Our nation is in dire need of effective strategies to address the opioid epidemic. With this in mind, we published Ending the Opioid Crisis: A Practical Guide for State Policymakers. The goal of this guide is to replace misinformation and stigma with research-based facts and practical, health-based solutions in order to help state policymakers understand how they can implement a public health approach and solve this crisis.
Here, Lindsey Vuolo, J.D., M.P.H., associate director of health law and policy at The National Center on Addiction and Substance Abuse (The Center), and lead author on this report shares additional thoughts about why this guide matters, what is wrong with a punitive approach and the important role states can play in ending the opioid epidemic.
The Center: What inspired you to create a policy guide focused specifically on the opioid epidemic?
Lindsey Vuolo (LV): In April 2017, our Center and the State Legislative Leaders Foundation (SLLF) co-hosted a policy summit, Addressing the Opioid Crisis in America: Strategies that Work! This summit convened our nation’s top state legislative leaders as well as key researchers and practitioners in the field of addiction to discuss the challenges of opioid addiction, how best to address them, and what some states are doing to respond. Discussions at the summit revealed the need for a concise resource with concrete and effective strategies to prevent, reduce, treat, and manage opioid use, opioid addiction, and their tragic consequences.
We created this guide to cull proven and promising strategies from a range of evidence-based resources to offer a clear set of actions states can take. We also included examples of data-informed and treatment-focused programs and initiatives on the state and local levels that can serve as models for others. These examples are not all-inclusive and most have not been rigorously evaluated for effectiveness, but they do hold promise in their approach to the problem. There are states that are emerging as leaders on this issue and we encourage state policymakers to learn from one another in adopting and implementing successful approaches.
The Center: Why is it important that policymakers adopt these recommendations?
LV: These detailed recommendations draw from years of our own research about how best to address addiction in the United States as well as research from other organizations with a deep interest in finding workable solutions to help end this epidemic. The recommendations will help state policymakers understand what a public health approach looks like.
We encourage states to implement the recommendations in this guide and to examine the resources and illustrative examples provided to learn about the strategies that other states have employed and perhaps model their own initiatives on those examples. We challenge states to commit to adopting a comprehensive public health approach and evidence-based prevention and treatment practices. States that make this investment will not only be able to overcome the current opioid epidemic but will be in a better position to prevent and, if necessary, face future drug crises.
The Center: In the past, we have seen leaders approach drug addiction by punishing people who use drugs. What’s wrong with taking this type of punitive approach to address this epidemic, and why do we need to confront this issue through a public health approach instead?
LV: A punitive approach is misguided because it is based on the belief that addiction is a moral failing, character flaw, or poor choice. This approach has not worked because it doesn’t address the problem for what it is. Addiction is a disease and must be addressed the same way we address other diseases: through a public health approach. Health-based strategies offer practical solutions. Policy interventions based on anecdote, intuition or emotion are counter-productive. Relying on morality doesn’t yield practical or effective solutions. A public health approach offers the comprehensive strategy necessary to promote health and address this problem in a meaningful and effective way.
The Center: Why is it important that states get directly involved in solving the opioid epidemic?
LV: The federal government has threatened to upend our nation’s turn towards a public health approach by (1) seeking to eliminate insurance coverage for millions of people in need of addiction treatment; (2) invoking the ineffective, decades-old “war on drugs” and (3) seeking to cut funding to key organizations and agencies that have been leading the charge of finding and implementing effective solutions to the current drug epidemic. Although the opioid crisis is a national issue, individual states bear the brunt of the burden. Despite declaring the epidemic a public health emergency, the federal response to the epidemic has been quite limited.
States pay the enormous expenses of untreated addiction (in costs related to criminal justice, healthcare, education, social welfare, public safety, and lost productivity). A report by our Center found that approximately 16 percent of total state spending goes toward substance use and addiction; 94 percent is spent on addressing the consequences of substance use and addiction rather than on prevention, treatment, or research. States cannot afford not to address this issue. States also have the authority to implement many of these recommendations. Finally, each state faces unique challenges in tackling this problem and must tailor their responses accordingly.
The Center: We know states are already doing a lot to address the opioid epidemic. Why aren’t we seeing results?
LV: No state has adopted a truly comprehensive approach to address the crisis. Any approach must focus on a broad set of actions to: prevent opioid misuse and abuse; reduce overdose deaths and other harmful consequences; improve opioid addiction treatment; and improve addiction care in the criminal justice system. As is true of any complex problem, there is no one simple solution or magic bullet. Additionally, states must dedicate resources to address this problem that are commensurate with its size.
The Center: What can the public do to get the changes you recommended made in their community?
LV: Share this guide with policymakers in your state and ensure that policies, programs, and initiatives developed by community leaders are informed by data and evidence. Advocate strongly for efforts to end this devastating epidemic via a compassionate approach based in good science and health-based solutions, rather than a combative approach based in fear, stigma, shame, and despair. We’ve been operating under the latter frame of mind for decades to no avail. Let’s try something new.