In November 2021, provisional data from the Centers for Disease Control and Prevention (CDC) showed that the U.S. surpassed 100,000 drug overdose deaths from April 2020 to April 2021. This record-setting number follows the previously reported figure of 93,145 overdose deaths in 2020 (roughly 30% higher than in 2019). The recent rise in overdose mortality rates has been exacerbated by increases in fentanyl and polysubstance use, and complicated by an accompanying long-standing stigma regarding addiction. Furthermore, the COVID-19 pandemic has intensified the conditions leading to overdose; people with substance use disorders (SUD) were greatly affected by the pandemic’s disruption of daily life and reduced access to treatment services. Drug overdose mortality rates in minority populations have disproportionately increased recently, with Black and Native American mortality rates increasing by 81%, and Hispanic mortality rates increasing by 65% between 2019 and 2021; by comparison, for whites, mortality rates increased by 40%. Since the start of the COVID-19 pandemic, the South and West regions have seen 57% and 67% increases in drug overdose mortality, respectively, versus an 18% increase in the Northeast and a 37% increase in the Midwest. In response to this crisis, Congress has maintained opioid-related discretionary spending at over $6 billion per year from fiscal year 2018 through fiscal year 2020. The COVID-19 relief funds have added an additional $2.5 billion in funds targeting SUD. It is important to note that these discretionary dollars are dwarfed by mandatory spending; Medicaid alone spent approximately $23 billion in 2019 on treatment for opioid use disorder. While considerable attention has focused on the drivers of the opioid crisis, policymakers in Congress remain unsure whether federal investments in opioid-related programs over the past several years have yielded improved patient outcomes, as treatment remains out of reach for the vast majority of Americans with SUD, and overdoses remain high. Building on its previous 2019 and 2020 reports, BPC launched the Opioid Crisis Task Force to develop recommendations for Congress and the Biden administration to optimize mandatory and discretionary spending and improve opioid-related population health outcomes. The recommendations fall into four policy areas: mandatory spending that could be more fully leveraged; discretionary spending with a focus on “smarter” spending that is evidence based and coordinated; data reporting and metrics that could be more uniform, frequently reported, and actionable; and governance and leadership to best ensure executive branch-wide coordination and accountability.
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