President Biden’s FY 2024 budget: An evidence-based investment in reversing and reducing America’s drug epidemic
Editor’s note: Don Mathis is a certified peer recovery specialist at Voices of Hope, a nonprofit recovery community organization serving Harford & Cecil counties in Maryland. He is a person in long-term recovery who has worked at a large residential treatment center, four drug courts, and with other national, state, and community-based advocacy groups.
A quick look through news stories could lead a person to believe that the drug addiction/overdose epidemic is a problem too widespread and too untreatable to be solved.
A 26-year-old man with severe open wounds on both legs is injecting fentanyl three days a day. A 22-year-old woman injection drug user just found out her boyfriend with whom she shares needles tested positive for HIV and hepatitis C. Two 14-year-old boys in Utah buy online what they think is Adderall; the counterfeit pills are really fentanyl and they die within hours after swallowing the pills.
Americans saw 110,315 fatal drug overdoses in the 12-month period ending in March 2022 — 294 deaths per day. The Centers for Disease Control and Prevention reports that 15 percent of high school students have used injectable or illicit drugs like heroin, fentanyl, methamphetamine, cocaine, and contaminated prescription pills. The increasing number of substance use disorder (SUD) overdoses are devastating lives and families in suburban, rural, and urban areas. This crisis pervades all income and educational attainment levels; all racial and ethnic groups, religious affiliations, and gender identity; all ages from drug-exposed newborns to people in their 80’s and beyond.
The good and relatively recent news is that there are realistic, cost-effective, humane strategies and services that can reverse these trends and significantly reduce the incidence of SUD. And vital support for these strategies is included in President Biden’s proposed FY 2024 budget. Before we look at three of the budget’s priorities, it’s important to understand what SUD is and what it isn’t.
The National Institute on Drug Abuse defines addiction as a “chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder because it involves functional changes to brain circuits involved in reward, stress, and self-control.”
As Surgeon General Vivek Murthy detailed in Facing Addiction in America, SUD is not a moral failing or a weakness in personal character. It is a disease. Let’s consider three key components of the President’s budget: treatment, harm reduction, and recovery.
Treatment. A 60-year-old man who incurred debilitating workplace injuries had a time-limited prescription for pain pills and turned to street dealer opioids. The 32-year-old single, pregnant mother whose two children were born substance-exposed; she’s been injecting fentanyl during her current pregnancy. A 19-year-old man smoking meth several times daily is experiencing psychotic episodes and has been ostracized by his family.
The President’s budget for the Substance Abuse and Mental Health Administration (SAMHSA/HHS) proposes $10.8 billion for several evidence-based prevention and treatment programs, including medication-assisted treatment (MAT) such as methadone, buprenorphine and naloxone. This funding includes $2 billion for State Opioid Response grants to states that are then awarded to community-based, nonprofit organizations, state and county health departments, and local governments; and $20 million for rural health programs addressing the opioid crisis. Another $385 million is designated for Certified Community Behavioral Health Clinics that provide Medicaid-supported behavioral health services for mental health and substance issues for anyone regardless of their ability to pay, age, or where they live.
An estimated 40 to 50 percent of people with substance use disorder have co-occurring mental health issues and funding for this population is included in funding and eligibility for Medicaid, ensuring that millions of people and families get the health care they need.
Harm Reduction. Harm reduction is a public health approach that focuses on mitigating the harmful consequences of drug use, including transmission of infectious diseases like HIV/AIDS, hepatitis C, and sexually transmitted infections. Harm reduction helps prevent overdoses by providing help that is free of stigma and meets people where they live and use and in recovery community centers. Syringe services programs (SSPs) provide new needles and supplies, wound care supplies, safe sex kits, needle disposal containers, and peer services. SSPs are safe, cost-effective, and they reduce HIV & Hep C infections by 50 percent. CDC reports that people who participate in SSPs are five times more likely to enter treatment and three times more likely to stop or reduce their drug use than users who do not go to SSPs. The President’s budget proposes $50 million for new harm reduction initiatives and $20 million for peer recovery specialists.
A 38-year-old woman who has overdosed on opioids is saved from dying by EMS using naloxone (narcan) to reverse the drug’s effect. She’s not ready to stop using but she wants take home doses of naloxone and fentanyl test strips to check if there is fentanyl in her drugs. She talks with certified peer specialists when she comes to a community recovery center, also returning her used syringes where they can be safely disposed.
President Biden’s budget offers positive game-changing funding and regulatory commitments for harm reduction. His budget requires evidence-based research and evaluation of harm reduction programs and makes major investments in community-based programs.
Recovery Services. After people go through de-tox, then inpatient or outpatient treatment, the life-long journey of sustaining recovery begins. Last year, President Biden created the first-ever Office of Recovery in the Substance Abuse and Mental Health Services Administration. The President’s budget emphasizes the importance of peer support specialists who bring their real-world experiences in helping people with SUD. In addition to new funding, the budget removes some restrictive regulatory requirements, making medication-assisted treatment, telehealth services, and recovery services more accessible for people with SUD and for health care providers.
The goal: expanded access to services that show positive results and new, promising approaches. The National Institute on Drugs and Addictions (NIDA) will be funded for $1.66 billion to evaluate, research, develop, and test best practices for prevention, treatment, and clinical resources; and award grants to keep pace with ever-changing illicit, dangerous drug markets. NIDA focuses on distinct at-risk groups such as veterans, pregnant women who use drugs, people who use multiple drugs, unsuspecting youth who buy fentanyl pills on-line, people who inject the animal tranquilizer xylazine, and other emerging issues and challenges.
A 33-year-old formerly incarcerated woman has been in recovery for four years. She wants to give back to the recovery movement that changed and saved her life. She wants to enter the state certification process to be a certified peer recovery specialist. Funds in the Biden budget will pay for her training and enable her to help people and families in her community.
In conclusion: President Biden’s FY 2024 budget is a reasonable, evidence-based investment in reversing and reducing America’s skyrocketing drug epidemic. In addition to the components above, it attacks the fentanyl crisis from both supply and demand sides. Members of Congress can save lives and families in their respective states and districts by voting for the President’s request.