OBAMA’S ENLIGHTENED RESPONSE TO THE OPIOID EPIDEMIC

The President’s 2017 Budget calls for our country’s largest investment in treating and preventing substance use disorders in history.

In the first 150 words of the 2016 State of the Union, President Obama highlighted the national toll being taken by the opioid epidemic. Reflecting on the actions that need to be implemented by the federal government to address this crisis, President Obama said, “I hope we can work together this year on some bipartisan priorities like… helping people who are battling prescription drug abuse and heroin abuse. So, who knows, we might surprise the cynics again.”

The budget overall includes $1.1 billion in new funding to address the prescription opioid abuse and heroin use epidemic.

With his extensive and profound budgetary response to the opioid epidemic and his willingness to fund recovery efforts that no president has funded before, President Obama is doing his best to positively surprise many more people than just the cynics. As shepherded by Michael Botticelli, the Director of the White House Office of National Drug Control Policy (ONDCP), and Sylvia Mathews Burwell, the United States Secretary of Health and Human Services (HHS), the enlightened aspect of the budgetary response is that demand and supply reduction efforts will be funded at similar levels. For the first time, treatment and enforcement are being given equal footing.

Submitted to the U.S. Congress on February 9th, 2016, the Obama Administration’s Fiscal Year 2017 Budget includes a request that contains $15.8 billion in federal funds for reducing drug use in the United States through prevention and treatment programs.

This is a significant increase of nearly $1.1 billion over 2016 with most of the money going towards treatment and prevention funding. The treatment funding will be funneled to the states based on two key factors: the severity of the local drug problem, particularly in relation to prescription drug abuse and heroin abuse, and detailed responses by the states of how the funds will be applied to treatment programs that focus on evidence-based options, particularly medication-assisted treatment (MAT). Combined with supply reduction funding, a total of more than $31.1 billion dollars is being requested by the Obama administration for federal drug control programs for 2017.

“The President’s 2017 Budget calls for our country’s largest investment in treating and preventing substance use disorders in history,” explained recovery czar Michael Botticelli. “By funding public health and public safety efforts at near-identical levels, this budget demonstrates the Obama Administration’s ongoing commitment to a balanced approach to drug policy. The Budget recognizes how important it is to expand access to prevention, treatment, and recovery support services so we can prevent youth substance use, provide treatment to those in need, and sustain long-term recovery.”

The big question is whether or not Congress will play ball with the president. Bipartisan support for the extensive funding is questionable at best. For Republican presidential candidates Donald Trump and Senator Ted Cruz, the main focus of drug policy is to build a wall on the border between the United States and Mexico to stop the influx of drugs into the country.

Although a wall could address the problem of heroin smuggling into the country, it does nothing to stop the prescription drug epidemic. The widespread abuse of prescription painkillers has only been partially stemmed by the crackdown on pill mills in Florida and other states. Despite greater enforcement of the illegal prescribing patterns of criminally negligent and profit hungry doctors, prescription painkiller abuse remains a huge part of the national opioid epidemic.

The damaging consequences of the opioid epidemic need to be addressed through an investment in treatment and prevention. Americans caught in the grip of the disease of addiction need to be treated, and everyone from kids to healthcare providers need to be made aware of the dangers of these drugs. As opposed to the GOP response, the multi-dimensional budgetary approach by the Obama administration should prove much more effective if approved.

There is no question that an effective response is urgently needed. Prescription drug and heroin misuse have led to the recent epidemic of drug addiction and overdoses while straining resources of law enforcement and treatment programs. Recent data from the Centers for Disease Control and Prevention (CDC) shows that opioids were involved in 28,648 deaths in 2014. In particular, CDC found a continued sharp increase in heroin-involved deaths, a steady rise in overdose deaths related to prescription painkillers, and an emerging increase in deaths involving synthetic opioids, such as fentanyl. For the first time ever, more Americans now die every year from drug overdoses than they do in motor vehicle crashes.

According to the White House provided fact sheet, the $31.1 billion drug-funding requests in the new budgetary response include the following broad investments:

1. $14.3 billion for treatment activities, a nearly eight percent increase over the 2016 funding level.

2. $1.5 billion for prevention activities, a 3.2% increase over the 2016 funding level with a focus on the ONDCP Drug-Free Communities program and prevention services supported by the Substance Abuse Prevention and Treatment Block Grant program.

3. $9.5 billion for domestic law enforcement activities, including $2.0 billion for the Drug Enforcement Administration, $501.1 million for Immigration and Customs Enforcement, $522.1 million for Organized Crime Drug Enforcement Task Forces, $174.3 million for High Intensity Drug Trafficking Areas, and $43.2 million for federal law enforcement training.

4. $4.1 billion for interdiction and border maintenance, including $2.4 billion for Customs and Border Protection and $1.3 billion for the U.S. Coast Guard.

5. $1.6 billion for international funding, including $467.8 million for the Drug Enforcement Administration and $382.4 million for the Bureau of International Narcotics and Law Enforcement.

Most importantly, in light of the remarks made by President Obama, the budget overall includes $1.1 billion in new funding to address the prescription opioid abuse and heroin use epidemic. The President and his advisors clearly understand that building a wall will not stop the epidemic. Although the heroin comes across our borders, the heart of the crisis is in our own country.

$1 billion in mandatory new funding is being requested to help people with an opioid use disorder seek treatment, successfully complete treatment, and sustain long-term recovery. An additional $90 million will be used to expand state-level prescription drug overdose prevention strategies, increase the availability of medication-assisted treatment programs, improve access to the overdose-reversal drug naloxone, and support targeted enforcement activities. Along with the DEA funding and the other interdiction efforts, the last part shows that the administration recognizes the importance of enforcement. The crime produced by illegal drug abuse and the criminal cost to communities is not being ignored.

In 2015, the Obama Administration, led by Michael Botticelli and Secretary Burwell, released the annual National Drug Control Strategy the primary blueprint for drug policy in the United States. The Strategy outlines a series of actions to expand health interventions and “smart on crime” alternatives proven to reduce drug use and its consequences in the U.S. Under the Affordable Care Act, substance use disorder services are essential health benefits that are required to be covered by health plans in the Health Insurance Marketplace. A major step forward was that substance use disorder benefits are now comparable to medical and surgical benefits.

The President’s FY 2017 Budget takes a two-pronged approach to address this epidemic. First, it includes $1 billion in new mandatory funding over two years to expand access to treatment for prescription drug abuse and heroin use. This funding will boost efforts to help individuals with an opioid use disorder seek treatment, successfully complete treatment, and sustain recovery.

This remarkable funding includes:

1. $920 million to support cooperative agreements with States to expand access to medication-assisted treatment for opioid use disorders. States will receive funds based on the severity of the epidemic and on the strength of their strategy to respond to it. States can use these funds to expand treatment capacity and make services more affordable.

2. $50 million in National Health Service Corps funding to expand access to substance use treatment providers. This funding will help support approximately 700 providers able to provide substance use disorder treatment services, including medication-assisted treatment, in areas across the country most in need of behavioral health providers.

3. $30 million to evaluate the effectiveness of treatment programs employing medication-assisted treatment under real-world conditions and help identify opportunities to improve treatment for patients with opioid use disorders.

SAMHSA is being given $12 million to help states promote and foster the increased use of naloxone to help save lives. States can use these funds to purchase and equip first responders with naloxone while providing training on other overdose death prevention strategies. In 2016, the CDC will expand their Prescription Drug Overdose: Prevention for States program for providers and patients. Their budget is being raised by $30 million dollars to allow them to expand from 16 states to a national scale. With ONDCP support, the Fraternal Order of Police will provide their 330,000 members with an Opioid Overdose Resuscitation card, educating members through in-person and webinar trainings in 2016.

To support the general public, Secretary Burwell and her staff at the Department of Health and Human Services are continually improving HHS.gov/opioids as a one-stop federal resource. The goal is to provide tools and information for families, health care providers, and other stakeholders on prescription drug abuse and heroin use prevention, treatment, and response. By creating a centralized online location for such information, the federal government is allowing the American people to see exactly what is being done and access the help they need.

A portion of this treatment, prevention and overdose funding is being directed specifically to rural areas, where rates of overdose and opioid use are particularly high. To help further expand access to treatment, the budget includes an HHS pilot project for nurse practitioners and physician assistants to prescribe buprenorphine for opioid use disorder treatment, where allowed by state law. Still, given the expenses, many fear that Congress will resist funding many of the initiatives in an election year.

There is hope, however, that Congress will approve these changes, particularly in light of the 2015 bipartisan budget agreement on treatment and recovery services. This agreement revised a longstanding ban on using federal funds to support syringe service programs, which can help reduce the transmission of HIV and viral hepatitis by confronting one major source of the outbreaks: injection drug use, including opioids.

Previously in October of 2015, the President announced a number of new public and private sector actions to address this issue, including a Presidential Memorandum on prescriber training and opioid use disorder treatment. He also announced a commitment by more than 40 provider groups that more than 540,000 health care providers will complete training on appropriate opioid prescribing in the next two years.

By being both comprehensive while also focusing on specific needs, the response balances the needs of the nation as a whole while helping those individuals already caught in the vise of this disease. The President’s concerted national effort to address the health crisis brought on by prescription drug abuse and the rise of heroin use is enlightened and desperately needed. For too long, the problem has been shoved under the rug as shown by the countless deaths that have fueled this tragedy.

The extent of the overdose prevention initiatives alone shed light on the Obama administration’s true desire to stop the encroachment of this fatal wave. Whether such funding and efforts are too little, too late in the harsh glare of the severity of the problem will have to be decided by those that come after the passing of the crisis and judge the results amid the graves. That is, of course, if the crisis passes.

The lessons of history have taught us, however, that both good and bad times eventually pass as relatively new forms arise or some imitation of the past. Hopefully, the funds being dedicated for prevention and treatment of the opioid epidemic will have a positive and lasting effect, leading to such a change and saving countless lives. To learn more about the opioid epidemic or to find treatment options for family, friends, or co-workers, please visit www.hhs.gov/opioids.

To read the complete list of national drug control policy updates and initiatives in the past and coming fiscal year, please click here.