The coronavirus isn’t the only epidemic President-elect Joe Biden will be facing.

The nation’s opioid crisis is far from solved — and may be worsening amid widespread job loss and Americans’ increased isolation.

Biden has proposed spending $125 billion on prevention, treatment and recovery services, vowing to make medication-assisted treatment such as buprenorphine and methadone available to everyone who needs it by 2025. He also wants to restructure the criminal justice system to ensure no one goes to jail for drug use alone and has promised to go after pharmaceutical companies that contributed to overprescribing of opioids.

The Trump administration made the opioid epidemic a priority, and saw some small improvements.

President Trump campaigned on ending the opioid crisis in 2016, and his administration declared it a public health emergency in October 2017. During his tenure, prescriptions for opiates declined significantly, and the country saw the first decrease in years in opioid overdose deaths in 2018.

But 2019 data suggested deaths were again rising. Experts say that could be due to the rise of fentanyl, a potent synthetic that is quickly replacing heroin on the black market.

Although the Trump administration increased funding for treatment, critics say it still fell short of what was needed to combat the rise of fentanyl. And the Office of National Drug Control Policy, the federal agency charged with combating drug abuse, has struggled to put together a comprehensive plan, amid staff turnover and the elevation of sometimes inexperienced political appointees, including a 24-year-old promoted to third in command. 

For Biden, whose son Hunter has struggled with addiction, the issue is personal.

“I give him credit for talking in a really human way about his son’s addiction. I think he is someone who has shown empathy…and the willingness to embrace science when there is scientific evidence,” said Brendan Saloner, an expert in health policy and addiction treatment at Johns Hopkins Bloomberg School of Public Health.

Saloner said he’s encouraged by those leading Biden’s transition team, which includes Rahul Gupta, the former chief health officer for West Virginia; and Regina LaBelle, a former ONDCP chief of staff under Barack Obama. Saloner dislikes the emphasis on drug courts in Biden's plan — he would prefer to see addiction treated outside the legal system — but he praised the stress on pragmatic measure.

Chuck Ingoglia, the president of the National Council for Behavioral Health, said there wasn’t much in Biden’s plan “not to like,” but the question was how much could actually get done and whether Biden would get support from a Senate that might be held by Republicans, depending on the results of two runoff elections in Georgia.

President Trump on Sept. 29 repeatedly interrupted Democratic presidential nominee Joe Biden as he tried to reference his son Beau's service to the military. (The Washington Post)
Biden has a complicated history with the war on drugs.

As a Delaware senator, he played a key role in passing legislation to ratchet up penalties for drug offenses, including sponsoring a 1986 bill creating a big sentencing disparity between crack and cocaine trafficking, fueling racial disparities in those who were incarcerated.

Biden has said that was a mistake, and some doctors who believe the punitive approach to drugs has severely undermined public health are willing to believe him.

“I am optimistic that there might be some reflection on past drug policy that was too draconian. Maybe a desire to undo that long history of punishment,” said Jeanmarie Perrone, a Philadelphia emergency physician. Even though legislation backed by Biden has been cited to shut down safe injection sites in her state, she thinks Biden is “a slightly different politician” now.

Combating the nation’s opioid crisis is a tall order, only complicated by the coronavirus pandemic.

More than 40 states have reported increased deaths from opioids since the pandemic began — a stark illustration of how dramatically the virus and resulting lockdowns have worsened life in the United States.

That finding from the American Medical Association underscores the extent to which social isolation, job loss and disruption of treatment programs have fueled a wave of drug overdoses. 

Reports of the problem are everywhere: Firefighters in Jacksonville, Fla., have seen a 40 percent jump in overdose calls, while in Rhode Island, overdose deaths increased by nearly a third in early 2020. In Nevada, treatment providers are conducting virtual trainings on how to administer Narcan in an attempt to stem a surge in opioid deaths.

Although researchers caution some of the findings are still preliminary, a Centers for Disease Control and Prevention  report based on initial data estimated a roughly 13 percent nationwide increase in fatal overdose deaths during the first three months of the year.

The pandemic has placed new strain on already overtaxed health-care systems and social services, while lockdown orders and social distancing guidelines have left many people struggling with addiction isolated from sources of support.

“Isolation is not good for any of us,” Ingoglia said. “You’re disrupted from normal sources of support; while some people can transition to online support groups, there are others who really struggle with that.”

The pandemic disrupted — and may have reversed — any progress on stopping overdoses.

Over the past two decades, in the wake of a prescription opiate boom, drug overdoses claimed the lives of 750,000 Americans and contributed to three consecutive years of declining life expectancy.

Now, measures meant to contain the virus’s spread have sent the economy into a tailspin, causing millions to lose their jobs and potentially exacerbating underlying factors that drive addiction. One paper published before the pandemic found that for every 1 percent increase in unemployment, the opioid death rate rises 3.6 percent. Another study that looked at the decline in manufacturing jobs found that counties where automotive plants closed had 85 percent higher rates of opioid-overdose mortality compared to counties where they remained open.

In an influential 2015 paper, Princeton economists Anne Case and Angus Deaton have pushed back, however, on the idea that short-term economic fluctuations drive deaths from drugs, suicide and alcohol — what they coined “deaths of despair." They point out in a recent op-ed these deaths were rising before the 2008-2009 financial crisis and continued to spike even as unemployment reached its lowest rate in decades. Instead, they say, the deaths are the result of longer-term trends of rising inequality and declining wages — patterns that the pandemic could exacerbate even after it ends.

Other experts have pointed to high levels of stress combined with social isolation as the culprit for rising drug overdose deaths during the pandemic.

Peter Grinspoon, a primary care physician at Massachusetts General Hospital who has written about his own struggles with opioid addiction, said the anxiety of the pandemic had left people “at their wit's end.” He has seen more of his patients slip up or relapse.

“You can’t hug people or have them over or do all the normal things that we do to let off steam,” Grinspoon said.

That lack of human connection can rewire the brain, according to Rachel Wurzman, the director of science for SeekHealing, an addiction treatment nonprofit organization.

Wurzman has studied the ways in which loneliness can hypersensitize the brain’s reward system, leaving people more likely to chase relief from opioids. In some cases, the brain can process loneliness as literal pain.

“There’s a lot of overlap between social reward systems and systems involved in compulsive behaviors and addiction,” said Wurzman, who is a neuroscientist by training. “The opioid epidemic and the epidemic deaths of despair have at their root a loneliness epidemic and a social disconnection epidemic.”

The Trump administration took some steps to stem the rise in opioids amid the pandemic.

On Oct. 1, the Department of Health and Human Services announced $20 billion in new funding for health-care providers on the front lines, including behavioral health providers responding to rising mental health and substance use issues.

President Trump said that the $1.8 billion in grant funds would be distributed to all 50 states and focused on problem neighborhoods. (Reuters)

The money was a relief but it also came late into the pandemic for many behavioral health providers, who were locked out of the initial round of coronavirus relief aid.

The administration has also eased restrictions on the prescription of medications, such as buprenorphine or methadone. 

Studies show those medications can slash the risk of dying from an overdose in half; indeed, HHS Secretary Alex Azar recently compared treating opioid addiction without medication therapy to treating an infection without antibiotics. But access to these treatments has long been an obstacle in part because of onerous regulations on who is allowed to prescribe them, and even before the pandemic only one-third of people struggling with addiction received the treatments. 

During the final presidential debate against Biden, Trump blamed increased drug and alcohol use on the lockdowns during the pandemic, repeating his concern the measures to control the spread of covid-19 are worse than the virus itself.

Fentanyl, a synthetic opioid about 50 times stronger than heroin, has ravaged communities across the nation. In this Washington Post original documentary, reporter Wesley Lowery travels to one of the hardest hit cities, Philadelphia, where he finds that despite efforts to deal with the crisis, it's only getting worse. (Whitney Leaming, Reem Akkad/The Washington Post)

Ahh, oof and ouch

AHH: Moderna announced its vaccine was 95 percent effective based on an early analysis. 

The finding is “a striking initial result that leaves the United States with the prospect that two coronavirus vaccines could be available on a limited basis by the end of the year,” The Post’s Carolyn Y. Johnson reports

“It’s extremely good news. If you look at the data, the numbers speak for themselves,” said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, who was briefed on the data by an independent commission on Wednesday morning. Moderna’s vaccine was co-developed with Fauci’s institute. “I describe myself as a realist, but I’m fundamentally a cautious optimist. I felt we’d likely get something less than this. … I said certainly a 90-plus-percent effective vaccine is possible, but I wasn’t counting on it.” 

The data have not yet been peer-reviewed but the initial findings are impressive. To test the effectiveness, researchers give a group of people the vaccine while another group receives a placebo.  

“Of the 95 cases of covid-19, the disease caused by the virus, 90 were in the group that received the placebo. There were 11 severe cases reported — all in people who received the placebo. With cases of covid-19 confined almost exclusively to trial participants receiving a placebo, that sends a strong signal that the vaccine is effective at thwarting the virus,” Carolyn writes.

OOF: Trump has disengaged from pandemic management even as cases soar.

“[A]s he fights for his political life, falsely claiming the election was somehow rigged against him, Trump has abdicated one of the central duties of the job he claims to want: leading the country through a devastating pandemic as it heads into a grim winter,” The Post’s Ashley Parker, Josh Dawsey, Yasmeen Abutaleb and Philip Rucker report.

One senior adviser told The Post that the president had not attended a coronavirus task force meeting for “at least five months,” a report that was subsequently confirmed by Assistant Secretary for Health Adm. Brett Giroir. Giroir said on ABC's “This Week” that the vice president briefs Trump “every day or nearly every day.” 

Trump appeared at the Rose Garden on Friday to offer encouraging news on the efforts to fast-track a vaccine, saying that 20 million doses of a vaccine could be ready as early as December. “But Trump seemed deflated, with the dour disposition of a man who understood that the coronavirus progress was too late to help him in the polls,” Ashley, Josh, Yasmee and Philip write. 

The president, who has made few public appearances since his Nov. 3 defeat, did not mention the surging number of virus cases during the Friday event. 

Interviews with more than a dozen administration officials, health advisers and others familiar with the coronavirus response paint a picture of a president who is tuned out of the public health emergency, even as reported cases reach record levels in many parts of the country. Trump has ignored calls from top health advisers who have urged more aggressive messaging on mask-wearing, expanded testing and limitations on in-person dining in restaurants and bars. Meanwhile, Trump’s refusal to admit election defeat has hindered efforts by Biden’s team to prepare to take over the federal government’s response in January.

OUCH: Officials are weighing a new round of lockdowns.

“But many are finding the call much harder to make this time — eight months after cities and states last implemented weeks-long shutdowns — amid angry backlashes, deeply polarized constituents and dire economic consequences,” The Post’s William Wan and Mark Guarino report.

  • Michigan and Washington announced sweeping new restrictions on Sunday. Michigan's order includes a three week ban on dining inside restaurants, in-person high school and college classes and organized sports. In Washington, people will be prohibited from indoor gatherings with people outside of their households unless they have quarantined for two weeks or received a negative coronavirus test.
  • Chicago became the first major city to announce a reinstatement of a stay-at-home advisory on Thursday.
  • Oregon Gov. Kate Brown (D) ordered a two-week “freeze” on Friday. Starting Wednesday, gyms, movie theaters and museums will shut down, while restaurants and bars will be limited to takeout. Social gatherings must be limited to six people.
  • New Mexico also prohibited on-site dining and required many nonessential businesses to close their physical locations.
  • North Dakota imposed a statewide mask mandate after months of resistance.
  • New York City warned that school closures could be imminent.

Leaders in many conservative states have rejected shutdowns. Mississippi Gov. Tate Reeves (R) called closing businesses “totally and completely unreasonable.”

Officials are making decisions under significant pressure from restaurant and business owners who say that their companies may not survive another round of shutdowns, especially without any imminent prospect of financial relief from the federal government, which helped cushion the economic blow of coronavirus restrictions in the spring. 

After Michael Osterholm, an epidemiologist and member of Biden’s coronavirus task force, suggested paying people to stay home for a four- to six-week shutdown to get the coronavirus under control, Republicans seized on the comment, accusing Biden of planning a national shutdown. Osterholm later said that such a plan was not feasible given the lack of economic stimulus from Congress, and Vivek H. Murthy, a co-chair of Biden’s task force, said that the Biden team is not calling for national shutdown.

Former CDC director Tom Frieden:

Rep. Jim Jordan (R-Ohio):

States say they urgently need more money to distribute a coronavirus vaccine.

Although the government has allocated billions to fast-tracking a vaccine, only a fraction of that amount has gone toward state efforts to distribute it. Public health departments already grappling with budget shortfalls are now tasked with developing systems to track vaccinations, recruit hundreds of thousands of health-care workers and convince people that they should be vaccinated, the New York Times’s Abby Goodnough and Sheila Kaplan report.

“The federal Centers for Disease Control and Prevention have sent $200 million to the states for the effort, with another $140 million promised in December, but state and local officials said that was billions of dollars short of what would be needed to carry out their complex plans,” Goodnough and Kaplan write. Health departments have asked Congress for at least $8.4 billion for the vaccine distribution campaign, but prospects for further aid have been stalled as Congress faces a stalemate over the next coronavirus relief bill.

Pfizer’s vaccine, which will likely be the first to get Food and Drug Administration authorization, comes with logistical hurdles, including the need for every recipient to get a booster shot after three weeks. Health departments are racing to develop systems that can closely monitor who has been vaccinated and can follow up when people need a second dose. Most state vaccine registries, however, have still not connected to a new federal platform that would allow health officials to follow patients across state lines.

More in coronavirus

More than 130 Secret Service officers are quarantining because of the coronavirus.

The officers who are charged with protecting the White House and the president were ordered to isolate because they had tested positive for the coronavirus or because they had close contact with someone who tested positive, The Post's Carol D. Leonnig and Josh Dawsey report.

“The spread of the coronavirus — which has sidelined roughly 10 percent of the agency’s core security team — is believed to be partly linked to campaign rallies that President Trump held in the weeks before the Nov. 3 election, according to the people who, like others interviewed for this report, spoke on the condition of anonymity to describe the situation,” Carol and Josh write. “In all, roughly 300 Secret Service officers and agents have had to isolate or quarantine since March because they were infected or exposed to infected colleagues, according to two people with knowledge of the figures.

Secret Service agents stepped in as a maskless President Trump approached a crowd of supporters while leaving an Oct. 24 campaign event in Lumberton, N.C. (The Washington Post)

The report comes as prominent figures in Trump's orbit have tested positive for the virus, including White House Chief of Staff Mark Meadows and outside political advisers Corey Lewandowski and David Bossie. Some of the cases among Secret Service officers could be linked to a blitz of campaign stops in the lead-up to the election, but one government official told The Post that the agency is also investigating whether infections could have originated at the White House.

“Trump has frowned on mask-wearing at the White House, and some Secret Service personnel have privately complained to colleagues that they were instructed by presidential detail agents and White House staff not to wear masks in his presence, according to two people who heard the complaint,” Carol and Josh report.

Georgia decides

Health care is front and center in Georgia runoff elections that will determine control of the Senate.

The first full week of campaigning saw Democrats pushing a message around preserving and expanding the Affordable Care Act, while Republicans painted the election as a bulwark against “socialism,” Politico’s James Arkin reports. “The eight-week sprint to the Jan. 5 runoffs comes amid the backdrop of rapidly rising covid-19 infections, along with the start of Biden's transition — even as Republicans defend President Donald Trump’s efforts to undermine and fight the results of the election.” 

Democrat Jon Ossoff, who is challenging GOP Sen. David Perdue, called for investing in rural hospitals, expanding Medicaid and preserving preexisting conditions protection during a drive-in rally last week. Meanwhile, his opponent told a packed sports bar on Friday that if Democrats won control of the Senate it could lead to a litany of left-wing policies, including the Green New Deal and Medicare-for-all. 

The opponents’ events also underscored a divergent approach toward the risk of coronavirus. Whereas attendees at Ossoff’s rally were in separate cars or socially distanced, many of the attendees at Perdue’s Friday event were not wearing masks.

The Rev. Raphael Warnock, the Democrat running against GOP Sen. Kelly Loeffler, meanwhile, launched his first attack ad, a shift from his positive ads ahead of the November vote. The ad focuses on stock trades that Loeffler made during the pandemic. Loeffler came under fire after selling millions in stocks within days of attending a private briefing on the coronavirus in February. The Senate ethics committee and the Justice Department both dismissed probes into Loeffler’s stock trades.

“It must be really hard to explain why you’re for getting rid of health care in the middle of a pandemic,” Warnock said. “It must be really hard to explain how it is you’ve done a great job profiting off of the pandemic and increasing your wealth portfolio, but you have not managed to provide any covid-19 relief to the people of Georgia in months.” 

Sugar rush