone to the overdose victim buys crucial time — which is often the difference between life and death.

As efforts to expand access to naloxone continue, we are going to need more naloxone. And for more naloxone, here’s what we need: funding. But access to sufficient naloxone only remains a temporary solution.

The situation with long-term treatment is even worse. Medications like methadone and buprenorphine are extremely effective: they cut mortality by more than half. Evidence also shows that such treatment significantly decreases risk of relapse, is effective in preventing infectious diseases like HIV and reduces violent crimes.

 But the infrastructure needed to offer this treatment does not exist. According to President Trump’s opioid commission, 85 percent of counties have no specialty addiction treatment center offering methadone and 47 percent have not a single doctor who can prescribe buprenorphine.

The Care Act would provide the resources required to build this infrastructure. It’s modeled on the Ryan White HIV/AIDS Program. Created near the height of the HIV/AIDS epidemic, Ryan White provides billions of dollars to states and local jurisdictions each year to ensure that treatment is available for anyone who needs it and that this treatment is delivered within a broader system of social support.

In other words, it’s not just the medication — it’s the medication and everything you need to make that medication effective. For addiction, that means counseling, housing support, job training, child care. It means teams of people in recovery who walk the streets connecting people with addiction to care.

We made a decision with the Ryan White Program — no longer would we allow our loved ones to die of HIV/AIDS. We need to make the same decision now. Congress has the power to prevent these overdose deaths and help individuals enter treatment with the goal of becoming productive members of our society

The start of a solution — the Care Act — is right in front of them. Without it — without the money to scale up what we already know works — we will be having the same conversation years from now, wondering why we didn’t stop this epidemic in its tracks when we had the ability and the resources to do so.

Dr. Leana S. Wen is the commissioner of bealth in Baltimore City, Md. Dr. Rahul Gupta is the state health officer and commissioner in West Virginia.