Communities of color have seen opioid overdose deaths increase disproportionately during the pandemic, according to a report released by the Bipartisan Policy Center. In addition, people experiencing homelessness and those involved in the criminal justice system are now unable to access the care they need. The report dives deeper in six states — Arizona, Louisiana, New Hampshire, Ohio, Tennessee and Washington — to understand how spending is being allocated across different priorities and communities throughout the country.
As America’s opioid epidemic continues amidst the pandemic, public health experts are grappling with major questions around funding for evidence-based treatment programs for opioid use disorder and whether those dollars are being deployed to assist the people who need it the most.
The BPC report shows that at-risk groups, including people who are experiencing homelessness and those who are involved with the criminal justice system, are not able to access the care they need. In addition, overdose deaths continued to increase in communities of color, who may be less likely to access doctors who have a DEA “X waiver” that allows them to prescribe controlled substances such as buprenorphine to treat opioid use disorder.
“All of America is being impacted. We need to close the gap for communities of color and improve access to treatment programs,” said Anand Parekh, MD, Chief Medical Advisor for the Bipartisan Policy Center.
Parekh and BPC staff found similar results last year in their first report, which tracked federal funding for fiscal years 2017 and 2018. This year, they emphasized the need to examine the efficacy of these programs and whether federal dollars are supporting evidence-based practices for opioid use disorder treatment.
“One of the primary goals of studying how funding is distributed is to ensure that the public response to the opioid crisis is prioritizing evidence-based solutions,” said Sarah Twardock, who oversees the opioids portfolio at Arnold Ventures. (Arnold Ventures provided support to the Bipartisan Policy Center for both reports.)
“We know that our country has a history of deploying non-evidence-based responses to the issues of drug overdose and high-risk drug use,” she said. “Our goal is to ensure that paradigm changes. Analyses like these can track how public dollars are being spent and inform what may need to change to improve the national response.”
The need for treatment has surged during the pandemic. America’s opioid epidemic is one of the most pressing public health challenges we face, claiming nearly 70,000 lives every year. In 2019, studies showed a troubling uptick: Overdose deaths increased that year, erasing the promising gains observed the year before. Then the pandemic hit in early 2020 and quickly spread across the country, exacerbating opioid use.
“Even though we’re consumed on a daily basis with COVID-19, the nation faces pre-existing public health challenges,” Parekh said. “Millions of Americans deal with opioid use disorder, most of whom still don’t receive the gold standard of medication-assisted treatment, and tens of thousands die each year from overdoses.”
Findings & Recommendations
Overall, the report found that federal funding was slightly higher in 2019 than the previous year, marking a 3.3 percent increase from $7.4 billion to $7.6 billion. About two-thirds (or $5 billion) was dispersed by the Department of Health and Human Services, and about two-thirds of that (or $3.7 billion) was administered by the Substance Abuse and Mental Health Services Administration, or SAMHSA.
Similar to the year before, about three-quarters of funding went to treatment, recovery and prevention efforts, with the rest going to research, law enforcement and criminal justice. Funds for interdiction, or the prevention of trafficking in illicit opioids, increased from 5 percent to 9 percent. In addition, Medicaid coverage for medications that help with opioid use disorder, such as buprenorphine and naltrexone, as well as the overdose antidote naloxone, increased by about 15 percent to $1.5 billion.
“It’s fair to say that the geographic distribution of dollars, not surprisingly, is going to population centers where overdose deaths occur,” Parekh said. “However, it’s hard to pinpoint whether the funding is going to at-risk populations and those who really need it.”
At-risk groups include people who are experiencing homelessness and those who are involved with the criminal justice system. Few people who are incarcerated receive the standard of care for opioid use disorder, and overdose is the leading cause of death once they’re released from jails and prisons. State officials from the six states involved with the report expressed concerns about a lack of sustainable funding for community-based care for vulnerable groups, as well as supportive housing for people who leave correctional facilities and are in the early stages of recovery.
All of America is being impacted. We need to close the gap for communities of color and improve access to treatment programs.Anand Parekh, MD Chief Medical Advisor for the Bipartisan Policy Center
In addition, harm reduction programs, including syringe services, received limited federal funding. Although some states allow syringe programs to operate, the report authors found little coordination between behavioral health and public health agencies for these types of services. Beyond that, none of the six states involved in the report used federal funding for fentanyl test strips, though fentanyl use is increasing. State officials also reported more “polysubstance” overdose deaths, or a lethal combination of opioids and other drugs such as cocaine or methamphetamines.
To reach these at-risk populations, Parekh and colleagues recommend an increase in SAMHSA’s funding for evidence-based programs for substance use disorder. The same $1.85 billion has been doled out for the past four years, which hasn’t kept up with inflation or the alarming increase in overdose deaths. As part of an increase, additional funding could support culturally-relevant interventions for Black and Latinx communities that are less likely to receive substance use disorder treatment.
On top of that, the report urges evaluations of programs that receive federal funding to better understand the efficacy of treatment services. The evaluations should include health equity goals and details about at-risk populations — and be publicly available for people to reference.
“We’re at a point right now where we need to step back and ask what is working and what is not,” Parekh said. “We need a comprehensive, strategic plan as a nation to tackle this enormous challenge, and we need to see where we are to figure out where we want to go.”
Removing Barriers
As part of this effort, the research team recommended better coordination of harm reduction services and criminal justice support systems, both inside correctional facilities and after people reenter their communities. They suggested changes to other regulatory and legal barriers as well, such as changing restrictive funding language that may prevent statewide groups from addressing polysubstance overdoses, and eliminating the waiver requirement for health care providers to prescribe buprenorphine to patients. In addition, Medicaid expansion could extend access to treatment for people who have been incarcerated but not sentenced, as well as post-partum mothers for up to a year after they’ve given birth.
During the pandemic, for instance, the federal government relaxed regulations around telemedicine, which eased access to treatment. The report suggests an extension of this policy, including increased flexibility around take-home doses to help patients with treatment access and retention. Additional flexibilities could help public health experts to refocus their efforts on prevention and get ahead of the epidemic.
“For the nation, this is a reminder that even in the midst of COVID-19, there are other public health challenges, and we’re all in this together,” Parekh said. “We have to work hard together to save lives.”
