We urgently need a COVID-level response to the US drug crisis

President Biden pledged during the election campaign that his administration would launch an all-out effort to end the opioid epidemic. Yet, after 100 days in office, he has so far done remarkably little to address a national drug crisis and surge in overdoses that last year killed an estimated 90,000 Americans. If any further proof were needed that Biden is AWOL on this issue, he didn’t even mention the epidemic or the dramatic, nearly 30 percent surge in overdose deaths during yesterday’s wide-ranging address to Congress.

With its primary focus the COVID-19 pandemic and pressing economic issues, the White House has unfortunately pushed the drug crisis to the sidelines — although it significantly worsened last year amid the loneliness and despair of social isolation and the curtailment of services for those struggling with substance abuse. Across the country, fatalities mounted as drug use surged and the number of overdose victims without access to adequate help skyrocketed. In San Francisco, twice as many people died in 2020 from drug overdose as from coronavirus. 

As city and state officials and treatment providers continue grappling with the crisis, what’s really needed is strong federal leadership in a comprehensive national policy approach with a massive boost in funding on the scale of the COVID response. This other public health crisis must be part of Biden’s transformative agenda, with a requisite marshalling of resources and expertise along with targeted policies that we know will work. 

That’s exactly what then-candidate Biden promised: an ambitious $125 billion anti-opioid effort over the next decade, focused on treatment, training the addiction workforce and stepping up education and prevention programs. But even with the number of drug deaths spiraling out of control during his first months in office, Biden has delivered only a $1.5 billion allocation through the American Rescue Plan for the prevention and treatment of substance use disorders. And despite outlining promising drug policy priorities, he has yet to  appoint a cabinet-level “drug czar” to oversee and coordinate federal policy.  

Biden did take one important step this week, announcing new federal guidelines making it easier for medical professionals to prescribe the addiction withdrawal medication, buprenorphine, which is used in medication-assisted therapy (MAT). The new rule allows physician assistants, nurse practitioners and others to prescribe the drug, thereby allowing wider use at a time at a time when only 20 percent of individuals with opioid use disorder receive any services.   

This could save an estimated 30,000 lives a year. But given the vast scope of a crisis that now reaches every corner of the country, it is not a solution. While MAT and harm-reduction programs — including clean needle exchanges and overdose-reversal drugs — are a critical first step, we must do more to provide a direct pathway to treatment. Otherwise, users routinely end up right back on the streets, trapped in the all-too deadly cycle of drug use.

A better, longer-term goal would be to make a wide range of drug treatment options — including residential care — universally available to and affordable for each of the estimated 20 million Americans who desperately need it. This starts with the Biden administration acknowledging that the scourge of addiction and overdose death is in many ways just as severe as the coronavirus. (Nearly 841,000 Americans have died since 1999 due to drug overdose, with about 70 percent involving an opioid). To expand drug treatment, the White House must propose and win congressional passage of legislation and funding at the level Biden promised as a candidate.

And it must help raise public awareness of what equated to roughly 250 Americans dying per day from overdose in 2020. Imagine the impact if Centers for Disease Control and Prevention officials, Health and Human Services Secretary Xavier Becerra or Vice President Kamala Harris held frequent briefings that highlighted not only the key metrics of the drug crisis, but also efforts being taken to bring it under control. With the same commitment it has dedicated to confronting and successfully containing COVID, the Biden administration could also make significant, steady progress against the disease of addiction.

Mitchell S. Rosenthal, M.D., is a psychiatrist who founded Phoenix House, the national substance abuse treatment organization, and is now president of The Rosenthal Center for Addiction Studies in New York City.