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OpEdNews Op Eds    H3'ed 5/27/19

My comprehensive plan to end the opioid crisis

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The Opioid Crisis.
The Opioid Crisis.
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Life expectancy in the United States dropped again in 2017, part of the longest sustained decline in a century -- one largely driven by the opioid epidemic. More than 685,000 Americans have died from a drug overdose in the United States this century, and it's getting worse. In 2017, that number was 70,000 people, the highest year on record, and the majority of those deaths were due to opioids. Emergency room visits for opioid overdoses have skyrocketed. Children have lost their parents. And only a small percentage of those suffering ever receive the treatment they need.

The crisis has also severely impacted communities of color, exacerbated by existing health disparities. For example, in 2017 the number of opioid-related deaths was 692 in Baltimore, almost as high as West Virginia, 833 -- the state with the highest death rate in the country -- with most deaths occurring in the black community.

This is not the first time our country has faced a national public health crisis of great magnitude. When deaths from HIV/AIDS grew rapidly in the 1980s, our country's medical system was ill-equipped to respond. In 1990, Congress passed the Ryan White CARE Act, which finally provided significant new, guaranteed funding to help state and local governments combat the growing epidemic and provided a safety net for those living with the disease. A similar national mobilization is needed to confront the opioid epidemic today.

That's why in partnership with Rep. Cummings of Baltimore, today I'm rolling out the CARE Act -- a comprehensive plan to end the opioid crisis by providing the resources needed to begin treating this epidemic like the public health crisis that it is.

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A Comprehensive Plan to End the Opioid Crisis

The CARE Act proposal is modeled on the Ryan White CARE Act, providing resources directly to first responders, public health departments, and communities on the front lines of this crisis -- so that they have the resources to provide prevention, treatment, and recovery services for those who need it most.

Under the CARE Act, states and communities will receive $100 billion in federal funding over the next 10 years -- because that's what's needed to make sure every single person gets the treatment they need. Here's how that breaks down each year:

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  • $4 billion for states, territories, and tribal governments;
  • $2.7 billion for the hardest hit counties and cities, including $1.4 billion to counties and cities with the highest levels of overdoses;
  • $1.7 billion for public health surveillance, research, and improved training for health professionals;
  • $1.1 billion for public and nonprofit entities on the front lines, including those working with underserved populations and workers at high risk for addiction, and to support expanded and innovative service delivery of treatment, recovery, and harm reduction services;
  • $500 million to expand access to naloxone and provide this life-saving overdose reversal drug to first responders, public health departments, and the public.
Resources would be used to support the whole continuum of care, from early intervention for those at risk for addiction, to harm reduction for those struggling with addiction, to long-term support services for those in recovery. Along with addiction treatment, the CARE Act would ensure access to mental health services and help provide critical wraparound services like housing support and medical transportation for those who need them.

But the CARE Act doesn't just provide resources to communities, it also works to strengthen our addiction treatment infrastructure -- demanding states use Medicaid to its fullest to tackle the crisis, expanding access to medication-assisted treatment, and ensuring treatment programs and recovery residences meet high standards.

Money, Power, and Accountability

The ongoing opioid crisis is about health care. But it's about more than that. It's about money and power in America -- who has it, and who doesn't. And it's about who faces accountability in America -- and who doesn't.

If the CARE Act becomes law, every single person would get the care they need. Scores of legislators in Congress have signed on to support this plan. The nation's top experts on the crisis stand behind it. It spells out in detailed terms exactly how funding would get to the communities that need it most. We should pass it -- not in two years, not after the 2020 elections -- but immediately.

If we don't, it will be because politicians who have spent years wringing their hands about this crisis aren't willing to do what's necessary to end it. Yes, getting everyone the treatment they need costs money. But I have a plan to pay for it: my ultra millionaire tax on the richest 75,000 families in America.

Here's how it works. If you have more than $50 million, we're going to ask you to pay a tax of 2 cents per dollar on every dollar after your fifty-millionth and first. It raises $2.75 trillion over the next 10 years -- enough to pay for my plans to cancel student loan debt and provide universal free college, fully fund universal childcare, and end the opioid epidemic. And guess what -- we'd still have nearly a trillion dollars left over.

Too many folks in Washington care more about protecting the wealthy from paying their fair share than they do about solving these kinds of urgent national problems. I want to change that.

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This week, I'll visit Kermit, West Virginia, a small town located along the Kentucky-West Virginia border. Kermit has been hard-hit by the opioid epidemic -- and not by accident. Over a period of just a few years, this town of only 400 people was flooded with approximately 13 million prescription opioid pills, all delivered to a single local pharmacy -- that's more than 30,000 pills per resident. The companies shipping these pills repeatedly disregarded requirements to report suspicious patterns of behavior, and the state Board of Pharmacy failed to enforce its own rules.

Now Kermit is fighting back with a lawsuit against the pharmacy and five wholesale drug distributors who exacerbated the crisis. It's just one of many similar lawsuits lodged by towns, counties, and states across the country -- and I hope they win. But the fact that any of this happened in the first place speaks to something rotten in our system.

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Elizabeth Warren was assistant to the president and a special adviser to the Treasury secretary on the Consumer Financial Protection Bureau. She single-handedly set us this bureau, putting in place the building blocks for an agency that will (more...)

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Missing from this article is any discussion of why Warren believes that the money she wants to spend combating the opioid crisis will in fact effectively combat it.

Granted, not spending money won't combat the crisis either. However, unlike HIV and AIDS, which Warren uses as an analogy, it's unlikely that money spent on medical research will result in more effective treatment for opioid addiction. Indeed, combating addiction is notoriously difficult, and just because well-funded programs exist doesn't mean that they will be effective. What specific programs does Warren want to fund and what evidence is there of their effectiveness?

And Warren wants to spend a lot of money--around $250,000 for each death that can be projected based on current rates. Maybe spending $250,000 is worth it to save one life, but what if the effectiveness rate of the treatment is only 5%? Under this scenario, each life saved would cost taxpayers $5 million which, while each life saved can be said to be "priceless," is starting to become a lot of money to ask of taxpayers for an addiction that some sufferers beat without any formal treatment program at all. Then there's the question of whether the $5 million might be more effectively spent on preventing deaths from some other cause, say breast cancer. There's also the issue of relapsing addicts, which will pretty much require continuing funding for the treatment programs indefinitely while another government bureaucracy becomes entrenched.

I don't necessarily oppose Warren's plan or taxing the rich to pay for it (although that's a lot easier said than done) but I would like to see some discussion of how effective the costly treatment programs can be forecast to be. Absent this discussion, Warren comes across as just another liberal wanting to throw taxpayer money at a problem without bothering to determine whether or not the money will even do any good.

Submitted on Tuesday, May 28, 2019 at 10:52:10 PM

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