America’s drug overdose crisis is out of control. Washington, despite a bipartisan desire to combat it, is finding its addiction-fighting programs are failing.
In 2018, Republicans, Democrats and then-President Donald Trump united around legislation that threw $20 billion into treatment, prevention and recovery. But five years later, the SUPPORT Act has lapsed and the number of Americans dying from overdoses has grown more than 60 percent, driven by illicit fentanyl. The battle has turned into a slog.
Even though 105,000 Americans died last year, Congress is showing little urgency about reupping the law since it expired on Sept. 30. That’s not because of partisan division, but a realization that there are no quick fixes a new law could bring to bear.
Aiming to expand access to treatment, Congress in December eliminated the waiver and training requirements physicians needed to prescribe buprenorphine, which helps patients stop taking fentanyl. The Drug Enforcement Administration recently extended eased pandemic rules for prescribing it via telemedicine through the end of 2024.
A bipartisan group of representatives focused on mental health and substance use has proposed more than 70 bills this Congress to fight the overdose crisis, but none of them has inspired the kind of urgency lawmakers showed five years ago when they packaged bills into one landmark package: the SUPPORT Act.
The law’s expiration on Oct. 1 means states are no longer required to cover all of the FDA-approved treatments for opioid use disorder through Medicaid but public health advocates don’t expect any state to drop that coverage.
I lost two family members to fentanyl in one year. My aunt was so fucked up she didn’t realize she cracked the back of her skull open on the floor when she fell, and then she got back up and went to bed for the last time. A few months prior to this, her grand daughter died of a fentanyl overdose. The mother died many years ago due to overdose.
Fuck addiction. And fuck fentanyl in particular. I worked professionally with an adult population which had high rates of drug use, and everyone will tell you how much more dangerous it is, regardless if they’re a mental health professional, a drug user, or both.
We need so much more funding for evidence-based programs and resources. We need to address and tackle homeless as well, because the two problems are so intertwined. I can’t tell you how many clients I had on my caseload tell me that they never had drug use problems until they had to live on the streets.
The sad truth is that severe mental illness, disordered drug use, and homelessness are highly related, and the Department of Corrections (DOC) is the largest mental health provider in the U.S. since deinstitutionalization. It’s a revolving door where an individual gets arrested, becomes sober/stable on anti-psychotics and/or mood stabilizers, is released without a proper support system, relapse occurs and/or medication is failed to be refilled, a psychotic episode or drug-induced psychosis presents, 911 is called, and rinse and repeat.
I worked exclusively with adults living at residential care facilities and assisted living facilities which this population often ended up at, especially if the courts were petitioned to assign a public administrator as a court-appointed guardian (most of my clients fell into this category). Some RCFs and ALFs were far from ideal and I hotlined facilities/assisted DHSS and DMH with investigations at various facilities.
But we need more places like this that can be described almost as a cross between a nursing facility and a halfway house, that provides residential care for these individuals (food, cleaning, meds, etc.). I worked for a 3rd party agency providing case management services for this particular population, and the type of work I did was called Community Psychiatric Rehabilitation.
I would work with these people to teach them coping skills/utilize evidence-based resources, I hosted an illness management and recovery (IMR) group, taught them how to improve their daily living abilities, helped apply for grants and resources, and I would assist people in the community (e.g. teaching budgeting skills or ensuring healthcare literacy in medical appointments). Essentially, my ultimate purpose and goal was to help these people transition from their facilities back into the community, or at least to a more independent setting.
In order to address the opioid/fentanyl crisis, we must also address the homelessness crisis as well as establish a better safety net and social programs to actually support our previously incarcerated population. There needs to be systemic change in the way we treat our criminals and individuals with severe mental illness and/or substance use disorder.
One thing that my years at that job working with that population really cemented is that black and white thinking is just a false construct, and we all really live in the grey. I worked with great humans who committed truly bad acts which they regretted deeply. It’s too easy for people to marginalize this population, but they are very vulnerable individuals who deserve a proper shot at life with real support, often for the first time in their lives.
At the same time, having personal relationships and loss of members of family who fell into this population, you also have to set firm boundaries and make hard decisions to protect yourself from friends/loved ones struggling with addiction.
Thank you for doing that work.