Remarks as Prepared for Delivery
Thank you for this opportunity to discuss the steps the Biden-Harris Administration is taking to curb overdose deaths and build the infrastructure that’s necessary to develop a holistic response to addiction in this country…and to discuss how opioid litigation funds can help further our nation’s work in this regard.
State of the Epidemic
About a month ago, we recognized Overdose Awareness Week, as declared by President Biden.
In his Presidential Proclamation, he said:
“Addiction is a disease that touches families in every community, including my own. The epidemic is national, but the impact is personal. It’s personal to the millions who confront substance use disorder every day, and to the families who have lost loved ones to an overdose… By enhancing our support for individuals facing substance use disorder we can save lives.”
And our challenge has never been greater.
The CDC numbers on overdose deaths paint a grim picture: the agency predicts that more than 93,000 people died of an overdose death in 2020, and almost 70,000 of these deaths involved an opioid.
These aren’t just numbers – these are our neighbors, our families, our children. And our communities – and our country – are counting on us to bend the curve on overdose deaths and help communities heal.
When I joined ONDCP in 2009, overdose deaths involving opioids were at 20,000, primarily driven by prescription opioids. It was a growing problem, and the Obama Administration developed a response plan.
At the time, we had record rates of opioid prescribing and we saw small towns in rural America flooded by prescription opioids. One town that became emblematic of the growing problem was Kermit, West Virginia.
Kermit is in Mingo County, West Virginia – a town that at the time, had a population of 382. And in a two-year period, 9 million pain pills were shipped to the pharmacy in this town.
Meanwhile, in Florida, illegal pain clinics were proliferating. You’ve heard the stories – a doctor would come in for an hour or so, sign prescriptions. People would line up, enter the doctor’s office – which also dispensed the pain pills – then leave. They would either drive back to their home or fly on one of the many cheap flights that went back and forth between Florida and Appalachia.
To be sure, these pain clinics were not treating patients.
They were operating criminal enterprises that led to unprecedented spikes in overdose deaths. Overdose deaths suffered in some of the most forgotten areas of the country.
We have seen the epidemic evolve – the CDC refers to the three waves of the epidemic – beginning with overprescribing of pain medications, then leading to heroin once prescription opioids were limited. Until finally, a new, more lethal strain of opioid – illicitly manufactured fentanyl – entered the drug supply.
And now we’re seeing unprecedented rates of overdose death, primarily driven by illicitly manufactured fentanyl but increasingly involving cocaine and methamphetamine.
And still, overdose deaths continue to rise.
While the opioid epidemic has evolved, so too has our understanding of this disease, and so have the tools we have to help people.
Where We Need to Go
In the years I’ve worked on this issue – including at the Office of National Drug Control Policy and at the O’Neill Institute – one thing has become abundantly clear: We must build a better addiction infrastructure that prevents substance use disorder while also meeting the needs of the 20 million Americans with substance use disorder, and while also sustaining recovery for the 23 million people in recovery.
Our efforts span the continuum of care – from evidence-based prevention, to harm reduction, treatment, and recovery services.
In addition, our efforts include improving racial equity in drug policy and healthcare…as well as disrupting criminal networks domestically and internationally that traffic in drugs.
And, finally, we need to improve services by making sure that our nation’s health care providers, including the medical community, fully understand addiction so they can better intervene where someone shows early signs of risky substance use that may develop into substance use disorder.
Prioritizing People and Data
As I mentioned, the latest National Survey on Drug Use and Health found that more than 20 million people 12 or older had a past-year substance use disorder. And certain factors are associated with a greater risk of overdose, this includes homelessness, injecting drugs, a prior history of overdose, race, and even geographic location, such as areas without access to evidence-based treatment.
I’d like to go back to Kermit, West Virginia for a moment.
According to the latest census data, about 20% of people living in Kermit are below the poverty line. And about 80 of the people who currently live in Kermit are children – children who are now likely more at risk for addiction because of trauma brought about by conditions relating to poverty. And these conditions aren’t unique to people affected by opioid use disorder.
Increasingly, overdose deaths are growing in other populations, including Black and Alaska Native, American Indian communities. In fact, from 2015 to 2019, the highest prevalence of methamphetamine use was among Alaska Native, American Indian communities, rather than what was traditionally considered a drug most often used in white, rural communities.
The issues are evolving – and so too must our policy approaches.
For example, we know that people with substance use disorder leaving incarceration are at a heightened risk for overdose death…and Black, Indigenous, and People of Color, pregnant women, and women with families often face barriers to treatment that others don’t.
For instance: It takes Black people 4 to 5 years longer than white people to enter addiction treatment. And too often, access to care in diverse communities is limited.
Last month, we held a summit on this topic at the White House, where we heard from Shekita McBroom, an Advisory Neighborhood Commissioner in Ward 8 here in Washington DC. She shared her daughter’s story, and highlighted just how difficult it is for young people to access the treatment they need, especially in the community where they live.
Improving access to treatment – this is an opportunity where we can make a difference.
We often don’t think of how policies affect people until we hear from people with lived experience. This summer, I met a young mother in western Maryland. She is receiving methadone for her opioid use disorder, and told us about the barriers she faces every day.
First, there’s the very real challenge of finding childcare so she can get to her treatment center each day for methadone. She said her childcare takes up almost all of her income, and she was very clear about the stigma she faces on a daily basis.
Breaking the stigma surrounding addiction – this is another opportunity where we can make a difference.
And, for justice-involved individuals with substance use disorder, we need to prioritize diversion, treatment in correctional settings, and strong recovery supports, because providing treatment during incarceration – and upon reentry – can bring rates of overdose down in communities, sustain recovery, and reduce recidivism.
Right now – today – we can put policies in place and make investments that will stop the continuous cycle of addiction fed by conditions like poverty, homelessness, and trauma.
At the federal level, President Biden has made it clear addressing the overdose epidemic and substance use disorder is an urgent priority.
That’s why, in April, the Office of National Drug Control Policy released the Administration’s First Year Drug Policy Priorities, which focus on building a stronger, evidence-based infrastructure to meet these needs.
We worked closely with many drug policy partners to make sure our priorities are based on evidence and also meet the urgent challenges we face: Reducing overdose deaths and building a strong foundation for effective, evidence-based drug policy.
Already this year, the Biden-Harris Administration has:
- Removed unnecessary barriers for prescribing buprenorphine to 30 or fewer patients, making it easier for physicians and other medical practitioners to treat patients with opioid use disorder with the standard of care;
- Allowed federal funds to be used for fentanyl test strips, a key harm reduction tool;
- Ended a decade-long moratorium on methadone vans, so treatment can be brought to more underserved communities;
- Designated six new counties as part of its High Intensity Drug Trafficking Areas program and funded the nationwide expansion of the HIDTA Overdose Response Strategy to all 50 states, Puerto Rico, the U.S. Virgin Islands, and the District of Columbia;
- Provided funding for the development of model legislation for states. This effort will provide model legislation so states can pass laws that remove barriers to harm reduction services, as well as promote equity in access to treatment and drug enforcement efforts for underserved communities;
- In addition, ONDCP also sent congress a legislative proposal on class-wide scheduling of fentanyl-related substances. This legislation seeks to reduce the proliferation of fentanyl related substances, while protecting civil rights, and reducing barriers to scientific research for all Schedule I substances.
The President is also working to send critical funding to States and communities to support this lifesaving work. His American Rescue Plan delivered nearly $4 billion for mental and behavioral health, including $30 million specifically for harm reduction…and most of this has already gone out to the states.
And, his budget request for fiscal year 2022 calls for $10.7 billion for the Department of Health and Human Services to address opioid use disorder.
These are important tools to help States, counties, Tribes, and localities address substance use disorder locally. These investments, coupled with funds from the litigation settlements, present a tremendous opportunity to make a difference.
How the Litigation Funds Will Help
Legal tools – including litigation – can be used to garner the attention of the public as well as policymakers. The consequences of litigation can drive change – and we saw this specifically from the tobacco litigation.
You don’t see Joe Camel anymore.
You also don’t have your baseball game viewing interrupted by The Marlboro Man, either on TV or in stadiums.
And – fortunately – you and your kids don’t have to fly on planes or eat in restaurants choking back second-hand smoke.
And most importantly – rates of smoking plummeted nationwide.
But there has been justifiable criticism about how the litigation funds were spent – $200 billion and less than 10% went to state tobacco control programs. Many practitioners, researchers, and advocates are urging leaders to apply the lessons from the tobacco litigation to the opioid litigation.
One success so far of the opioid litigation is that there is now a trove of documents on the opioid litigation that will be hosted by the University of California at San Francisco library. These documents will be useful for journalists and researchers and will give us the opportunity to learn from the past.
The opioid settlements and the tobacco settlement are great examples of how the law and litigation can affect change. Law has the power to shape our policies and our lives in so many ways…from decisions at the Supreme Court – which was established on this date in 1789 – to local district courts in communities nationwide. And while law can drive policy, it must be informed by science and community-based evidence so we can build the type of infrastructure so urgently needed.
Settlement funds will begin to flow to states and local communities and, given the mounting death toll from overdoses, it’s critically important that we spend these funds wisely. So of course we’re here to discuss how that can be done.
Call to Action
I’d like to suggest three ways to use these funds:
- Identify the gaps and opportunities;
- Look at the evidence and build your community;
- Evaluate and adjust.
Begin by assessing your community’s needs.
Where are the gaps? And if you don’t have this data, spend money on getting the data. For example, how many providers of medication treatment do you have in your community? And how many people are they treating? What are your rates of bloodborne disease due to injection drug use? Do you have enough data to look at the entire cascade of care? Look at prevention, treatment, harm reduction, recovery – start by figuring out where the gaps and opportunities are.
Based on these gaps, develop a plan for filling the gaps.
There are many high-level, excellent documents in the public domain that include evidence-based ways to address these issues.
But you know your state or local community best and can best identify where you need to go.
Bring your community along with you – make sure to include people with lived experience – those in recovery, family members, as well as other members of your community so they’re as invested in the success of your efforts as you are.
Lastly, make sure you build in a way to evaluate and reassess along the way.
Are you reaching people at greatest risk for overdose? Who are you leaving out?
This work should begin today – in anticipation of these litigation funds.
Although half of the states have already passed legislation that will guide how these funds will be spent, some states require advisory boards to oversee spending, while others establish trust funds that would serve as repositories.
But there is still an opportunity to make sure that opioid litigation funds address the overdose epidemic – but there must be planning, community support, and evaluation.
As we near 100,000 overdose deaths in a 12-month period, the urgency of this issue increases.
Using these funds wisely will help us heal, and build the local, State, Tribal, and national addiction infrastructure we need to bend the curve on overdose deaths.
Thank you for joining today’s conversation…thank you for being a leader in addressing the overdose epidemic…and thank you for your service to your community and your country.