5 Fast Facts: America’s Opioid Epidemic
Adapted from the work of J. Stephen Morrison and Lillian Dattilo, CSIS: cs.is/2sYXttp
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1. The opioid epidemic is unlike any other health emergency America has experienced
It is the first epidemic rooted in modern medicine: the overuse, misuse, and abuse of prescription opioids, propelled by clinical and industrial practices. Today we are witnessing a fast-evolving, highly fluid epidemic that has become a hybrid, in which heroin, methamphetamine, fentanyl, and other illicit substances (atop prescription drugs) increasingly fuel addiction, overdoses, and death. Each drug that emerges as a new driver of the epidemic changes the equation and requires multiple adjustments in approach.
Opioid misuse is particularly dire in the eastern Appalachian region of Kentucky, where several counties have death rates due to overdose three times the national average.
2. Local action has profound power and influence over the opioid epidemic
Multi-sectoral community and county initiatives have acquired enduring capacity, proven their resilience, become indispensable, and inspired others. Public knowledge has deepened, and there has reportedly been substantial reduction in stigma. The Louisville Courier-Journal and other Kentucky-based media have been highly impactful in spotlighting corruption and illicit drug markets, including diversion of prescription medications, and in pressing to overcome woefully insufficient access to treatment and prevention.
3. Medicaid expansion is at the epicenter of the opioid epidemic
At the federal level, Medicaid expansion in Kentucky has been the single-most powerful tool to expand access to treatment, aided by the flow of additional resources and programs under the 21st Century Cures Act and Comprehensive Addiction and Recovery Act (CARA). The uninsured rate in Kentucky’s 5th Congressional District decreased from 17.4 percent in 2012 to 5.7 percent in 2015.6 This was the third-largest reduction in the rate of uninsured in the entire United States following Medicaid expansion.
Inversely, a significant reduction in access to Medicaid prevention and treatment services will undermine progress to date and set in motion a dangerous regression.
4. Shortcomings limit the ability to control the epidemic
The police face acute cross-pressures: officers and judicial officers who shorten sentences for drug offenders are criticized by drug offenders’ neighbors for being too easy on crime. At the same time, officers who press for felony convictions are viewed as excessively harsh on the mentally ill. And far too often, treatment is simply not available. There remains an acute shortage of transitional housing and professional post-rehabilitation support. Almost every facet of the epidemic suffers from incomplete and poor-quality data and the lack of data on nonfatal opioid overdoses further obscures the epidemic’s severity.
5. The U.S. has a pressing need for a coherent, unified strategy to address the epidemic
Local action alone will not suffice. There simply are not adequate fiscal resources and human and institutional capacities available at the community, county, or state level to meet urgent multiple needs. And if such external flows do materialize, that step will bring with it demands for heightened coordination, oversight and accountability, and calls for far better metrics and data, along with expanded research.
Adapted from the work of J. Stephen Morrison, CSIS, and Lillian Dattilo, CSIS: cs.is/2sYXttp
