Harm reduction and addiction treatment need infrastructure investment

The nation is in the throes of a devastating and escalating addiction epidemic. Last year, over 93,000 individuals died of a drug overdose, setting a grim new record. More than 20 million Americans struggled with addiction in 2019 — yet less than 20 percent of them received treatment.

Science and clinical practice have shown that properly treated addiction is not an intractable illness — it can be prevented, and it can be managed. Yet, over the past decade, we have made little progress in ending the overdose and addiction epidemics. A major reason for this is that the addiction treatment system is not equipped to properly treat the illness of addiction because it was built before we knew that addiction was an illness at all. It was built on a poor foundation — and like the infrastructures for so many of our important energy, transportation and communication needs, the addiction treatment infrastructure is now antiquated and crumbling under the weight of the crisis.

As Congress moves legislation forward to strengthen the nation’s critical infrastructure, investments to revitalize and modernize the addiction health care infrastructure must be included.

In the late 1970’s when addiction treatment programs were proliferating, the prevailing view — despite the American Medical Association declaring alcoholism an illness in 1956 — was that the ‘cure’ for substance use problems was to ‘cure’ the bad moral character of those affected. Addiction treatment programs were geographically, financially, culturally, and organizationally separate from the rest of mainstream health care, because addiction was not considered a health care issue.

Today we know addiction is a preventable and treatable chronic medical disease. Decades of scientific and clinical research have shown that substance use problems are best treated through continuing care and monitoring, using individualized treatment regimens comprised of evidence-based medications, behavioral therapies, social supports and clinical monitoring.

Yet, misguided policies, regulatory practices and insurance provisions have limited the availability and potential of these evidence-based treatments. As result, we have a system that is plagued by inconsistent quality standards, inadequate funding for effective clinical care and lack of available treatment for most Americans who need it.

The time has come to modernize addiction treatment by integrating it into mainstream healthcare. To pour a new foundation and build back better.

As Congress and the president debate the scope of infrastructure legislation, they have an extraordinary opportunity to do just that. They must resist the all too frequent impulse to address it the usual way, by simply adding new dollars to old institutions, more beds and traditional outpatient addiction treatment slots. Although this might seem like a wise approach given the significant need, replication without modernization would be ineffective and a huge missed opportunity.

Instead, we must re-envision the addiction treatment system as an essential part of the human infrastructure system that sustains this country.

The cost of not investing in this critical infrastructure is too high to defer any longer. The president and Congress can make the most of this moment by including the following priorities in the upcoming legislation:

Enhance professional education and address the workforce shortage — Congress should fund programs that help to ensure that all physicians and other health care workers have basic training in addiction and expand and diversify the workforce of addiction medicine professionals, both of which will help to increase access to care. Far too few healthcare organizations currently have adequate numbers of nurses and physicians who can prescribe effective addiction medications, or accessible and modern addiction treatment programs.

Promote telehealth options — COVID-19 made clear that telehealth can work on a large scale — but not for people who are on the wrong side of the digital divide. Congress should fund expanded access to telehealth services and the technological capacity of addiction service providers in order to ensure more people can receive health care, regardless of geography.

Expand treatment, employment and housing opportunities for recovering individuals — Millions of Americans are in recovery from addiction, and between 70 million and 100 million — or one in every three adults — have some type of criminal record, which can make it nearly impossible to get into college, find a job, or secure a place to live. Congress should fund efforts to expand the use of alternatives to arrest or incarceration for all but the most serious offenses. For those in recovery and/or leaving the criminal justice system, Congress should fund programs that reduce barriers to education, employment, public benefits, and voting and expand safe and affordable housing.

Investing in these solutions will create the framework needed to build a more sensible and durable prevention, treatment, recovery and harm reduction infrastructure for the future. It is an investment in the health, safety and well-being of our nation.

Paul N. Samuels is president of the Legal Action Center, a nonprofit focused on fighting discrimination, building heath equity, and restoring opportunities for people with substance use disorders, HIV/AIDS and criminal records.

Marcia Lee Taylor is chief external affairs and government relations officer at the Partnership to End Addiction, a nonprofit organization that leverages advocacy, education and research to help families impacted by addiction.

Emily Feinstein is chief operating officer at the Partnership to End Addiction.