It's Time to Trump Addiction
Some people may find it surprising that the three of us are working together in this political environment. However, when it comes to the opioid epidemic, we are willing to put aside party politics so we can save thousands of lives.
We urge President Trump to implement his campaign promise to “end the opioid epidemic in America.” The most efficient and cost-effective way to achieve this is by breaking down the barriers to the treatments that actually work. What works best is medication-assisted treatment (MAT) — the combination of behavioral counseling and recovery medication.
Today, only three out of every 100 people living with opioid addiction are receiving this type of treatment. The scale of the epidemic, as well as the medical community’s endorsement of MAT, makes these numbers even more dramatic and indefensible. The economic case for MAT is also clear. Studies show that every dollar spent on treatment saves $4 in health care costs and $7 in criminal justice costs.
The bottom line: breaking down barriers to opioid addiction treatment that works will save lives and money. And the President, who knows what it is like to lose someone close to him to addiction, has an opportunity to act.
With this in mind, there are three areas in which President Trump could make significant progress with direct leadership and action: changing policies that create barriers to treatment, reforming criminal justice to favor treatment over jail, and ensuring that funding is available to treat addiction as the public health emergency that it is.
Some of these areas can be addressed through presidential and administrative action, some by working with Congress, but all of it can happen more quickly, and more lives could be saved, if the president makes this a top priority. Our hope, and the hope of the millions of others impacted by addiction, is that we hear more about his plans to work with Congress to solve the opioid addiction epidemic during his Congressional address today.
The President should start by ensuring the health care system is doing everything it can to support people fighting addiction. Yet, the treatment regimen that is known to work best is out-of-reach for many because of obsolete government and insurance policies.
Getting the right treatment the first time is the best way to create a pathway to long-term recovery. The government would never allow insurers to force a person who just suffered a heart attack to try diet and exercise before being prescribed beta blockers, and then only pay for the drugs after he or she suffered another heart attack. Yet, that is what is being done to people with opioid-use disorders by many insurers. Too often, these types of “fail first” restrictions result in an otherwise-preventable opioid overdose death.
To be crystal clear how wrong this is—a fail-first policy for opioid use disorder treatment means the patient overdoses and may die. At 52,000 deaths in 2015, drug overdose is now the number one cause of accidental death—more than car fatalities or gun violence. This must stop.
We urge the President to protect and ensure that addiction treatment receives the same effective and proactive treatment as other chronic diseases. Although it is the law of the land because of the Bipartisan Mental Health Parity Acts of 1996 and 2008, enforcement has been lax. It is inexcusable that, years after the bipartisan bill was passed, our nation is still placing the burden to fight for effective treatment squarely on the shoulders of those living with a substance use disorder – often at the height of their personal crisis. President Trump should direct federal agencies to accelerate the required “action plan for parity enforcement” mandated in the bipartisan 21st Century Cures Act that would require interagency cooperation to proactively review insurance policies and investigate violations. The President should also call for a thorough review of medication-assisted addiction treatment policies in the government’s own health care plans, such as those that cover the military, veterans, government employees, seniors, and Medicaid recipients.
Compounding these insurance barriers are obsolete policies that bar access to treatment. For example, the Medicaid Institutions for Mental Disease (IMD) exclusion—a law as old as the program itself – is the single largest impediment to quality inpatient care. The exclusion prevents many facilities from getting Medicaid reimbursement to treat the most vulnerable in society. Congress should repeal this exclusion. Another law, the Drug Addiction Treatment Act of 2000, results in arbitrary caps on the number of patients a doctor can treat with medication that helps patients manage withdrawal and reduces cravings. Based on the recent Surgeon General's report, fewer than 7 percent of US primary care doctors have taken the necessary steps to treat individuals with opioid addiction. This leaves a large majority of patients without access to treatment. These 17-year-old caps, put in place when the fear was that recovery medications would be “diverted,” have not been adequately modified despite the skyrocketing addiction epidemic. There are now formulations of drugs that are injected or implanted which make diversion for illegal use nearly impossible. It’s time for Congress to eliminate these caps.
We urge President Trump to make good on his promises to “not compound the tragedy with government policies and bureaucratic rules that make it even harder for them to get help,” and to “lift the cap on the number of patients that doctors can treat, provided they follow safe prescribing practices and proper treatment supervision.”
The second area where presidential leadership could accelerate access to needed treatment for people living with addiction is the criminal justice system. Though under resourced to help those struggling with addiction, county jails are often the crisis point of addiction. Instead of putting people with opioid addiction behind bars, federal courts should implement – and states and local governments should be incentivized to implement – a system that diverts them into community- based treatment and support services. Many of the people who are involved should be treated more like patients, not prisoners. After all, studies have shown that medication-assisted treatment reduces the risk of someone committing another crime. President Trump stated his intention to “expand incentives for states and local governments to use drug courts and mandated treatment” as “a cost effective, appropriate, and humane response to addiction” while campaigning in New Hampshire last fall. We sincerely hope this is a promise the President will choose to keep.
Finally, treatment program funding is needed. Until the insurance industry catches up with science and the law by eliminating barriers to treatment, and the capacity for treatment matches the epidemic, government intervention and funding is essential. We urge the president to quickly distribute the $500 million in state grants authorized in the bipartisan 21st Century Cures Act to help states provide prevention, treatment, and recovery services to patients. We also urge that the $500 million for 2018 be at least doubled. The authors disagree on the important question of whether the ACA should be strengthened or repealed. But we do agree that any reform or replacement of ACA should expand real access to recovery treatment for millions of people living with opioid addiction.
America’s opioid misuse epidemic knows no geographical, partisan, or ideological boundaries. In fact, of the top 10 congressional districts with the highest rates of opioid overdose deaths, five are Democratic and five are Republican. Join us in supporting strong action to address this epidemic. President Trump can stand united with the millions of impacted Americans and make sweeping progress on opioid addiction by leading in these three areas – policy changes, criminal justice and funding. It’s time to turn words into action. And time to "trump" addiction.
Former Speaker Newt Gingrich, Former Congressman Patrick Kennedy, and #cut50 Founder Van Jones are paid advisors of Advocates for Opioid Recovery, www.opioidrecovery.org.