The opioid epidemic — responsible for more than two-thirds of all drug overdose deaths1 — has evoked major shifts in perspective and outlook when it comes to addiction. Politics aside, the Affordable Care Act made health coverage more attainable and reclassified substance abuse treatment as an essential health benefit. In short, the legislation unofficially known as “Obamacare” made addiction treatment more accessible for many.
Obamacare wasn’t without its critics, though, including our current president, Donald Trump. Shortly after taking office in early 2017, President Trump reaffirmed his intent to not only find an effective replacement for Obamacare, but also devise a strategy to address the opioid epidemic. So the proposal of a new Trump healthcare plan was no surprise, but the decision to cut federal funding for addiction-related ventures was an unexpected development.
Released in late May, the president’s proposed budget for 2018 was met with an outcry from those who have been affected by the disease. After Trump repeatedly announced his intent to end the opioid crisis2 and spend more money on addiction treatment3 while campaigning last year, many of his previous supporters see the proposed budget as a broken promise.4 Many treatment professionals and drug policy experts consider the “war on drugs” to be a resounding failure5 and assert that the best course of action is to focus on treatment and prevention to alleviate the opioid epidemic;6 as such, the concern being raised over a decreased budget for addiction treatment, research and prevention is valid. But what, exactly, might the effects of the budget decrease actually be?
Addiction is Already Underfunded
It’s often said that the federal government has been extremely slow to respond to the opioid epidemic; the evidence for this claim is the fact that it wasn’t until 2016 that the Obama Administration passed legislation that was a direct response to the opioid crisis, granting $1 billion in funding for addiction treatment through the 21st Century Cures Act.7 While that was a start, it takes a lot of money to research new treatment methods, build rehab centers and implement anti-drug campaigns. Much more funding is needed to develop solutions to an epidemic that currently kills more people than guns and car accidents.
According to the Office of National Drug Control Policy, next year’s budget actually shows a two-percent increase for addiction treatment overall, adding an additional $200 million and bringing the total to $10.8 billion; however, when you consider the amount that comes from the Cures Act — $500 million since the Act’s $1 billion is split between 2017 and 2018 — and the numerous decreases across most addiction-related programs, it actually comes out to be less than before.8 This is why is the prospect of subtracting, rather than adding, funding is alarming to many working in the treatment field as well as those who rely on those programs. Moreover, since the Cures Act only allocated funding for 2017 and 2018, we’ll likely see an even greater drop in funding for addiction-related ventures in 2019.
Crippling Prevention Programs Across the Board
As mentioned previously, most professionals agree that treatment and prevention are the best ways to address addiction. Obviously, treatment initiatives target those who are already addicted while prevention focuses on decreasing the number of people developing addictions. Incidentally, many prevention programs are tailored toward youth, which is arguably the most at-risk demographic for addiction. Fortunately, the proposed budget won’t cut 95 percent of funding received by the Office of National Drug Control Policy (ONDCP), as was previously reported,9 but numerous programs have seen reductions in funding, amounting to a total of 11 percent.10
The implications of these cuts could be huge since the ONDCP directs national anti-drug efforts and campaigns, manages prevention programs, establishes budgets, and creates guidelines to implement at federal, state, and local levels. Some of the most notable of ONDCP’s initiatives include the National Youth Anti-Drug Media Campaign and Drug Free Communities.
Addiction Treatment Becomes Less Accessible
Despite some valid criticisms of the Affordable Care Act, it enabled Medicaid to pay for approximately 25 percent of the $31 billion that the public spent on drug addiction treatment in 2014.11 That means there were a lot of people who previously wouldn’t have been able to pay for treatment getting help for their addictions.
President Trump is proposing an astounding 47-percent cut to Medicaid over the course of the next 10 years,12 meaning that many of the people who gained health coverage via the Affordable Care Act would once again be without health insurance. President Trump has also proclaimed himself a supporter of the American Health Care Act,13 which would make substance abuse treatment much less likely to be covered by health insurance plans.14 In fact, analysts predict that the American Health Care Act could result in 2.8 million Americans losing access to affordable addiction treatment.15
Moreover, the budget proposes roughly $400 million in cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA),16 an agency that notably provides hundreds of millions of dollars in grants and scholarships for mental health treatment, substance abuse included. There are also billions of dollars in budget cuts to the National Institutes of Health, Food and Drug Administration, and the Center for Disease Control and Prevention. While these agencies don’t deal solely with addiction, some of their programs play a small part in addressing the opioid crisis.
These are just some of the ways that upcoming budget cuts could affect addiction treatment, research, and prevention. The full proposal — currently available online — shows a more detailed breakdown of government spending for next year and may include budget cuts that inhibit programs to address the opioid epidemic in unexpected ways. Of course, a lot can change between now and then, so treatment professionals are continuing to monitor the situation. A major increase in activism for addiction treatment and prevention could have a positive effect on addiction-related initiatives as we move forward.
1. Lopez, German. “The opioid painkiller and heroin epidemic, explained.” Vox.
2. “Donald Trump Outlines Plan to End Opioid Epidemic in America.” Wayback Machine.
3. Lurie, Julia. “Remember When Trump Said He Cared About the Opioid Crisis? Fast Forward to Now.” Mother Jones.
4. Johnson, Carla K. & Peoples, Steve. “Trump’s Budget Dismays Families Hit by Drug Addiction Crisis.” U.S. News.
5. Lopez, German. “The war on drugs, explained.” Vox.
6. “Report of the International Narcotics Control Board for 2014.” International Narcotics Control Board.
7. Belluz, Julia. “The biggest health reform bill since Obamacare, explained in 600 words.” Vox.
8. “National Drug Control Budget: FY 2018 Funding Highlights.” Executive Office of the President of the United States.
9. Lurie, Julia. “Trump Budget Would Slash Funds for Office Fighting Opioid Epidemic.” Mother Jones.
10. Diamond, Dan. “White House dials back cuts to drug control office.” Politico.
11. Mark, Tami L., Levit, Katharine R., Yee, Tracy, & Chow, Clifton M. “Spending On Mental And Substance Use Disorders Projected To Grow More Slowly Than All Health Spending Through 2020.” Health Affairs.
12. Hirschfeld Davis, Julie. “Trump’s Budget Cuts Deeply Into Medicaid and Anti-Poverty Efforts.” The New York Times.
13. Kaplan, Thomas & Pear, Robert. “House Passes Measure to Repeal and Replace the Affordable Care Act.” The New York Times.
14. Lopez, German. “The Republican health care bill would make America’s deadliest drug overdose crisis even worse.” Vox.
15. Frank, Richard G. & Glied, Sherry A. “Keep Obamacare to keep progress on treating opioid disorders and mental illnesses.” The Hill.
16. Diamond, Dan. “It’s Budget Day: What’s in Trump’s proposals for health care.” Politico.
Written by Dane O’Leary