The number of overdose deaths in the United States from the use of illicit drugs and the misuse of prescription drugs has risen to unprecedented levels. This crisis has worsened despite dozens of ongoing federal, state, local, and private-sector efforts to prevent drug misuse and to treat substance use disorders.
Drug misuse—the use of illicit drugs and the misuse of prescription drugs—has been a long-standing and persistent problem in the United States. National rates of drug misuse have increased over the past two decades and represent a serious risk to public health. This has resulted in significant loss of life and harmful effects to society and the economy, including billions of dollars in costs. The federal drug control budget for FY 2019 was over $36 billion, and it funded the efforts of over a dozen federal agencies that are working on prevention, treatment, international counternarcotics, and law enforcement activities.
Because of the devastating effects of this issue, National Efforts to Prevent, Respond to, and Recover from Drug Misuse will be added to the high-risk list in 2021. (This has been considered a High-Risk area since March 2020 but it was not added to the high-risk list immediately because the federal government’s efforts were focused on the COVID-19 pandemic.)
Increasing access to treatments
The federal government is urged to further support improved access to treatments that can assist with drug misuse.
- Medicaid is one of the largest sources of coverage for individuals undergoing medication-assisted treatment (MAT), which combines medications like methadone and buprenorphine with behavioral therapy to treat opioid use disorders. The Department of Health and Human Services (HHS) has identified expanding access to MAT as important for reducing opioid use disorders and overdoses and has taken action to increase access. However, some state and federal policies restrict Medicaid beneficiaries’ access to MAT medications.
- Veterans coping with the stresses of deployment or with readjusting to civilian life are at particular risk for drug and alcohol addiction. Veterans living in rural areas use the VA’s substance use disorder treatment services at the same rate as those in urban areas, but their access to these services is sometimes more limited. Providing treatment in rural areas poses challenges, such as a shortage of specialized providers and lack of transportation. VA is taking steps to address these challenges.
- Neonatal abstinence syndrome (NAS)—a condition causing withdrawal symptoms in newborns such as difficulties breathing and feeding—has also increased as a result of the opioid crisis. In May 2017, HHS published a strategy with key recommendations to help address some of the challenges related to treating NAS. However, HHS lacks a sound plan for implementing these recommendations, such as establishing priorities, stakeholder responsibilities, implementation timeframes, and methods for assessing progress.
- Federal law requires the governors of all states to provide assurances that their states have laws or programs that include policies and procedures to address the needs of infants affected by prenatal substance use. While HHS provides some guidance and technical assistance to implement this federal law, it needs to expand its assistance to help states better implement protections for children.
In 2016, experts at a Comptroller General Forum identified several high-priority areas to help prevent illicit drug use and the misuse of prescription drugs.
- Supporting community coalitions made up of the health care, education, and law enforcement sectors that work together to prevent illicit drug use at the local level
- Consolidating federal funding for multiple prevention programs into a single fund that addresses a range of unhealthy behaviors (including illicit drug use)
- Increasing the use of prevention programs that have been proven to be effective
- Supporting drug prevention efforts in primary-care settings—such as reimbursing providers for conducting preventative drug screenings