Despite early challenges in scaling diagnostic testing for Covid-19 and a halting start to the vaccine rollout, the U.S.’s rapid response to the pandemic has highlighted the importance of coordination between the government, private business, and citizen mobilization. Those efforts, orchestrated in part by Operation Warp Speed, delivered multiple effective vaccines in an unprecedented time frame.
But even as the country rightfully focused on the pandemic, a record number of individuals in the U.S. have died from drug overdoses. Adults between the ages of 25 and 44 years have been more than twice as likely to die from opioid overdose than from Covid-19, yet no coordinated effort in the mold of an Operation Warp Speed exists to stop this epidemic.
As nationwide vaccination programs help nudge the U.S toward the recovery phase of the Covid-19 pandemic, industry leaders and legislators should use the lessons learned from the public-private coalitions forged in Operation Warp Speed to solve the decades-long overdose epidemic. Several actions that mirror steps taken during the Covid-19 pandemic could significantly improve the country’s response to overdose deaths.
Eliminate government barriers to opioid addiction treatment
A lack of clear and consistent messaging from federal and state governments at the start of the pandemic was a catastrophic mistake that hampered the country’s response.
To provide a clear road map on overdose deaths, the Biden administration must eliminate contradictory messaging on prescription medications for addiction that have been shown to reduce deaths from opioid overdose by approximately 50%. On one side, the federal Substance Abuse and Mental Health Services Administration has encouraged prescription of FDA-approved medications for opioid use disorder. On the other side, the Drug Enforcement Administration has increased surveillance activities that discourage potential prescribers for these medications. This contradictory messaging has confused ordinary citizens, clinicians, and even pharmacists, who frequently refuse to fill legitimate prescriptions for these medications, further reducing access to treatment that is already constrained.
The Biden administration’s announcement on Tuesday to lift some barriers to prescribing buprenorphine to treat opioid use disorder was a step in the right direction. Yet many barriers still remain to making this form of treatment mainstream and accessible to those who need it most. The new guidelines still limit prescribers to treating just 30 patients at a time with buprenorphine. Ironically, no such restrictions exist on prescribing the opioid pain medications that have fueled the epidemic.
Many providers are reluctant to prescribe buprenorphine. One 2016 study showed that 53% of rural providers with a 30-patient DEA waiver were not treating any patients with buprenorphine. These findings suggest that the recent guideline modifications may not be a panacea for the opioid epidemic, and more changes will need to be considered. The Biden administration should signal its support for the bipartisan Mainstreaming Addiction Treatment Act to lift the remaining restrictions on buprenorphine and expand access to this lifesaving medication.
Telemedicine became an essential tool for health care providers during the pandemic. For many people with addictions, telehealth became the only way to access care, as most treatment providers were forced to close their doors to in-person care. Congress should pass a recently introduced bipartisan bill that will allow health care providers to continue using telemedicine to prescribe medications for opioid use disorder. The Comprehensive Addiction and Recovery Act 3.0 would help create a permanent regulatory pathway for prescribing buprenorphine and other medicines for treating addition via telemedicine — a proven modality for expanding access to care.
Expand insurance coverage and address social determinants
Under government mandate, public and private insurers uniformly offered coverage for Covid-19 diagnostic testing and vaccinations during the pandemic. Compare that with the variability in coverage for addiction treatment that has mitigated the quality of care for people with opioid addictions for years.
Facilities across the country regularly — and illegally — deny admission to patients with addictions. In some states, clinicians are encouraged to terminate outpatient treatment after a patient being treated for a substance use disorder has three positive drug tests — a shortsighted policy that completely misunderstands the chronic nature of addiction and the deadly, costly consequences of being expelled from treatment.
Many state Medicaid authorities have prohibitive prior-authorization requirements that restrict access to adequate care. More broadly, Medicaid reimbursement rates are often so low that they inhibit private-sector interest in providing care for Medicaid patients, who constitute the majority of individuals seeking treatment for addictions.
One possible policy solution to this vexing interstate variability could come from the new comprehensive outpatient opioid addiction treatment bundle. It was enacted under the 2020 Medicare physician fee schedule and provides sustainable reimbursement for providers who treat patients with substance use disorders holistically and in a coordinated fashion. Extending these Medicare bundle codes to all state Medicaid plans could provide immediate standardization of reimbursement rates across states and provide a much-needed incentive for quality of outpatient addiction care in the Medicaid space.
Despite the clear need for further government action, some progress has been made toward standardizing access to care for addictions. CMS expanded Medicaid coverage for the treatment of opioid use disorder at the end of 2020. The Biden administration has also proposed government spending to combat the underlying corrosive and costly societal problems that are strong drivers of addiction, such as income inequality, housing insecurity, underemployment, and social isolation, and we encourage continued investment in this area for communities that are most impacted by opioid addiction.
The national opioid epidemic has worsened since the outbreak of the Covid-19 pandemic for reasons that could be corrected with a policy approach similar to what was deployed against the Covid-19 pandemic. We urge the Biden administration to learn from its Covid-19 successes and prioritize a bold, coordinated agenda against opioids, which have been killing Americans by the thousands for decades — most of them in the primes of their lives.
We need an Operation Warp Speed for the opioid epidemic to reverse this tragedy.
Thomas McLellan is the founder of the Treatment Research Institute, an independent, nonprofit organization focused on science-driven reform of substance use treatment and policy, and former deputy director of the White House Office of National Drug Control Policy during the Obama administration. Jacob Crothers is an addiction medicine physician and chief medical officer of Groups Recover Together, a national health care company for individuals with opioid use disorder.