The consensus among leading public health experts has long been that the spiraling U.S. opioid epidemic cannot be effectively curbed with half-measures.
Some in Congress have been trying to act on the recommendations from experts, introducing legislation to spend $10 billion a year on treatment, research, prescriber monitoring, and other consensus priorities. But as heroin-like chemicals continue to push the overall overdose death toll to grim new yearly records, that call to action has gone nowhere.
Now Sen. Elizabeth Warren (D-MA) is using the added spotlight of her presidential candidacy to bring renewed energy to the legislation she and Rep. Elijah Cummings (D-MD) first put forth a year ago. She made the case for the legislation on the same Medium blog she’s been using to roll out a series of intricate and aggressive policy ideas directly tied to her campaign for the White House.
“We should pass it – not in two years, not after the 2020 elections – but immediately,” Warren wrote. In case her peers in D.C. don’t go for that, though, she also made clear that the proposal is included in her promise to presidential voters, connecting its modest cost to the huge windfall her tax policy platform would generate.
The $100 billion, 10-year proposal in the Cummings-Warren bill shouldn’t have to wait that long, with President Donald Trump and his fellow Republican electeds now routinely content with passing multi-trillion-dollar spending packages. This bill’s costs would essentially amount to a rounding error on recent budgets.
The legislation is designed to push money out to leaders close to the crisis’ front lines, and to minimize the strings that are attached to those resources.
More than a billion dollars a year would go directly to non-government organizations working directly with drug users, and could be used for medication-assisted treatment, needle-exchange programs, and other proven public-health winners that have been politically controversial in the past. Fully $500 million a year would go just to getting the overdose reversal drug naloxone into the hands of first responders around the country.
The bulk of the proposed spending, though, would go to governments. State and tribal governments would split $4 billion in annual opioid money, on top of a $2.7 billion grant program targeted to the county and city level, with a special emphasis on places where overdose rates are most common. The remainder — $1.1 billion a year, or $11 billion over the decade-long life of the plan – would funnel to public health research and monitoring work that’s essential to gauging the evolution of the crisis and generating new ideas for tackling it.
The $100 billion ten-year total almost exactly matches what public health professionals and addiction treatment specialists have been saying is required to properly address the mix of prescription opioid medicines and their black-market cousins that’s driven a spike in overdoses and deaths for two decades.
Despite the clarity and unity around that specific threshold, Trump and his congressional allies have insisted it’s possible to do more with less. The result, for more than two years now, has been a mix of bold posturing and feeble policy.
The White House used splashy emergency declarations to show some initiative in 2017, but failed to attach any new funding for either services or research to that effort. Trump subsequently issued helpful but small executive actions to make treatment more accessible, but counteracted their efficacy by continuing to undermine Medicaid.
The crisis’ victims and their advocates saw some improvement the following year. While the president was still issuing diatribes about executing drug dealers, he also signed a spending bill to actually provide new dollars for frontline work on addiction. But it amounted to about $2 billion a year for about half a decade – a far cry from the decade-long $100 billion commitment the advocates had clamored for.
The White House’s desire to have it both ways on opioids – to play tough in the public square while withholding meaningful resources – were already evident when Cummings and Warren first proposed the package she spotlighted again Wednesday. But that didn’t galvanize support for their idea on Capitol Hill, where fewer than one House member in five signed onto Cummings’ legislation and Warren’s got zero co-signs in the Senate.
Since then, however, the popular attention paid to the opioid epidemic has only sharpened. Democrats have won back half the Congress, creating an avenue to alternative ideas to the ones generated by the White House. And the ugly fact that some people have gotten extraordinarily rich by spawning this modern version of the ages-old heroin problem has helped to stoke a larger public outrage.
Warren’s willingness to stage a confrontation with the scheming plutocrats who’ve used this slow-motion crisis to fatten their own purses is central to her appeal as a candidate as well. The billionaire Sackler family behind both OxyContin and a for-profit chain of recovery centers marketed to OxyContin addicts come in for special ire – though not, tellingly, a call to treat them any differently than the other hyperwealthy people Warren’s tax proposals target.
“They’re billionaires. They own mansions around the world. Entire wings of museums in New York and London have been stamped with the family name,” Warren wrote. “Under my opioid plan, billionaires like the Sacklers wouldn’t get to live the high life while only 1 out of 5 folks who need opioid treatment get the help they need.”