OPINION

Op-Ed: America's opioid epidemic is getting worse

By Nishi Rawat

The COVID-19 pandemic continues to overwhelm the U.S. healthcare system as the delta variant rapidly works its way around the country. More than 40 million COVID cases have been reported in the U.S. since early 2020, including more than 8 million active cases. The COVID death toll now exceeds 700,000 people, with 800 to 2,500 deaths currently reported each day.

While COVID rightly remains a high priority for healthcare professionals, public policymakers, and the media, the pandemic has drawn attention away from the opioid epidemic. The Centers for Disease Control and Prevention reports that 93,331 people died of drug overdoses in 2020, up 32% from 70,630 in 2019. This astounding number exceeds the overdose death toll in any year since the opioid epidemic began in the 1990s and is the largest annual percentage increase since 1999, according to The Commonwealth Fund. Of those 2020 overdose deaths, 74.7% (or 69,710) involved opioids.

Given the continuing negative impact of the pandemic on mental health and financial stability, it’s no surprise that opioid addiction remains at historically high levels as people struggle to cope and as support and treatment resources remain limited. In a National Council for Mental Wellbeing survey taken in February, 63% of members that offer substance abuse treatment said demand for their organization’s services has increased over the previous three months. Ominously, 40% of mental health and addiction treatment organizations responding to the survey reported that they may run out of funds in less than a year under conditions at the time.

Nishi Rawat, M.D. is chief medical officer at Bamboo Health, which works with the PA Department of Health to help providers access the commonwealth's prescription drug monitoring program.

Not only does opioid addiction devastate communities and families across the country each year, but it also exacts a huge toll on our economy. According to the CDC, the total economic burden of prescription opioid misuse alone in the U.S. — including the costs of healthcare, lost productivity, addiction treatment and criminal justice activity — was $78.5 billion in 2013. That number undoubtedly is far higher today.

It’s clear, then, that healthcare providers, behavioral health professionals, and federal and state governments collectively must renew their focus on opioids and the tragic damage they do to communities and families across the country each year. First, treatment services for substance use disorders such as opioid addiction need to be made more accessible and affordable to those who need it. Accessible starts with helping to fund financially imperiled and resource-strapped treatment organizations to keep their doors open and services available. To that end, the Biden Administration in August announced $10.7 million in federal grants to enable state and regional networks of pediatric mental health care providers to integrate telehealth services into behavioral health care programs and substance abuse treatment. While that’s a start, more government investment in opioid treatment is critical.

Related to accessibility is affordability. Opioid treatment programs currently cost from $500 to $1,275 per month, depending on the treatment plan. This is far beyond the ability of many people to pay out of pocket yet plans commonly have coverage limitations for treating opioid use disorders.

Second, we need to upgrade and expand crisis services to make these easily accessible to all in need. All states are currently investing in the necessary clinical infrastructure, including crisis lines, mobile crisis teams and crisis stabilization services, in preparation for the rollout next July of the 988 initiative, which establishes a new nationwide three-digit phone number for people in crisis to connect with mental health and suicide prevention counselors. States also need to invest in the digital infrastructure necessary to ensure people can access care once they’ve contacted a crisis line.

Third, we must integrate new treatment models such as telemedicine into care plans. This may require relaxing regulations governing the delivery of remote care. During the pandemic, for example, the need for in-person consultation prior to prescribing buprenorphine — used to treat opioid use disorder — was waived and will remain so for the duration of the declared national emergency (which was extended in late February by President Biden). We know from our experience during the pandemic that telemedicine is effective, so it makes sense to permanently waive remote care restrictions so more people can get help to overcome their addictions.

This exemption will continue for the period of the national emergency declared in response to the COVID-19 pandemic and applies exclusively to OTP patients treated with buprenorphine. This exemption does not apply to new OTP patients treated with methadone.

Finally, we must continue to use the powerful tools already at our disposal to monitor and control the dispensing of prescribed opioids. State prescription drug monitoring programs allow clinicians and pharmacists to see a patient’s recent prescription history and make more informed dispensing decisions to keep patients safe. Providers are more informed of all prescriptions and changes in prescription history to help reduce negative drug interactions, prevent opioid misuse, and reduce risk of opioid-related harm. More healthcare organizations and pharmacies should integrate these PDMPs into their EHRs and networks.

President Biden recognizes the importance of this work, so much so that he proclaimed September as National Recovery Month. The opioid epidemic isn’t going away by itself anytime soon. We must all focus on reducing the death and destruction caused by this insidious and persistent addiction. It will take caring, commitment, cooperation and the right tools and resources. It will be a tough fight, but it’s one we can win.

Nishi Rawat, M.D. is chief medical officer at Bamboo Health, which works with the PA Department of Health to help providers access the commonwealth's prescription drug monitoring program.