The coronavirus vaccines now being shipped across the United States promise to curb the nation’s most imminent public health crisis. But the next one awaits the incoming president, Joe Biden.
“The bottom line for the Biden administration is that the crisis is going to come into full awareness once covid starts moving into the background,” perhaps in the first half of 2021, said Daniel Ciccarone, a professor of family community medicine at the University of California at San Francisco. “And we’re going to realize the crisis is still big, still growing, it’s morphing in different ways and we kind of lost track of it for a year.”
Transition officials declined to discuss plans for addressing the drug epidemic, but Biden spelled out many of his initiatives during the campaign. The hallmark is a plan to provide $125 billion over 10 years to states to further the goals of prevention, treatment and recovery services for everyone who needs them.
That sum would dwarf the money in the SUPPORT for Patients and Communities Act, which President Trump signed into law in October 2018, when the overdose crisis was a prominent topic. It provided $3.3 billion over 10 years to fight the opioid epidemic by offering greater access to treatment through Medicaid and Medicare, as well as expanded development of non-opioid alternatives for pain, among a host of other measures.
Under Biden’s plan, states could spend the money on efforts to prevent drug use, to stop the spread of diseases and viruses such as HIV — including through syringe exchanges — and to implement proven treatment and prevention programs.
Biden wants to make access to medication-assisted treatment, which research shows is the most effective way to combat drug abuse, available to anyone who needs it by 2025. Currently, his plan asserts, fewer than half of the nation’s substance abuse disorder facilities offer even one such medication, including buprenorphine and methadone. Biden would spend $20 billion of the overall sum to expand such programs and lift restrictions that hinder wider prescribing of buprenorphine by doctors.
It is unclear where the money for Biden’s wish list would come from. It would certainly require another major legislative package. His plan contains language about holding drug companies accountable for starting the opioid crisis, but does not include measures to make them pay for treatment and overdose prevention drugs such as naloxone, as states and cities are attempting to do through lawsuits.
Ronda B. Goldfein, vice president of Safehouse, an organization that is trying to open the nation’s first supervised drug consumption facility in Philadelphia, said Biden appears to be assembling a team of “progressive, thoughtful, evidence-based health-care providers. They’re looking at progressive folks who are motivated by public health.”
She mentioned California Attorney General Xavier Becerra, whom Biden has nominated to head the Department of Health and Human Services, and infectious-diseases specialist Rochelle Walensky, the president-elect’s nominee to lead the CDC.
Becerra has been an advocate for supervised drug consumption facilities like those used in Canada and Europe, where drug users who inject or snort narcotics are watched by volunteers or paid staff members who are equipped to prevent overdoses. Goldfein’s organization won a court battle to open such a center in Philadelphia, where 1,150 people died of overdoses in 2019, but the Trump administration has appealed the ruling.
Because Biden has not named an appointee for attorney general, it is unclear what might become of that case.
“We haven’t had any contact with any transition team members,” Goldfein said. “We are, like everyone else, patiently waiting for the new administration to take over.”
Ciccarone said he hopes the next administration, which considers drug addiction a disease, will quickly turn its attention to “low-hanging fruit,” such as widely expanding the availability of buprenorphine and getting inexpensive naloxone into medicine cabinets nationwide.
“It should be our generation’s mercurochrome or EpiPen, or aspirin, for that matter,” he said.
But then would come the longer-term challenges of disrupting 40 years of rising abuse of drugs, by devoting resources to the causes of self-medication, including childhood trauma and financial deprivation, he said.
“It’s a foundational, multigenerational problem with drug consumption in this country,” he said. “How are we going to address that?”