February 13th, 2017

Despite the recent expansion of addiction treatment, 78 people die every day from overdoses according to the surgeon general, and the number continues to grow.  To me, this frightening number represents the magnitude of the problem rather than the failure of increased access to treatment. I believe that the number of deaths would be even higher if treatment opportunities had not expanded.

In the 1970s, President Richard Nixon, of all people, demonstrated the benefit to society of increasing access to addiction treatment. Nixon, the originator of the “War on Drugs,” was focused on reducing urban crime and realized that heroin addicts, seeking to support their habit, were contributing to it He reduced crime by bringing in Dr. Jerome Jaffe to establish a nationwide program to increase access to treatment for opioid addicts.

Today’s headlines are about overdose more than crime.  The shift from prescription opioids to heroin has become deadlier because of the addition of potent synthetic opioids like fentanyl to street heroin. I believe, however, that the best remedy is still the one adopted by Nixon. The good news is that access to treatment has been expanding for decades. It began with “parity” legislation requiring insurance plans to stop discriminating against diseases of addiction. Buprenorphine became available in 2003, just as the opioid epidemic was surging. It temporarily reduced overdoses in areas where it was widely available. It is now taken by over one million people with opioid addiction. Most recently, the Affordable Care Act has allowed addicts to obtain insurance coverage including for the treatment they need.

The bad news is that relatively few people with substance use disorders receive treatment. As of 2014, only 10 percent of the 23 million Americans affected were treated. That percentage may have increased under the Affordable Care Act. However, a New York Times story on February 11 focused on the potential impact if changes in the Affordable Care Act cause those with low incomes to lose their insurance. People suffering from addiction, as well as those with mental health disorders, have historically been unable to advocate for themselves.

At this time of uncertainty about the policies of the new administration, I will continue to report on any changes that I see in this important area of access to treatment.  

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