After a brutal year of overdose deaths, the US needs urgent, coordinated action

We as Americans should be shocked that we reached the grim milestone of 100,000 drug overdose deaths year over year. The November announcement by the Centers for Disease Control and Prevention’s National Center for Health Statistics should cause all of us, whether serving in government or not, to redouble our efforts and act with urgency. 

We cannot become numb to increasing rates of overdose deaths in our country. It’s almost too much to comprehend the broad swath of the nation that has experienced overdose deaths. Over the past decade, nearly half a million people have suffered a drug overdose death.  

While we mourn these lost lives, that isn’t enough. We owe it to them to do the hard things now.  

The increasing presence of illicitly manufactured fentanyl in the U.S. drug supply is driving the majority of these overdose deaths. Simply put, the illegal drug supply in the United States has become more lethal.  

In April, the Office of National Drug Control Policy, which I led as acting director until November, released its drug policy priorities. For the first time ever, this plan included prioritizing harm reduction services. The priorities included expanding syringe services programs and the overdose antidote naloxone, as well as increasing the availability of test strips to detect the presence of illicitly manufactured fentanyl in drugs. The administration also sent Congress a historic budget request for fiscal year 2022 to fund the nation’s response. This was a blueprint for action and requires diligent follow-up by all levels of government.

Three steps must be taken now, beginning with scaling up harm reduction. First, state and local governments must act with dispatch to remove policies or laws that limit harm reduction programs. These barriers may include laws that prohibit syringe services programs or that classify fentanyl test strips as drug paraphernalia. 

In the absence of state action, local governments should consider using their own authorities to expand access to these services. Almost two decades ago, Philadelphia’s mayor issued an executive order that sanctioned syringe services programs even in the face of a state prohibition. New York City is taking local action by opening an overdose prevention site, the first such sanctioned program in the country. City officials will evaluate the program to determine the appropriate role it should play in local overdose response. 

When only about 10 percent of people receive treatment for a substance use disorder, it’s time to take a closer look at our policies to get help to the vast majority of people who are not receiving care. 

Second, Congress must pass a budget for fiscal year 2022 and not rely upon another continuing resolution. The president’s proposed budget would provide almost $41 billion dollars to expand the nation’s public health and public safety response to include building out the country’s addiction workforce capacity. The fiscal year 2022 Department of Health and Human Services budget request also includes an unprecedented $3.5 billion for the Substance Abuse and Mental Health Services Administration’s block grant. This block grant program will fund substance use prevention services and treatment for people without adequate insurance coverage. This same block grant would also include, in an unprecedented move, a 10 percent set aside for recovery support services. The set aside will lead the way for more people to receive services to sustain their recovery, thereby avoiding a return to use that could be deadly.

Lastly, Congress must act to remove barriers to treatment for people with substance use disorders, particularly for those most at risk of overdose. Congress is considering two pieces of legislation that, if passed, would expand access to life-saving treatment. The Mainstreaming Addiction Treatment Act (MAT Act) would remove the waiver requirement, training that is required before a prescriber can treat an individual with buprenorphine, one of the three FDA-approved medications for opioid use disorder. In addition, the Medicaid Reentry Act would allow Medicaid coverage 30 days prior to release from incarceration. People leaving incarceration are at heightened risk of overdose, connecting them to care upon reentry to the community will save lives by reducing overdose death rates. Taken together, the MAT Act and the Medicaid Reentry Act would help the nation bend the curve of overdose deaths by expanding access to care for people at risk of overdose. 

Curbing overdose deaths and building an effective response to the nation’s addiction problem is within reach. There are policies we can change and barriers we can remove that will make a difference. But swift and bold action is needed today — before we reach another milestone in this decades-long problem.     

Regina LaBelle, JD is the director of the Addiction Policy Initiative at Georgetown University Law Center and director of the Addiction Policy and Practice Master of Science program at Georgetown University’s Graduate School of Arts and Sciences. LaBelle served as acting director of the White House Office of National Drug Control Policy from January to November 2021.