As a kid, my formative years were spent in Maysville, KY, in the Greater Cincinnati area. With long, hot summers, a sports-loving culture, and kind-hearted people who cared about their community, it was a great place to grow up. Sadly, like many other parts of the country, today, the place I grew up and loved is struggling with opioid addiction.
In February, PBS did a segment on “the deaths of despair” in Maysville, chronicling the local epidemic of addiction, overdose, and suicides. This piece offers an unsettling window into how deeply the opioid epidemic is ravaging communities around the country. In the past two years in Maysville there has been a 300% increase in drug-related overdose ambulance runs and the prevalence of the opioid addiction in the area continues to increase. And, Maysville is not alone.
We are a nation confronting a crisis where heroin and synthetic opiates kill an American every sixteen minutes. We’re left asking ourselves harrowing questions: How did we get here? Why won’t this stop? What can we do to help?
One of the most high-profile groups asking these questions is the Commission on Combatting Drug Addiction and the Opioid Crisis, a bipartisan task force assembled at the President’s behest to identify public policies and government interventions to help stem this tide of tragedy. Yesterday, the Commission convened at the White House to continue the discussion started by Governor Christie (NJ) on the planned development of a public-private partnership between industry, the NIH and the FDA to accelerate the development of non-opioid, non-addictive pain medicines and medication-assisted treatments for long-term addiction recovery. Since March, this Commission has assiduously received input from elected officials and public health leaders from all 50 states, as well as from addiction, law enforcement, and social service experts around the country. Earlier this summer they released a preliminary report, which posed one finding I would like to reiterate in importance: The strong connection between opioid abuse and mental illness.
In their preliminary report, the Commission found that over forty percent of people with a substance use disorder also have a mental health problem. As shocking as this number is, it may in fact understate the connection. According to a recent study by the Dartmouth-Hitchcock Medical Center, 51 percent of the sixty million opioid prescriptions written in the U.S. a year are prescribed to patients who have a mental illness, meaning that people with mood disorders are nearly four times more likely to receive an opioid prescription than the general population.
While it will require an immense effort that touches nearly every facet of American life to defeat this epidemic, any attempt to reduce opioid abuse hinges in large part on treating the mental illnesses that lead so many people to abuse pain medications in the first place. In particular, building on the Commission’s preliminary recommendations, when their final report is issued, there are three policies I believe are essential to addressing the twin problems of untreated mental illness and widespread opioid addiction.
1. Improving mental health screening capabilities for first responders. One of the major recommendations that emerges from the Commission’s preliminary report centers on the important role law enforcement plays in identifying and responding to drug abuse. These recommendations include making it mandatory that officers nationwide carry naloxone, a drug that may instantaneously counteract an opiate overdose. While these recommendations are wise, in my view, they should be expanded to include training for first responders in the criminal justice system to better identify where mental illnesses underlie addiction. Today, many addicts are trapped in cycles of incarceration that flood our jails and demand an undue percentage of our officers’ time. Improving identification of underlying mental illnesses will hopefully result in a patient visiting a psychiatrist’s office rather than a jail cell.
2. Identifying at-risk youths with mental illness: As the Commission’s preliminary report correctly identifies, today, due to lack of access to care, stigma, and discrimination, many people, including young people, are afraid to report their symptoms and seek treatment for mental illness. While the Commission recommends early intervention programs to intercept kids who possess substance abuse risk factors, I would expand those programs to include early interventions for young people who exhibit budding signs of mental illness as well.
3. Expanding access to mental health treatments: One of the key findings of the Commission’s initial report is the important role that Medication-Assisted Treatments (MATs), like methadone, play in dealing with opioid addictions. For this reason, the Commission recommends that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient. Given the connectivity between mental illness and substance abuse, it makes sense to provide the same guaranteed access to all available mental health treatments, based on a physician’s assessment of a patient’s unique needs. Guaranteeing access to one without the other allows an unnecessary window for relapse.
Kids in Maysville – like kids everywhere – deserve to remember their childhoods the way I remember mine. Sadly, tens of thousands today will grow up to remember their towns in the throes of a crisis, torn apart by tragedy, overwhelmed by the sadness of senseless, needless death.
We cannot hide from the depth of this opioid crisis and the many factors that have given it rise. To beat opioid addiction, we must confront it for everything it is, including a signal of our neglect of mental healthcare. When the President’s Commission issues its final report, I hope that the fullness of the connection between opioid abuse and mental illness is recognized, and that these policy recommendations are put forward.