Last month, the Obama administration declared a public health emergency in Puerto Rico to cope with the spread of the Zika virus. There’s no question that Zika poses a threat to public health, but its magnitude is uncertain. In contrast, we know that the opioid epidemic is killing more than 500 Americans a week and harming thousands more. Why isn’t that a public health emergency, too?
This epidemic is a personal one for us. We practice medicine in Charlestown, a Boston neighborhood with 17,000 residents. Last week, families held a vigil for loved ones lost to opioid overdoses: 112 pictures were on display. Every day, we treat overdose survivors and others desperately seeking help for drug addiction. But we find ourselves stymied by our inability to get access to the treatments needed by our patients with opioid use disorders.
Congress took a first step toward responding to this expanding epidemic by passing, nearly unanimously, the Comprehensive Addiction and Recovery Act this summer. This $181 million act was designed to fund a wide range of activities essential to turning the tide on opioid addiction, including expansion of overdose reversal, recovery, and prevention programs.
When President Obama signed the act into law on July 22, there was much cause for celebration. The press covered the passage of the bipartisan bill in an extremely favorable light, highlighting the devastating impact the growth of opioid addiction is having across the country. The bill wasn’t just a political success. It also elicited congratulations from leading addiction medicine and psychiatry organizations, signaling to Americans that addiction is not a moral failing but a chronic disease to be treated with compassion and urgency. As addiction and primary care physicians, we believed that the passage and signing of the act would get more addiction treatment efforts up and running in time for September, which is National Recovery Month.
But since the Comprehensive Addiction and Recovery Act became the law of the land, Congress hasn’t made any money available to turn it into real treatments for real people. Lawmakers looked good by approving the act, but sadly, given the extreme partisan infighting and budgetary inaction in Congress, they never appropriated the money to fund it, rendering the bill and its good intentions effectively useless.
In the eight weeks since the act became law, more than 4,200 Americans have died from opioid overdoses. They were young and old, some wealthy and some living on the margins of society. They were husbands, wives, parents, children, siblings, and friends. The stigma and isolation of addiction led many of them to hide their disease until it was too late.
Recovery from opioid addiction is a challenging process. The early stages are extremely tenuous, and relapse can lead to unintentional overdose, especially as extra-potent opioids such as fentanyl and carfentanil enter the drug supply chain as adulterants in counterfeit pills and heroin.
We have seen in our patients how long-term treatment with medications like buprenorphine, methadone, and naltrexone can help those with addiction regain their lives. We know firsthand that deaths can be prevented by making naloxone, which quickly reverses an opioid overdose, universally available to treat overdoses before brain injury occurs from lack of oxygen. Yet without funding from Congress, our friends and community members will continue to die needlessly.
In light of the failure of Congress to fund the Comprehensive Addiction and Recovery Act, we call on the Obama administration to do for the opioid addiction epidemic what it has done for Zika in Puerto Rico: declare it to be a public health emergency under section 319 of the Public Health Service Act. Such a declaration could rapidly mobilize significant financial and human resources. Individual state governments would then have the power to declare a state of public emergency to make additional funding available in their communities and extend the reach of federal funds.
Health care systems throughout the United States could use these funds to invest in our citizens in recovery, enhance the addiction prevention and treatment services urgently needed by millions of Americans and their families, strengthen programs to monitor and track prescription trends, and intervene to prevent our children from ever developing addiction.
Frustrated by the lack of treatment availability and exhausted by the ever-mounting human toll, we are counting on President Obama, Department of Health and Human Services Secretary Sylvia Burwell, and other leaders to help us bring proven treatments to Americans who urgently need them.
Benjamin Bearnot, MD, is a primary care physician at the Mass General Hospital Charlestown Community Healthcare Center and an innovation fellow in the Division of General Internal Medicine. Mark Eisenberg, MD, is a primary care physician at the Mass General Hospital Charlestown Community Healthcare Center and assistant professor of medicine at Harvard Medical School.