Elizabeth Warren’s ambitious plan to fight the opioid epidemic, explained


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Most presidential candidates aren’t talking much about the opioid epidemic. But Warren wants to put serious resources toward ending the crisis.

Elizabeth Warren is widely known for her public battles with big banks and Wall Street. She’s gotten attention for her wealth tax proposal. She’s praised, even by some conservatives, for her book The Two-Income Trap.

One part of the 2020 presidential hopeful’s record doesn’t get as much attention: her efforts to fight America’s opioid crisis.

As a US senator for Massachusetts, Warren has built a formidable record on the opioid crisis, which now kills more Americans than gun violence or car crashes. She’s called for more research into alternative painkillers, including medical marijuana. She’s tried to hold President Donald Trump’s administration accountable for its weak response, even pushing a government watchdog agency to investigate the administration.

And Warren, along with Rep. Elijah Cummings in 2018 introduced what experts regularly cite as the best bill in Congress on the issue: the Comprehensive Addiction Resources Emergency (CARE) Act. The bill would authorize $100 billion over 10 years to combat drug addiction, funneling money to cities, counties, and states — particularly those hardest hit by drug overdoses — and other organizations to boost spending on addiction treatment, harm reduction services, and prevention programs.

“Our communities are on the front lines of the epidemic, and they’re working hard to fight back,” Warren told me in an interview. “But they can’t do it alone. They can’t keep nibbling around the edges.”

Warren is now running for president, and her record could set her apart on one of America’s worst public health crises. In 2017, there were a record 70,000 drug overdose deaths, about two-thirds of which were linked to opioids. The number of overdose deaths was so high that the Centers for Disease Control and Prevention linked it to a rare drop in US life expectancy that year. Preliminary data suggests 2018 was about the same, or perhaps a bit worse, nationwide.

There’s wide agreement, among activists and drug policy experts, that much more action is needed to reverse the opioid crisis. Congress has changed some regulations and rules to open up access to treatment, and it’s allocated some funds here and there, in the single-digit billions, to the crisis. But advocates and experts argue something far more comprehensive — tens of billions of dollars over the next few years — is needed. Republicans, however, have resisted such calls, voicing skepticism of running up government spending (outside tax cuts for the wealthy).

Yet so far, no presidential candidate but Warren has put forward a concrete plan to confront the opioid epidemic. Her Massachusetts Senate seat has likely influenced her actions: Like the rest of New England, Massachusetts has seen a disproportionate number of overdose deaths. Its rate of drug overdose deaths was 31.8 per 100,000 people in 2017, far above the national average of 21.7.

The CARE Act makes the kind of commitment that advocates and experts have called for. As I’ve traveled around North America and talked to people on the ground about the opioid epidemic, experts and activists have, without even being asked about federal legislation, pointed to the CARE Act as an example of a serious attempt to tackle the crisis.

The bill “is the only one that really grasps the nettle of how big the problem is,” Keith Humphreys, a drug policy expert at Stanford University, told me. “Whatever else people might say about it, this is the first thing that really recognizes that [the opioid crisis] is a massive public health problem, like AIDS, and is not going to be solved by a tweak here, a tweak there.”

This comparison to the HIV and AIDS epidemic is one that experts and activists — and Warren — frequently use, because it’s an example both of the death toll of government indifference and of the power of Congress to actually make change. (Relatedly, drug overdoses now kill more people in the US each year than HIV and AIDS did at its peak.)

In the 1980s, as the death toll from AIDS rose, the federal government took only small-scale actions. Then in 1990, Congress passed the Ryan White CARE Act, which dedicated billions of dollars over the years to boost access to treatment and medications. A few years later — following the law, other programs, and treatment breakthroughs — the crisis hit a turning point: After a decade and a half of rising death, the toll started to decrease in the mid-’90s.

Warren said she and Cummings see the two epidemics as having something in common: “the federal response was constantly too little, too late.” So they reached out to advocates and experts about what would finally turn the opioid epidemic around. Even the name of their bill, the CARE Act, echoes the Ryan White CARE Act that passed nearly two decades ago.
What the CARE Act does

The CARE Act would authorize $100 billion to address drug addiction in the US over 10 years, with the goal of dramatically boosting addiction treatment and other policy initiatives that can reduce overdose deaths.

The money is divided into several pots. Some would go to states, territories, and tribal governments, while others would go to local governments and nonprofit programs. Some would be based on overdose levels; others would go out through competitive grants. Parts of the money would go to funding innovative treatment models, and some would be dedicated to expanding access to the opioid overdose antidote naloxone. Other funding would be dedicated to research, surveillance, and training for health care staff.

There are some guardrails. For example, the bill would direct the secretary of health and human services to develop standards for the treatment that gets funding. And there are rules, with waivers available, that would push treatment facilities to provide the full range of medications for opioid addiction treatment. The idea is to make sure the gold standard of treatment gets preference, which, in the case of opioids, means medications like buprenorphine and methadone.

There’s some flexibility too. The money, for instance, can go to ideas that aren’t related to opioids. (But given that most overdoses today are linked to opioids, most of the funds would likely go to opioid-related programs, at least at first.) It’s also not limited to addiction treatment; funding could go to, say, needle exchanges or other harm reduction services — as long as there’s evidence that a program would reduce overdose deaths and it doesn’t violate the law.

This generally follows the model set up by the Ryan White program, which has sent funding to all sorts of organizations and governments to scale up the response to HIV and AIDS at every level. It’s widely credited by experts for helping reverse the HIV and AIDS epidemic in the 1990s, particularly by unlocking treatment options for the uninsured and underinsured.

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