At the height of the HIV/AIDS epidemic, more than 43,000 Americans died in a single year from the deadly virus. As public concern grew, one boy, Ryan White, became the face of the crisis, humanizing the disease and spurring Congress to act. In 1990, just months after Ryan's untimely death, Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act — legislation widely regarded today as a turning point in the epidemic.
Since then, we have made tremendous progress toward ensuring HIV/AIDS is no longer a death sentence. It is now time to take similar bold action against the opioid overdose epidemic, which represents the deadliest public health threat in the U.S. today — killing over two-thirds of the 70,000 Americans who died of drug overdoses in 2017. Maryland is a particularly hard hit state, with nearly 90 percent of the 2,385 overdose deaths in 2018, according to preliminary numbers, related to opioids.
Unfortunately, not enough Americans with addiction to opioids and other substances get the help they need. In 2017, an estimated 20.7 million Americans needed treatment for a substance use disorder, but only a fraction, about 4 million of them, reported receiving any form of treatment or ancillary services.
Addiction is a complex, chronic brain disease whose symptoms are behaviors that can affect a person's family, employment, their ability to sustain healthy relationships, and many other facets of their lives. Even when people with addiction want help, they face many barriers to accessing and continuing medical treatment. Social determinants of health — including housing, social supports and employment — must also be addressed to help people recover.
In Baltimore, where I practice addiction medicine, many of my patients have lost their social supports, housing, employment and educational opportunities. While many Marylanders with addiction may be able to access treatment, some find it challenging to make their appointments because of transportation issues. Meanwhile, our city has too few outreach workers who can help support recovery and deliver harm reduction services by meeting people in their communities when they are unable to access care in traditional medical settings.
Moreover, 75 percent of my patients with opioid use disorder grapple with polysubstance use — meaning they are at risk of premature death or disability not just from opioids, but also cocaine, alcohol and other deadly drugs. These statistics are unfortunately not getting better so time is of the essence; we need to strengthen our addiction prevention, treatment and recovery infrastructure now.
Fortunately, there is a hopeful path forward. Maryland Congressman Elijah Cummings and Sen. Elizabeth Warren of Massachusetts, both Democrats recently introduced a new version of last year's Comprehensive Addiction Resources Emergency (CARE) Act, which is modeled on the Ryan White CARE Act.
The CARE Act of 2019 would apply a strategic approach to ending the addiction crisis by authorizing the investment of $100 billion over the next decade in the areas of prevention services, core medical services, harm reduction, and recovery and support services.
This bold legislation is desperately needed here in Baltimore and in communities across America. Many addiction treatment professionals like me strongly support the CARE Act because it offers states, local communities and other organizations and institutions the funding and flexibility needed to meet the unique care needs of patients in their communities.
Importantly, the legislation would also tie certain funding to the use of evidence-based practices within a framework of nationally-recognized standards, bringing much-needed infrastructure and accountability to the current addiction treatment system. The CARE Act can increase the rates of remission and recovery and stop the tragedy of overdose deaths that leave families torn apart and communities in despair. Those results would signal true progress.
Congress should pass the CARE Act to deliver funding and infrastructure proportionate to the size and scale of our nation's addiction crisis. If we truly want to stop the overdose epidemic, then let's treat addiction like the national public health emergency it is.
To paraphrase that brave little boy, Ryan White: Let's end the discrimination, fear, panic and lies that surround addiction. And let's carry out the courageous, comprehensive response that this crisis merits. Only then will we be able to ensure our fathers, mothers, sisters, brothers, children and friends get the help they truly need and are treated with the dignity every American deserves.
Dr. Yngvild Olsen (Twitter: @YngvildOlsen) is medical director of the Institutes for Behavior Resources Inc/REACH Health Services in Baltimore and co-author of the book "The Opioid Epidemic: What Everyone Needs to Know." She serves as Vice President of the American Society of Addiction Medicine.