By Linda Richter, Lindsey Vuolo, and Robyn Oster, Health Affairs, June 10, 2021
The recent and ongoing opioid crisis has prompted a surge in much-needed legislative attention and action to bolster our nation’s response to addiction. Congress passed the Comprehensive Addiction Recovery Act in 2016 and the SUPPORT for Patients and Communities Act in 2018 to address opioid misuse, addiction, and overdose deaths through a variety of initiatives in prevention, treatment, harm reduction, and recovery support. The federal government has also provided billions of dollars directly to states through the Substance Abuse and Mental Health Services Administration’s State Opioid Response grant program. More recently, amid considerable increases in substance use during the COVID-19 pandemic, funding to address opioid and other substance use and addiction was included in several COVID-19-relief packages.
Despite these noteworthy increases in attention to and funding for substance use and addiction, especially in ways consistent with an evidence-based public health approach, prevention has received mostly lip service within the substance-specific funding streams. Initiatives that have been promoted within these laws primarily have focused either on adding the topic of prescription opioid misuse to existing drug prevention curricula, modifying clinical practice to reduce access to prescription opioids, or preventing opioid overdose deaths. While helpful and necessary, this approach is not sufficient to curb future drug epidemics, including the growing cases of stimulant misuse and addiction we are currently facing in the United States. Our country traditionally underinvests in prevention and tends to take a narrow, drug-specific approach that fails to address the root causes of substance use, build youth resilience, or adequately protect our nation from experiencing the next substance use and addiction crisis.
To really meet the goal of preventing substance use and addiction, we have to fundamentally rethink our approach by both starting prevention efforts earlier in a child’s life and broadening the lens of what we consider to be effective prevention. Fortunately, with new and emerging legislation from the Biden administration, we seem to be on the cusp of an unprecedented opportunity to accomplish this much needed shift. Although preventing youth substance use is not the stated intention of the administration’s Build Back Better plan, many of the initiatives within the already passed or proposed components of the plan seek to invest in children and families in ways that undoubtedly will help to mitigate the risk factors known to contribute to youth substance use and the incidence of addiction in the United States.
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