What a grim sign of the times: According to the National Safety Council, Americans are now more likely to accidentally die from an opioid overdose than an automobile wreck. The council’s analysis of preventable injury and fatality statistics from 2017 concluded that Americans had a 1 in 96 chance of dying from an accidental opioid overdose over their lifetimes. The odds of dying from a motor vehicle accident were 1 in 103.
These numbers show the urgent need to quickly implement the opioid-response law approved by Congress and signed by President Donald Trump in October. As the National Safety Council’s Maureen Vogel told CNN, “Too many people still believe the opioid crisis is abstract and will not impact them. … These data show the gravity of the crisis.”
Among its dozens of provisions, the new law changes Medicare and Medicaid rules to push the use of less powerful painkillers; increases federal efforts to keep cheap, dangerous synthetic drugs like fentanyl from being mailed to the U.S., generally from China; and expands a program that would equip more first responders with naloxone, a powerful medication that quickly reverses opioid overdoses. It also aims to make health care providers more aware of the danger of prescribing drugs like OxyContin and to establish easily replicated best practices for dealing with opioid overdoses.
In a polarized era in which it’s rare to see comprehensive legislation get enacted, it may seem churlish to criticize any of the Support for Patients and Communities Act. But stakes are high: The opioids epidemic is so serious it’s reduced U.S. life expectancy in recent years. And the $8.5 billion that Congress has approved for the opioids response this year is impressive, but it’s less than half what the U.S. government spends on AIDS/HIV.
That’s an apt comparison. The breadth of the federal response to AIDS/HIV should be the model for what’s done on opioids. The crisis is arguably as serious. More than 47,000 Americans died of opioid overdoses in 2017. More than 40,000 died a year at the peak of the AIDS epidemic in the mid-1990s.
Two decades later, thanks to federally funded medical breakthroughs and efforts to ensure broad access to quality care, less than 16,000 people died of HIV/AIDS in 2016 in the U.S. Now more than half the Americans with HIV have used medicine to achieve “viral suppressions,” giving them strong immune systems and a better chance at general good health.
So what would a similarly vigorous federal response to the opioids crisis look like?
If goal No. 1 is preventing people from dying, then the obvious first step is making sure every ambulance, police car and health-treatment center has naloxone, and launching national campaigns showing how to administer the drug.
If goal No. 2 is helping people fight addictions, then health centers should have much greater access to medications like methadone and buprenorphine. A 2016 Pew study said the drugs were highly effective. A 2017 British Medical Journal study found they cut mortality rates by more than half. But for goal No. 2 to be successfully achieved, the U.S. needs a far better addiction-treatment infrastructure. The specialty clinics that can help addicts are relatively rare. That means the government needs to launch the opioids equivalent of the Ryan White HIV/AIDS Program, created in 1990 to ensure much broader access to HIV care and treatment.
As with AIDS a quarter-century ago, the opioids scourge now feels out of control. But it too can be brought under control with an effective, broad, thoughtful public health response. What Congress and the president have done to date is important and necessary. But it doesn’t go nearly far enough.
