Third Way: The First Epidemic; Biden And The American Opioid Crisis
Spencer Platt
The COVID-19 epidemic has dominated American attention, and for good reason. It has caused the deaths of 265,000 Americans at the time of writing. As the holidays approach, case numbers are set to break new records in the United States as communities in the Midwest begin to face the full force of the virus.
COVID-19 is the second epidemic Americans have faced in the past four years. The first, which COVID-19 has undoubtedly overshadowed, is the ongoing opioid addiction crisis that began rattling the United States in 2013. It is responsible for double the number of deaths. From 1999-2018, about 450,000 people have died from overdoses relating to opioids in both prescription and illicit forms. When COVID-19 came, it helped heighten the problems caused by the opioid epidemic. The American Medical Association and many others have reported that over 40 states have seen increases in opioid-related mortality during the pandemic. Isolation and the economic crisis brought on by COVID-19 has led to an increase in overdose deaths. Federal reports estimate that 76,000 people will have died from spikes in opioid use in the past year, and the number of opioid-related deaths is set to increase.
Although the problem started with the over-prescription of opiates, which has been increasing since 1999, it has moved beyond prescription drugs and now involves heroin and fentanyl, a synthetic and highly effective opiate. The Trump administration tried to make handling the opioid crisis a landmark success for their administration, but fell short in their efforts. Biden cannot afford to make the same mistake. The President-elect's plan is ambitious, with the aim of spending $125 billion over the next ten years on opioid relief, it is comprehensive and likely to get bipartisan support. That is a good start. If the plan is to be fully successful, however, Biden must provide sustained and immediate support for the project.
Dealing with the opioid epidemic needs to be one of Biden's top priorities if he intends to jumpstart the American economy. While COVID-19 has obviously crippled American markets, the opioid epidemic has also adversely affected the economy. Alan Kreuger of Princeton University showed in a 2017 paper that "the increase in opioid prescriptions from 1999 to 2015 could account for about 43% of the observed decline in men’s labour force participation during that same period." A more recent paper by three academics from the University of North Carolina affirmed this correlation, and also found the opioid crisis had negative effects on the growth of new business. The lack of available labour leads to firms investing more in capital, IT, and automation, which in turn squeezes the job market even further.
To give credit where credit is due, Trump made the opioid epidemic a key issue of his early years in the presidency. In 2017, he became the first president to declare the opioid crisis a national health emergency. In the following year, he increased federal opioid funding to record levels, doubling the amount of federal funding and quadrupling federal treatment and recovery monies. As tempting as it is to compare Trump's comments about the opioid epidemic to his claims that COVID-19 would disappear, his administration actually did take the opioid crisis seriously.
At least the Trump administration did at first. Big budget spending does nothing if it is not made sustainable and practicable. Trump made contact, but did not follow through. Funding is only one necessary, though not entirely sufficient way of dealing with the opioid epidemic. In their FY2019 Opioid Funding report, the Bipartisan Policy Center acknowledged Trump's increase in federal opioid spending. The report also highlights the need for a loosening of restrictions on opioid use disorder medicine and greater harm reduction response by the federal government, as well as criminal justice reform and expanded access through Medicaid, which Trump tried to remove by attacking the Affordable Care Act.
Another failure of the Trump administration was its fixation on policing the trafficking of opioids from Mexico and China rather than making substantive change at home. Indeed, in 2019 the amount of money spent on interdiction and drug trafficking saw a significant increase from 5% to 9%. While the administration was right to point a finger at China, which has become a mass producer of fentanyl, controlling the production of the illicit substance in the country is difficult. Even if Xi Jinping had kept his word and strictly enforced the policy change which increased state control of 1,400 fentanyl-like substances, cracking down on the transportation of fentanyl is practically impossible. The drug, which is highly potent even in small doses, can be disguised as the tiny sachets of desiccant which keep packaged goods dry. The Chinese postal system, which processes 75,000 new parcels every minute, could never keep up. Trump's opioid response, while not bad, never pushed the needle where it should have been, mostly because of a lack of sustained attention to the crisis.
Biden V. Opioids Inc.
In contrast, the Biden administration seems ready to implement its comprehensive opioid plan as soon as the President-elect enters the White House. The crisis is something a bipartisan Senate should be willing to work on. Biden, having experienced addiction through his son Hunter, will bring a much needed human touch to the crisis, as well as a healthy belief in scientific evidence.
Biden's opening salvo against the opioid epidemic will almost certainly be the removal of restrictions on the medicine used to treat opioid use disorder, such as drugs containing buprenorphine or methadone. These drugs can halve the risk of death by overdose. Trump began this process but failed to fully eliminate the restrictions blocking access to medicine. This task is bundled with the broader $20 billion aim to make medication-assisted treatment for opioid use disorder universal by 2025. $10 billion of Biden's opioid plan will be devoted to supporting local community health by increasing Narcan training and local education efforts. Most of the other money will be spent on increasing the amount of trained medical personnel in localities heavily affected and to prevent the over-prescription of opiates.
Big budget investment is always appealing to progressives, and it is a step that must be taken by the Biden administration to combat the opioid crisis. Biden, however, should not make the same mistake as Trump, assuming that massive government spending will be enough to deal with the crisis. The opioid epidemic has become a multi-faceted problem, its arms reaching into over-prescription, fentanyl and synthetic opiates, and accessibility factors, among a myriad of other challenges involving poor regulation on every level.
Biden Plan For The Opioid Epidemic, Funding Distribution
The President-elect's plan seems to appreciate this in some ways. One stand-out feature of it is Biden's desire to expand the coverage of Medicare and Medicaid to include alternative treatment to chronic pain, which may have psychological origins. Next week, the Third Way columnist will investigate the criminal justice aspect of Biden's plan, however, it is important to note that the President-elect plans on reforming the criminal justice system so that "no one is incarcerated for drug use alone." This mark a decisive shift away from the "war on drugs" rhetoric used in the past, signalling a much-needed reevaluation of how drug users are treated.
Despite that shift, Biden's rhetoric on China and Mexico, bracketing the use of "cooperation," sounds like more of the same. That is not to claim that cooperation efforts are wasteful; better global accountability spurred by alliances with other democracies is what a Biden China-strategy should look like. Too much focus on China and Mexico regarding opioids, however, would be a waste of an investment. Biden would do far better to focus on remedies at home rather than stopping the flow from aboard.
Of course, the funding for Biden's plan must come from somewhere. The President-elect's team claims that the "$125 billion investment in a comprehensive response to the opioid epidemic and substance use disorders (will be) paid for by raising taxes on the profits of pharmaceutical corporations." Biden is right to place the burden on pharmaceutical companies like Purdue Pharma, which, through its unscrupulous supplying of OxyContin, is largely considered one of the prime movers of the crisis. Although Biden has committed to charging big pharmaceutical companies, both legally and financially, to support his plan, this source of income may not be enough. The recent DOJ settlement with Purdue pharma was only worth $8.3 billion. More generous settlements will likely not fill American coffers with $125 billion, assuming the settlements actually occur, which is still in question.
The President-elect may face the ever-looming threat of a Republican-controlled Senate. Issuing his $125 billion opioid plan could be met with resistance by a GOP, who, as the current squabble over a second COVID-19 stimulus bill has shown, are concerned by excess spending. A massive plan like Biden's seems all but certain to gain some right-wing ire. Solutions to the opioid epidemic, however, have seen bipartisan support from congress. In 2018, the SUPPORT act included a myriad of provisions for dealing with the crisis, ranging from increases in education about the opioid epidemic and increasing access to treatment. The comprehensive bill easily passed the Senate with 99 votes in favor. Even if the majority of Republicans make it their mission to block any of Biden's policy, Republican Senators Rob Portman of Ohio and Shelley Moore Capito of West Virginia have indicated a willingness to cooperate on opioid related policy, as the crisis has overwhelmingly affected their states. Biden, then, would likely have enough bipartisan wiggle room to get an opioid policy through the upper house.
Whatever the iteration, Biden must take steps to tackle the opioid epidemic in America. With harsh economic tolls, an increasing death-rate, and the potential for the problem to grow exponentially, action needs to be taken in comprehensive, multilateral ways. Funding can only go so far. This leaves the President-elect with another herculean task to shoulder once he enters the Oval Office. Yet, with a personal connection to the problem and an intensely detailed plan, the Biden administration looks ready to end the war on drugs and find a far more successful solution.
