As the U.S. Surgeon General’s recent report on addiction highlights, the United States faces a serious opioid epidemic that shows no signs of abating.1 In 2015, more than 13 million Americans reported nonmedical use of opioids in the previous year, and about 2.5 million of those people have an opioid use disorder that requires treatment.2 The rate of death due to opioid-related overdose has increased by more than 200% over the past 15 years, and we are now losing more Americans to overdose deaths each year than we did to AIDS during the peak of that epidemic. The human cost of addiction and overdose is accompanied by a substantial financial price: for 2013 alone, the costs of opioid use, abuse, and overdose were estimated at $78.5 billion.
An effective response to the epidemic requires a multifaceted strategy: better regulation and monitoring of opioid prescribing, a concerted effort at prevention, expanded options for safe disposal, and greater support for effective nonopioid approaches to pain management. Most important for the 2.5 million Americans who are already addicted, we must also rapidly expand access to medication treatment for opioid use disorders. Decades of evidence has established that provision of medication for treatment of opioid use disorder results in a greater reduction in opioid-related morbidity and mortality than provision of psychosocial treatment alone and that medication treatment reduces the risk of relapse and overdose during recovery.4 Nonetheless, receiving such treatment remains stigmatized, and such treatment is difficult to obtain. Key federal stakeholders, including the White House Office of National Drug Control Policy, the Office of the Surgeon General of the United States, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the Veterans Health Administration, and the National Institutes of Health, have all identified improving access to medication treatment as a priority.
Although the Affordable Care Act (ACA) was not designed with the opioid epidemic in mind, it provides valuable tools for expanding access to medication treatment: major health insurance coverage expansions through Medicaid and the establishment of state health insurance marketplaces, inclusion of addiction treatment as an essential health benefit that existing insurance plans must cover, and requirements that benefits for treatment of opioid use disorder be provided at parity with coverage of medical and surgical procedures. The dramatic rise in opioid use disorders has prompted many states to take a hard look at deficiencies in their current systems of treatment and to leverage opportunities presented by the ACA for addressing them.
Originally published March 9, 2017 in The New England Journal of Medicine.