Congress needs to act on overdose prevention

2023 was a year of heartbreak for thousands of people who lost loved ones to overdose. It was the deadliest year on record — in the United States, more than 110,000 people died from a drug overdose. This tragedy left deep and indelible marks on communities across the country, as overdose rates rose sharply among communities of color, older adults, adolescents, and pregnant women.

But 2023 was not without hope. More than 21 million Americans are currently in recovery, a number that will continue to climb with increased access to high-quality substance use disorder treatment.

At the start of 2023, Congress increased the number of health care practitioners who can effectively treat opioid use disorder from 130,000 to 1.8 million by removing onerous regulatory requirements to prescribe buprenorphine, an FDA-approved medication proven to reduce the risk of fatality from overdose.

In addition, the Biden administration approved the first state demonstration waivers that make it possible for Medicaid coverage of limited services for individuals who are soon to be released from incarceration. These Medicaid policy changes offer an unprecedented opportunity to build strong, effective, evidence-based services for people with opioid use disorder (OUD) when they are incarcerated, a policy that will help save the lives of the tens of thousands of Americans who die of an overdose each year following release from incarceration.

In 2024, advocates and policymakers must focus on closing the treatment gap. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), while more than six million Americans aged 12 and older had opioid use disorder in 2022, just 18.3 percent received medications for opioid use disorder (MOUD) to treat their disease.

Congress must prioritize legislation that expands access to medication treatment and consider specific intervention points that can reach people most at risk of an overdose.

Racial inequities. Americans living in communities of color have considerably less access to MOUD. In recent years, the overdose death rate for Black Americans has skyrocketed, eclipsing that of white Americans, yet Black patients have been found to be 77 percent less likely to receive a prescription for buprenorphine than white patients.

Geographic inequities. Rural counties in the United States have fewer addiction treatment providers than urban or suburban counties, with 88 percent of large rural areas lacking a sufficient number of opioid treatment programs (OTPs), which provide methadone.

Jails and prisons. People who are incarcerated are 40 times more likely to die from an overdose after release, yet only a small number of jails and prisons nationwide offer MOUD. When they do offer these medications, risk of fatal overdose upon release can drop 80 percent in the first month post-release.

Multiple pieces of bipartisan legislation will make a significant impact in efforts to broaden access to evidence-based treatment. In 2024, Congress should:

• Reauthorize and expand the SUPPORT Act, which contains important policies that can increase access to treatment and much-needed funding for community-based treatment and recovery services;
• Expand access to methadone by passing the Modernizing Treatment Opioid Access Act which would allow Board-certified addiction medicine specialists to prescribe this lifesaving medication for opioid use disorder; and
• Advance the Reentry Act and the Due Process Continuity of Care Act, two pieces of legislation that will broaden access to treatment in jails and prisons by allowing Medicaid coverage of health services prior to release from incarceration.

In the United States, overdose deaths are unacceptably high — and will remain so — without continued, persistent action from Congress. The overdose crisis impacts every state and every congressional district. It affects all Americans, regardless of their political views, judging from the broad bipartisan and bicameral support for these bills, is an issue that has united both political parties.

Congress must take action to end the overdose crisis. Advocates will continue to fight for passage of these bills in 2024, and we need Congress to join us.

Libby Jones is the program director of the Overdose Prevention Initiative at the Global Health Advocacy Incubator (GHAI). Jones leads the Initiative’s advocacy efforts, advancing federal policies to reduce the overdose death rate in the United States by expanding access to treatment and promoting harm reduction.