Failing Women Caught In The Grips Of The Opioid Epidemic

Women Die Of Opioid Overdoses At Significantly Greater Rates Than Men

1999-2015: The Rate Of Prescription Opioid Overdose Death Increased 471 Percent Among Women, Compared To 218 Percent Among Men. According to the U.S. Department of Health and Human Services, “Opioid use disorder is increasing at alarming rates for both men and women in the United States. The prevalence of prescription opioid, heroin, and illicit synthetic opioid use among women is substantial. Between 1999 and 2015, the rate of deaths from prescription opioid overdoses increased 471 percent among women, compared with an increase of 218 percent among men, and heroin deaths among women increased at more than twice the rate than among men.” [U.S. Department of Health and Human Services, Office of Women’s Health, 7/19/17]

1999-2015: Heroin Overdose Deaths Among Women Increased At More Than Twice The Rate Among Men. According to the U.S. Department of Health and Human Services, “Opioid use disorder is increasing at alarming rates for both men and women in the United States. The prevalence of prescription opioid, heroin, and illicit synthetic opioid use among women is substantial. Between 1999 and 2015, the rate of deaths from prescription opioid overdoses increased 471 percent among women, compared with an increase of 218 percent among men, and heroin deaths among women increased at more than twice the rate than among men.” [U.S. Department of Health and Human Services, Office of Women’s Health, 7/19/17]

1999-2015: Synthetic Opioid-Related Deaths Increased 850 Percent Among Women. According to the U.S. Department of Health and Human Services, “Most alarmingly, there has been a startling increase in the rates of synthetic opioid-related deaths; these deaths have increased 850 percent in women between 1999 and 2015.” [U.S. Department of Health and Human Services, Office of Women’s Health, 7/19/17]

2005-2014: Opioid-Related Hospitalizations Rose 75 Percent For Women, Compared To 55 Percent For Men. According to NBC News, “There’s a startling new snapshot of the nation’s opioid epidemic. In just a decade, the rate of people hospitalized because of pain relievers and heroin rose 64 percent, while the rate of opioid-related emergency room visits almost doubled, according to a report released Tuesday. The findings are particularly troubling for women. Hospitalizations surged 75 percent for women between 2005 and 2014, compared to 55 percent for men the Agency for Healthcare Research and Quality reported. That means the rate of opioid-related hospital stays, which used to be rarer for women, is now about equal among the sexes nationwide — about 225 per 100,000 people. That’s ‘absolutely remarkable,’ Anne Elixhauser, senior research scientist at AHRQ, told TODAY.” [NBC News, 6/20/17]

Women Are More Likely To Experience Chronic Pain And Use Prescription Opiods For Longer And In HIgher Doses

HHS: The CDC Says “Women Are More Likely Than Men To Experience Chronic Pain And Use Prescription Opioid Pain Medications For Longer Periods And In Higher Doses.” According to the U.S. Department of Health and Human Services, “The picture of substance use is different for women and men. According to the Centers for Disease Control and Prevention (CDC), women are more likely than men to experience chronic pain and use prescription opioid pain medications for longer periods and in higher doses.” [U.S. Department of Health and Human Services, Office of Women’s Health, 7/19/17]

Women Have Higher Rates Of OPioid-Related Hospitalizations In Most States

Anne Elixhauser, Senior Research Scientist At The Agency For Healthcare Research And Quality: “Now, In Three-Quarters Of States In The U.S., Women Have A Higher Rate Of Opioid-Related Inpatient Stays Than Do Men.” According to NBC News, “Hospitalizations surged 75 percent for women between 2005 and 2014, compared to 55 percent for men the Agency for Healthcare Research and Quality reported. That means the rate of opioid-related hospital stays, which used to be rarer for women, is now about equal among the sexes nationwide — about 225 per 100,000 people. That’s ‘absolutely remarkable,’ Anne Elixhauser, senior research scientist at AHRQ, told TODAY. ‘Now, in three-quarters of states in the U.S., women have a higher rate of opioid-related inpatient stays than do men,’ she said. ‘For most of the country, it seems to be a larger problem for women.’” [NBC News, 6/20/17]

[U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, 8/2017]

March 2017: Trump Created A New National Opioid Commission To Be Led By Chris Christie

March 2017: Trump Issued An Executive Order Creating A New National Opioid Commission To Be Led By Chris Christie. According to PBS, “New Jersey Gov. Chris Christie will lead a new national opioid commission created Wednesday by an executive order from President Donald Trump that also maps out his administration’s latest strategy to combat the public health crisis. The fight against the opioid epidemic is ‘one that’s incredibly important to every family in every corner of this country,’ Christie said Wednesday in an interview with The Today Show, adding he and Trump ‘both care passionately about this issue and we want to save lives.’” [PBS, 3/29/17]

Critics Panned The New Commission As Redundant And A Waste Of Precious Time In The Fight Against Opioid Addiction

Politico: Public Health Advocates Said Trump’s Plan For “Yet Another Big Presidential Commission” Would, At Best, Duplicate Those Of The Obama White House And, At Worst, Set Back Efforts To Combat The Opioid Epidemic. According to Politico, “Trump won many of those communities — often overwhelmingly. But as president, he’s proposing deep cuts to research and treatment in favor of funding a border wall to stop drug traffic, while hinting at bringing back policies like criminalization of drug misuse — and announcing Wednesday yet another big presidential commission to study the problem. Public health advocates say those plans at best duplicate those of the Obama White House and at worst could set back efforts to tackle a problem that contributes to more than 47,000 deaths per year.” [Politico, 3/29/17]

Baltimore Health Commissioner Dr. Leana Wen: “We Do Not Have The Luxury Of Giving This Commission Months To Rehash Facts That Experts, Including The Surgeon General And Coalitions Of Doctors And Public Health Experts, Already Agree Upon.” According to an opinion by Baltimore health commissioner Dr. Leana S. Wen for CNN, “Little is known about the Trump administration’s plan to end this public health epidemic of opioid abuse, apart from the creation of a Commission on Combating Drug Addiction and the Opioid Crisis. So far, the White House has only said that the commission will produce a report and look for federal funding mechanisms. But that is not nearly enough. At a time when opioid overdose deaths kill tens of thousands of Americans every year — including more than 33,000 in 2015 — we do not have the luxury of giving this commission months to rehash facts that experts, including the surgeon general and coalitions of doctors and public health experts, already agree upon.” [Dr. Leana Wen – CNN, 4/12/17]

Former Obama Administration Official Who Worked To Address The Opioid Crisis: “These People Don’t Need Another Damn Commission.” According to Politico, “Public health experts question the value of the commission. It was just last November when Surgeon General Vivek Murthy released his office’s first-ever report on opioids and addiction, which included tools and recommendations collected from more than a year of research. The CDC also released prescribing guidelines after thorough study. ‘These people don’t need another damn commission,’ said a former Obama administration official who worked to address the opioid crisis and asked not to be named. ‘We know what we need to do. … It’s not rocket science.’” [Politico, 3/29/17]

Longtime Drug Policy Official: “You Know What’s Redundant And A Waste Of Time, Effort And Money? The Commission.” According to Politico, “Another said that the office would be redundant, given the new White House opioids commission. ‘You know what’s redundant and a waste of time, effort and money?’ a longtime drug policy official countered. ‘The commission.’” [Politico, 5/5/17]

The Commission Failed To Meet Its First Two Reporting Deadlines

The Commission Was To Submit An Interim Report To Trump With Its Findings After 90 Days, And Submit A Final Report By October 2017 Unless More Time Was Needed. According to PBS, “According to Trump’s signed order, the commission is designed to: Identify existing federal dollars to combat drug addiction, including opioids; Assess availability and access to addiction treatment centers and overdose reversal and identify underserved areas; Measure the effectiveness of state prescription drug monitoring programs; Evaluate public messaging campaigns about prescription and illegal opioids, and identify best practices for drug prevention. In 90 days, the commission will submit an interim report to Trump with its findings. It will submit a final report by Oct. 1, unless more time is needed, according to the executive order. The commission will dissolve a month later.” [PBS, 3/29/17]

Headline: “White House Opioid Commission To Miss Deadline For Second Time” [CBS News, 7/13/17]

The Commission Missed Both Its June 27^th And July 17^th Deadlines To File An Interim Report. According to CBS News, “President Trump’s commission to fight the opioid epidemic will miss a deadline to file an interim report on the crisis for a second time, according to a notice set to be released Friday. The Commission on Combating Drug Addiction and the Opioid Crisis was created by executive order in March. Mr. Trump tapped New Jersey Gov. Chris Christie to chair the panel, tasking the commission with studying the federal government’s response to the growing opioid epidemic and offering recommendations to improve efforts to combat its effects. The executive order set a deadline of 90 days, or June 27, for the commission to file an interim report outlining a federal strategy to combat the epidemic. The commission failed to issue the report before the initial deadline, announcing instead it would issue its interim assessment during a conference call on July 17. According to a notice scheduled to appear in the Federal Register on Friday, the commission is rescheduling the July 17 call until 31, missing the extended deadline.” [CBS News, 7/13/17]

When The Commission Finally Issued Its First Set Of Recommendations, Trump Ingored Them

Trump Did Not Address Any Of The Commission’s Major Recommendations In His “Major Briefing” Following Release Of The Commission’s Report. According to NBC News, “Trump announced no new policies in the fight against opioids after promising a ‘major briefing’ in a tweet Tuesday morning. Last week, the presidential opioid commission, chaired by New Jersey Gov. Chris Christie, urged Trump to ‘declare a national emergency’ and noted that ‘America is enduring a death toll equal to September 11th every three weeks.’ It recommended, among other things, expanding treatment facilities across the country, educating and equipping doctors about the proper way to prescribe pain medication, and equipping all police officers with the anti-overdose remedy Naloxone. Trump did not address any of the recommendations. Instead, the president repeated his well-worn pledge to be ‘very, very strong on our Southern border.’” [NBC News, 8/8/17]

• Commission Chair Christie Missed Trump’s Briefing Because He Was On Vacation In Italy. According to NBC News, “In addition to Price, the Trump briefing was attended by First Lady Melania Trump, top adviser and son-in-law Jared Kushner, Counselor to the President Kellyanne Conway, and other White House officials. Not present was Christie, who is on vacation in Italy.” [NBC News, 8/8/17]

Rather Than Express Support For The Commission’s Recommendations, Trump Used The Briefing To Blame China And Mexico For Supplying Americans With Drugs

At The Briefing, Trump Pledged To Be “Very, Very Strong On Our Southern Border.” According to NBC News, “Trump announced no new policies in the fight against opioids after promising a ‘major briefing’ in a tweet Tuesday morning. Last week, the presidential opioid commission, chaired by New Jersey Gov. Chris Christie, urged Trump to ‘declare a national emergency’ and noted that ‘America is enduring a death toll equal to September 11th every three weeks.’ It recommended, among other things, expanding treatment facilities across the country, educating and equipping doctors about the proper way to prescribe pain medication, and equipping all police officers with the anti-overdose remedy Naloxone. Trump did not address any of the recommendations. Instead, the president repeated his well-worn pledge to be ‘very, very strong on our Southern border.’” [NBC News, 8/8/17]

Trump: “We’re Talking To China, Where Certain Forms Of Man-Made Drug Comes In And It Is Bad.” According to NBC News, “Trump announced no new policies in the fight against opioids after promising a ‘major briefing’ in a tweet Tuesday morning. Last week, the presidential opioid commission, chaired by New Jersey Gov. Chris Christie, urged Trump to ‘declare a national emergency’ and noted that ‘America is enduring a death toll equal to September 11th every three weeks.’ […] ‘We’re talking to China, where certain forms of man-made drug comes in and it is bad,’ Trump said. ‘We are speaking to other countries, and we’re getting cooperation.’” [NBC News, 8/8/17]

Trump Suggested Teaching Abstinence From Drugs As A Means Of Curbing The Epidemic, Calling To Mind The Failed “Just Say No” Campaign Of The 1980s and 90s

Trump: The “Best Way To Prevent Drug Addiction And Overdose Is To Prevent People From Abusing Drugs In The First Place.” According to The Washington Post, “Even with the opioid crisis intensifying and more than 142 Americans dying of drug overdoses each day, President Trump is not yet ready to declare a national emergency, as was recommended last week by a commission he organized. Instead, the president met Tuesday afternoon with health officials and members of his administration to receive an update on the crisis and to briefly address reporters. He said the ‘best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place.’” [Washington Post, 8/8/17]

Trump: “If They Don’t Start, They Won’t Have A Problem.” According to The Washington Post, “‘If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off,’ Trump told reporters at the clubhouse at his private golf club. ‘So if we can keep them from going on — and maybe by talking to youth and telling them: ‘No good, really bad for you in every way.’ But if they don’t start, it will never be a problem.’” [Washington Post, 8/8/17]

Trump: “So If We Can keep Them From Going On – And Maybe By Talking To Youth And Telling Them: ‘No Good, Really Bad For You In Every Way.’” According to The Washington Post, “‘If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off,’ Trump told reporters at the clubhouse at his private golf club. ‘So if we can keep them from going on — and maybe by talking to youth and telling them: ‘No good, really bad for you in every way.’ But if they don’t start, it will never be a problem.’” [Washington Post, 8/8/17]

CNN: Trump’s “Abstinence-Based Treatment” Was “Evocative Of The ‘Just Say No’ Ad Campaign Of The 1980s And Early 1990s.” According to CNN, “Trump also advocated for more abstinence-based treatment to combat the opioid crisis. ‘The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off,’ Trump said. That sort of strategy advocates for targeting kids and young adults with anti-drug messaging, evocative of the ‘Just Say No’ ad campaign of the 1980s and early 1990s.” [CNN, 8/8/17]

Trump Also Suggested A Stronger Law Enforcement Role, Another Failed Strategy

Trump: “It’s A Problem The Likes Of Which We Have Never Seen. Meanwhile, The Overall Drug Prosecutions Have Gone Down In Recent Years.” According to CNN, “President Donald Trump said Tuesday a stronger law enforcement response is needed to combat the opioid crisis, speaking at his New Jersey golf club and flanked by Secretary of Health and Human Services Tom Price and acting Director of National Drug Control Policy Richard Baum. ‘It’s a problem the likes of which we have never seen. Meanwhile, the overall drug prosecutions have gone down in recent years,’ Trump said of opioid abuse during a briefing on the topic. He heralded Price as the person to lead his effort to tackle the issue, and said that no one is safe from opioid addiction. ‘At the end of 2016, there were 23% fewer federal prosecutions than in 2011. So they looked at this surge and they let it go by,’ Trump said, referring to enforcement under former President Barack Obama. ‘We’re not letting it go by. The average sentence for a drug offender decreased 20% from 2009 to 2016.’” [CNN, 8/8/17]

Senior Director For The Drug Policy Alliance Bill Piper: “A Supply Side Approach To Drugs Has Never Worked. That Is What Has Been Tried For Decades And It Has Failed For Every Drug It Has Applied To.” According to CNN, “Bill Piper, senior director for the Drug Policy Alliance, told CNN Tuesday that stricter enforcement ‘has never worked’ and the President would be ‘better focusing on the treatment side of things.’ ‘A supply side approach to drugs has never worked,’ Piper said. ‘That is what has been tried for decades and it has failed for every drug it has applied to, including alcohol during Prohibition. As long as there has been and demand for drugs, there will be a supply.’” [CNN, 8/8/17]

Trump Declined To Designate The Opioid Crisis A “National Emergency” As Recommended By His Commission

Trump Did Not Declare The Opioid Epidemic A National Emergency, As Recommended By His Commission. According to NBC News, “President Donald Trump vowed Tuesday the U.S. would ‘win’ the battle against the heroin and opioid plague, but stopped short of declaring a national emergency as his hand-picked commission had recommended. Instead, Trump promised to ‘protect innocent citizens from drug dealers that poison our communities.’” [NBC News, 8/8/17]

• Mayor Of Huntington, West Virginia: “There’s A Recommendation On One Hand And Then It’s A Rebuffing Of That Recommendation And We Would Encourage The President And Those In Congress To Be Encouraging The President That We Need To Have A Very Aggressive Effort.” According to MetroNews, “The mayor of Huntington is ‘a bit perplexed’ by President Donald Trump’s decision to not declare a national emergency in the opioid crisis as his own Commission on Combating Drug Addiction and the Opioid Crisis has recommended. ‘There’s a recommendation on one hand and then it’s a rebuffing of that recommendation and we would encourage the President and those in Congress to be encouraging the President that we need to have a very aggressive effort,’ Mayor Steve Williams said.” [MetroNews, 8/9/17]
• Portland Press Herald Editorial: Trump Is “Squandering An Opportunity To Follow Through On His Promise” To Help Those Suffering From Drug Addiction. According to an editorial by the Portland Press Herald, “The president’s tragically shortsighted proposals are at odds with the recommendations of his Commission on Combating Drug Addiction and the Opioid Crisis, which formally urged Trump to take steps that could make a real difference, like declaring a state of emergency – which would allow states or communities deemed addiction ‘disaster zones’ to use federal funds for things like addiction treatment or the overdose-reversal medication naloxone. […] As a presidential candidate, Donald Trump pledged to help those struggling with addiction. As president, he’s squandering an opportunity to follow through on his promise, instead putting forth a substance-free plan of action that may beef up his tough-on-crime image but will do nothing to help the millions who have seen their own or their loved ones’ lives ravaged by this merciless epidemic.” [Editorial – Portland Press Herald, 8/9/17]

A National Emergency Designation Would Allow The Administration To Waive Certain Federal Rules, Including One Restricting Where Medicaid Recipients Can Receive Addiction Treatment

The National Emergency Designation Would Allow The Administration To Waive Certain Federal Rules, Including One Restricting Where Medicaid Recipients Can Receive Addiction Treatment. According to The Washington Post, “Last week, the commission issued a preliminary report that described the overdose death toll as ‘September 11th every three weeks’ and urged the president to immediately ‘declare a national emergency under either the Public Health Service Act or the Stafford Act.’ Doing so would allow the administration to remove some barriers and waive some federal rules, such as one that restricts where Medicaid recipients can receive addiction treatment. It would also put pressure on Congress to provide more funding.” [Washington Post, 8/8/17]

• Medicaid Is The Largest Payer For Behavioral Health Treatment, Including Opioid Treatment, In The Nation.[United States Government Accountability Office, 2015]

Trump Eventually Called The Crisis A “National Emergency,” But Has Not Filed The Paperwork Making It Official Or Announced Any Changes In Policy

HEADLINE: “A Month Has Passed Since Trump Declared An Opioid Emergency. What Next?” [New York Times, 9/10/17]

A Month After Trump Declared The Opioid Crisis A National Emergency, Nothing Had Been Done By His Administration To Act On The Declaration. According to The New York Times, “When President Trump announced in early August, following a presidential commission’s recommendations, that the opioid crisis was a ‘national emergency,’ he called it ‘a serious problem the likes of which we have never had.’ A month has now passed, and that urgent talk has yet to translate into urgent action. While the president’s aides say they are pursuing an expedited process, it remains to be seen how and by what mechanism Mr. Trump plans to direct government resources. While the president’s opioid commission, led by Gov. Chris Christie of New Jersey, has urged him to move swiftly, Mr. Trump and his cabinet — primarily his health secretary, Tom Price — are trying to determine how best to move forward amid warnings from deficit hawks within the administration about the potential costs.” [New York Times, 9/10/17]

The Hill: “On Aug. 10, Trump Said The Opioid Epidemic Was A National Emergency, But Nothing Has Happened Since. No Paperwork Has Been Issued Formally Declaring An Emergency, And No New Policies Have Been Announced.” According to The Hill, “On Aug. 10, Trump said the opioid epidemic was a national emergency, but nothing has happened since. No paperwork has been issued formally declaring an emergency, and no new policies have been announced.” [The Hill, 9/11/17]

The Trump Administration Once Floated 95% Cuts To The Office Of National Drug Control Policy

The Trump Administration Considered Cuts Of 95% To The Office Of National Drug Control Policy. According to Politico, “President Donald Trump’s fiscal 2018 budget would cut about 95 percent of funding for the Office of National Drug Control Policy, effectively ending its mission as the lead agency in charge of combating the opioid crisis and other drug epidemics, according to an internal office email and two sources who spoke with Politico.” [Politico, 5/5/17]

• The Office Of National Drug Control Policy Received $388 Million In Federal Funding In Fiscal 2017, But The White House Budget Proposal Only Allotted $24 Million For The Agency. According to Politico, “President Donald Trump’s fiscal 2018 budget would cut about 95 percent of funding for the Office of National Drug Control Policy, effectively ending its mission as the lead agency in charge of combating the opioid crisis and other drug epidemics, according to an internal office email and two sources who spoke with POLITICO. The office, which received $388 million in federal funding in fiscal 2017, would only receive $24 million in fiscal 2018, according to the White House budget proposal. The agency’s high-intensity drug-trafficking program, which received $254 million in federal funding in 2017, and its drug-free communities support program, which received $100 million, would be completely zeroed out under Trump’s proposal.” [Politico, 5/5/17]

The Cuts Would Have Reduced The ONDCP Staff By Half

Trump’s Cuts Would Have Cut Almost $7 Million In Salaries From The ONDCP, A Cut Projected To Reduce The Office’s Staff By About Half. According to Politico, “President Donald Trump’s fiscal 2018 budget would cut about 95 percent of funding for the Office of National Drug Control Policy, effectively ending its mission as the lead agency in charge of combating the opioid crisis and other drug epidemics, according to an internal office email and two sources who spoke with POLITICO. […] The budget also seeks to cut almost $7 million in salaries, leading to projected cuts of as many as 33 full-time equivalents. About 70 people currently work at the drug control office.” [Politico, 5/5/17]

Acting Director Rich Baum, In An Internal Email To Staff: “These Drastic Proposed Cuts Are Frankly Heartbreaking And, If Carried Out, Would Cause Us To Lose Many Good People Who Contribute Greatly To ONDCP’s Mission And Core Activities.” According to Politico, “‘These drastic proposed cuts are frankly heartbreaking and, if carried out, would cause us to lose many good people who contribute greatly to ONDCP’s mission and core activities,’ acting Director Rich Baum wrote in an internal email to staff that was shared with POLITICO.” [Politico, 5/5/17]

• Baum Was A Former Hill GOP Staffer Picked By The Trump White House To Lead The Office Of Drug Control Policy. According to Politico, “The White House on Tuesday also shuffled the leadership at the Office of Drug Control Policy, replacing acting head Kemp Chester — a compromise pick between the outgoing Obama and incoming Trump administrations — with acting head Rich Baum, a former Hill GOP staffer who’s been critical of legalizing marijuana and wants to tackle drug cartels abroad. Baum specializes in what’s called the ‘supply side’ of drug policy — cracking down on the flow of illegal drugs — as opposed to ‘the demand side,’ or treating the end user. Baum is close to GOP policy experts who worked to enact the ‘war on drugs’ tactics under previous Republican presidents, several sources told POLITICO.” [Politico, 3/29/17]

The Cuts Would Have Totally Defunded The High-Intensity Drug-Trafficking Areas Program

ONDCP’s High-Intensity Drug-Trafficking Program Received $254 Million In Federal Funding In 2017 But Would Have Received No Funding At All Under Trump’s Proposal. According to Politico, “President Donald Trump’s fiscal 2018 budget would cut about 95 percent of funding for the Office of National Drug Control Policy, effectively ending its mission as the lead agency in charge of combating the opioid crisis and other drug epidemics, according to an internal office email and two sources who spoke with POLITICO. […] The agency’s high-intensity drug-trafficking program, which received $254 million in federal funding in 2017, and its drug-free communities support program, which received $100 million, would be completely zeroed out under Trump’s proposal.” [Politico, 5/5/17]

The HIDTA Program Is A Coordinated Effort Between Federal, State, And Local Law Enforcement To Address Drug Trafficking In Specific Areas. According to congressional testimony by Office of National Drug Control Policy Director Michael P. Botticelli in Congressional Quarterly, “The HIDTA Program was created as part of ONDCP’s original authorization to reduce drug trafficking and production in the United States by facilitating cooperation among Federal, state, local, and tribal law enforcement agencies. The HIDTA Program is a locally-based program that responds to the drug trafficking issues facing specific areas of the country. Law enforcement agencies at all levels of government share information and implement coordinated enforcement activities; enhance intelligence sharing among Federal, state, local, and tribal law enforcement agencies; provide reliable intelligence to law enforcement agencies to develop effective enforcement strategies and operations; and support coordinated law enforcement strategies to maximize available resources and reduce the supply of illegal drugs in designated areas.” [CQ Congressional Testimony, 12/2/15]

Approximately 60% Of Americans Live In High-Intensity Drug-Trafficking Areas

The Nation’s 28 High-Intensity Drug-Trafficking Areas Cover About 17% Of U.S. Counties And About 60% Of The Population. According to The Washington Post, “By comparison, the $2.5 million being committed to the latest program by the White House Office of National Drug Control Policy is a small investment, but a senior law enforcement official involved in developing the new strategy said the pairing of public health workers and police is a key step toward ‘both reducing crime and reducing the number of people who end up in emergency rooms.’ The new money will pay for hiring ‘a cop and a health data analyst’ in 15 of the nation’s 28 High Intensity Drug Trafficking Areas, which cover about 17 percent of U.S. counties and about 60 percent of the population, the official said.” [Washington Post, 8/16/15]

The Cuts Would Have Totally Defunded The Drug-Free Communities Support Program

The ONDCP’s Drug-Free Communities Support Program Received $100 Million In Federal Funding In 2017, But Would Have Received No Funding At All Under Trump’s Proposal. According to Politico, “President Donald Trump’s fiscal 2018 budget would cut about 95 percent of funding for the Office of National Drug Control Policy, effectively ending its mission as the lead agency in charge of combating the opioid crisis and other drug epidemics, according to an internal office email and two sources who spoke with POLITICO. […] The agency’s high-intensity drug-trafficking program, which received $254 million in federal funding in 2017, and its drug-free communities support program, which received $100 million, would be completely zeroed out under Trump’s proposal.” [Politico, 5/5/17]

The Drug-Free Communities Support Program Was The Nation’s Leading Effort To Mobilize Communities To Prevent Youth Drug Use. According to congressional testimony by Office of National Drug Control Policy Director Michael P. Botticelli in Congressional Quarterly, “The DFC Support Program, created by the Drug Free Communities Act of 1997, serves as the Nation’s leading effort to mobilize communities to prevent youth drug use. Directed by ONDCP in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA) in the Department of Health and Human Services, the DFC Program provides grants to local drug-free community coalitions, enabling them to increase collaboration among community partners and to prevent and reduce youth substance use. ONDCP provides oversight of the DFC Support Program to include final award determination, program regulation, policy, and its national evaluation.” [CQ Congressional Testimony, 12/2/15]

The Drug-Free Communities Support Program At Least Doubled The Financial Resources Available To Implement And Enhance Community Substance Use Prevention Activities Through Matching Federal Funds. According to the Drug-Free Communities Support Program 2014 National Evaluation Report by ICF International, “From the beginning of the DFC Support Program to the awarding of Fiscal Year (FY) 2013 DFC grants, ONDCP has awarded over 2,000 DFC grants to community coalitions across the nation. DFC grantees have included community coalitions in all 50 states, the District of Columbia, the Virgin Islands, American Samoa, Puerto Rico, Guam, Micronesia, and Palau. They represent rural, urban, suburban, and tribal communities. DFC grantees receive awards of up to $125,000 per year for up to five years per award, with a maximum of 10 award years. DFC grantees are required to match Federal funds, thus at a minimum doubling the financial resources available to implement and enhance community substance use prevention activities and resources.” [Drug-Free Communities Support Program 2014 National Evaluation Report – ICF International, August 2015]

A House GOP Health Care Proposal Would Have Effectively Reversed Medicaid Expansion, A Major Source Of Addiction Treatment

The Bill Would Have Frozen The ACA’s Medicaid Expansion Enrollment In 2020, And Was Later Amended To Prohibit States That Had Not Yet Accepted Medicaid Expansion From Doing So

The GOP Bill Would Have Frozen The ACA’s Medicaid Expansion Enrollment In 2020. According to New York Magazine, “The Medicaid expansion would continue — until 2020, when enrollment would ‘freeze,’ and states would be barred from adding new low-income people to the rolls. Medicaid would also adopt per capita funding limits — meaning states would get a set allotment from the federal government for each enrollee. Currently, the federal government pays all of their bills.” [New York Magazine, 3/6/17]

The Bill Was Amended To Prohibit States That Did Not Yet Accept Medicaid Expansion Under The ACA From Doing So. According to PBS, “The biggest news here might be what Republicans did not change. They did not change the date for freezing the Medicaid expansion program under the ACA. It still closes at the end of 2019. But the proposal out Monday does limit the number of people in the program by blocking any of the 19 states which don’t have the expansion now from signing up.” [PBS, 3/21/17]

After 2020, People Who Became Ineligible For Medicaid For More Than A Month Would Not Have Be Able To Rejoin

After 2020, Those Who Became Ineligible For Medicaid For More Than A Month Would No Longer Be Allowed To Enroll. According to The Atlantic, “After 2020, states will no longer be allowed to enroll additional expansion adults, though those already covered will be allowed to remain covered if they don’t become ineligible for more than a month.” [The Atlantic, 3/6/17]

• The Idea Behind Allowing States To Continue Receiving Federal Help For People As Long As They Remained Eligible Was That Most People On Medicaid Drop Off After A Few Years. According to The Washington Post, “Thirty-one states, plus the District of Columbia, have adopted that expansion. Starting in 2020, however, the GOP plan would restrict the government’s generous Medicaid payment — 90 percent of the cost of covering people in the expansion group — only to people who were in the program as of then. States would keep getting that amount of federal help for each of those people as long as they remained eligible, with the idea that most people on Medicaid drop off after a few years.” [Washington Post, 3/6/17]
• NY Times: Continuous Enrollment in Medicaid Was “A Somewhat Rare Circumstance In A Program In Which People Tend To Cycle In And Out Of Eligibility As Their Incomes Change.” According to New York Times, “And the amount states would get for the people signed up under the Obamacare expansion would be substantially reduced, by more than a third in some states, except in the case of people who stay continuously enrolled in Medicaid, a somewhat rare circumstance in a program in which people tend to cycle in and out of eligibility as their incomes change.” [New York Times, 3/6/17]

As Many Of Half Of Medicaid Beneficiaries Have A Break In Coverage Each Year

Manatt Health Managing Director Jocelyn Guyer: Up To Half Of Medicaid Beneficiaries Had A Break In Coverage Each Year, Making It Likely Participation Would Fall Off Quickly. According to CNN Money, “The American Health Care Act would reverse much of this. It would end the enhanced federal Medicaid funding for new enrollees starting in 2020. Those already in the program could stay as long as they remain continuously insured. But since up to half have a break in coverage each year, it’s likely participation would fall off quickly, said Jocelyn Guyer, managing director at Manatt Health, a consulting firm.” [CNN Money, 3/6/17]

The Bill Would Have No Longer Required States To Provide Substance Abuse Treatment To Medicaid Expansion Beneficiaries

The GOP Bill Would Have No Longer Required States To Provide Substance Abuse And Mental Health Coverage To Medicaid Expansion Beneficiaries, A Requirement Put In Place Under The ACA’s Medicaid Expansion. According to The Washington Post, “House Republicans confirmed Wednesday that their health-care bill would remove a requirement to offer substance abuse and mental-health coverage that’s now used by at least 1.3 million Americans. Substance abuse and mental-health services are among the ‘essential benefits’ states are required to provide under the Affordable Care Act’s expansion of Medicaid, a program that provides health-care coverage to those who can’t afford it. But during a Wednesday meeting of the House Energy and Commerce Committee, a lawyer for the committee Republicans confirmed such coverage would no longer be mandated under the Medicaid expansion. Instead, individual states could decide whether to include mental-health coverage in their Medicaid plans.” [Washington Post, 3/9/17]

A Senate GOP Health CAre Proposal PRovided $45 Billion To Fight The Opioid Crisis – $145 Billion Short Of What Experts Say Is Needed – While Cutting Off Treatment To The Poor

A Version Of The Better Care Reconciliation Act Included $45 Billion To Address Opioid Addiction. According to The Washington Post, “The Senate GOP’s latest attempt to rewrite the Affordable Care Act showed few signs of gaining traction Thursday, further imperiling the party’s quest to overhaul Barack Obama’s 2010 health care law. […] It provides $70 billion to an existing $112 billion state stabilization fund aimed at helping offset consumers’ costs, as well as a $45 billion fund to treat opioid addiction sought by Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.).” [Washington Post, 7/13/17]

Advocates Say $190 Billion Over 10 Years Is Needed To Address The Crisis. According to Vox, “As an unprecedented number of Americans die from opioid overdoses, the Senate’s new health care bill is trying to put a Band-Aid over a gaping wound. The Better Care Reconciliation Act of 2017, the Senate’s plan to repeal and replace Obamacare, would appropriate $2 billion in 2018 to fund state grants to boost treatment and recovery services for those struggling with drug addiction and mental health disorders. There’s no mention of more money going to fund drug treatment beyond 2018. The $2 billion number proposed is a fraction of what two key Republican senators from states hardest hit by the opioid crisis were asking for in the bill’s final version. Ohio Sen. Rob Portman and West Virginia Sen. Shelley Moore Capito had requested $45 billion over the next 10 year. And it’s way less than the number that opioid advocates say will truly help in addressing the addiction crisis: $190 billion over the next 10 years.” [Vox, 6/22/17]

The Bill Would Have Simultaneously Made Deep Cuts To Medicaid

The Senate GOP Health Care Bill Would Have Ended The ACA’s Medicaid Expansion And Make Deep Long-Term Cuts To The Program. According to The Washington Post, “Senate Republicans on Thursday morning plan to release a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law. […] The Senate measure would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health-care program for low-income Americans.” [Washington Post, 6/22/17]

CBO: The BCRA Would Cut $772 Billion From Medicaid. According to the Congressional Budget Office, “The total deficit reduction that would result from the insurance coverage provisions includes the following amounts (shown in Table 3, at the end of this document): • A reduction of $772 billion in federal outlays for Medicaid” [Congressional Budget Office, H.R. 1628 Cost Estimate, 6/26/17]

• By 2026, Medicaid Spending Would Be 26 Percent Lower Compared To The ACA. According to The New York Times, “But the Congressional Budget Office said that the bill would reduce projected Medicaid spending by a total of $772 billion in the coming decade, and that the number of people covered by Medicaid in 2026 would be 15 million lower than under current law. In 2026, it said, Medicaid spending would be 26 percent lower than under current law, and enrollment of people under 65 would be 16 percent lower. Beyond 2026, Medicaid enrollment would keep declining compared with what would happen under current law.” [New York Times, 6/26/17]

CBO: There Would Be 15 Million Fewer Medicaid Enrollees By 2026 Under The BCRA Than Under Current Law. According to the Congressional Budget Office, “Enrollment in Medicaid would be lower throughout the coming decade, with 15 million fewer Medicaid enrollees by 2026 than projected under current law in CBO’s March 2016 baseline (see Figure 4). Some of that decline would be among people who are currently eligible for Medicaid benefits, and some would be among people who CBO projects would, under current law, become eligible in the future as additional states adopted the ACA’s option to expand eligibility.” [Congressional Budget Office, H.R. 1628 Cost Estimate, 6/26/17]

• By 2026, Medicaid Enrollment Of People Under 65 Would Be 16 Percent Lower Compared To The ACA. According to The New York Times, “But the Congressional Budget Office said that the bill would reduce projected Medicaid spending by a total of $772 billion in the coming decade, and that the number of people covered by Medicaid in 2026 would be 15 million lower than under current law. In 2026, it said, Medicaid spending would be 26 percent lower than under current law, and enrollment of people under 65 would be 16 percent lower. Beyond 2026, Medicaid enrollment would keep declining compared with what would happen under current law.” [New York Times, 6/26/17]

The Bill Would Have Also Waived Essential Health Benefits Requirements, Putting Affordable Substance Abuse Treatment At Risk

The BCRA Would Have Allowed States To Waive Some Of The 10 Essential Health Benefits (EHBs) Put Into Place By The ACA. According to Business Insider, “The BCRA, like the AHCA’s MacArthur Amendment, would allow states to apply for permission to rescind some of the Affordable Care Act’s regulations as long as states show how it provides ‘for alternative means of, and requirements for, increasing access to comprehensive coverage, reducing average premiums, and increasing enrollment.’ Unlike the AHCA, the Senate bill would not allow states to rescind regulations related to preexisting conditions, but it would allow states to waive some of the 10 essential health benefits that Obamacare mandated all health plans cover.” [Business Insider, 6/25/17]

According To Health Economist Christine Eibner, Substance Abuse Treatment Was The EHB “Most At Risk” To Be Cut By States. According to Business Insider, “Christine Eibner, a health economist for the Rand Corporation, told Business Insider in May that while there was uncertainty about how states would change regulations, it was reasonable to think state legislators would be under a lot of pressure to cut back on EHBs if other states are able to show that doing so brings down premiums. If that happens, substance-abuse treatment is viewed as the benefit ‘most at risk‘ to be cut, Eibner said.” [Business Insider, 6/25/17]

• According To Eibner, State Legislators Would Be Pressured To Cut Back On EHBs If Other States Were Able To Lower Premiums By Making Cuts. According to Business Insider, “Christine Eibner, a health economist for the Rand Corporation, told Business Insider in May that while there was uncertainty about how states would change regulations, it was reasonable to think state legislators would be under a lot of pressure to cut back on EHBs if other states are able to show that doing so brings down premiums. If that happens, substance-abuse treatment is viewed as the benefit ‘most at risk’ to be cut, Eibner said.” [Business Insider, 6/25/17]

Over 1.8 Million Americans Receive Substance Abuse Or Mental Health Treatment Under Medicaid Expansion, And 29% Of Expansion Beneficiaries Suffer From Mental Health Or Addiction Problems

Approximately 1.84 Million Americans Receive Mental Health Or Substance Abuse Treatment Under Medicaid Expansion. According to Business Insider, “Approximately 1.84 million people in the US are receiving treatment for substance-use disorders or mental illnesses through Medicaid expansion or the ACA’s individual insurance marketplace, according to research conducted by Richard Frank, a professor of health economics at Harvard Medical School, and Sherry Glied, a dean at New York University.” [Business Insider, 6/25/17]

Emily Kaltenbach Of The Drug Policy Alliance Said 29% Of Those Who Benefitted From Medicaid Expansion Have Mental Health Or Addiction Problems. According to Vice, “‘This plan would be a disaster for individuals who are struggling with problematic drug use, currently enrolled in treatment services, or would want to be,’ said Emily Kaltenbach, the Drug Policy Alliance’s senior director of national criminal justice reform strategy. She noted that about 29 percent of the people enrolled in the Medicaid expansion have mental health or addiction problems, and said virtually all of those people could eventually lose health coverage if Congress approves the current version of the Republican plan.” [Vice, 3/9/17]

Those Receiving Treatment For Substance-Abuse Disorders And Mental Illness Through Medicaid Could Lose Approximately $5.5 Billion Under The BCRA. According to Business Insider, “Approximately 1.84 million people in the US are receiving treatment for substance-use disorders or mental illnesses through Medicaid expansion or the ACA’s individual insurance marketplace, according to research conducted by Richard Frank, a professor of health economics at Harvard Medical School, and Sherry Glied, a dean at New York University. Those people would be at risk of losing the approximately $5.5 billion paid out for treatment through those two avenues of insurance.” [Business Insider, 6/25/17]

• Out-Of-Pocket Costs For Consumers In Need Of Substance-Abuse Treatment Could Rise By $1,333 A Year On Average, And By $12,261 A Year For “High-Need” Consumers. According to Business Insider, “An analysis conducted by Eibner and Christopher Whaley, a policy researcher at Rand, found that in places that waive substance-treatment benefits, the out-of-pocket cost for consumers who use those benefits could rise by $1,333 a year. For ‘high-need’ consumers, like those who need an in-patient stay at a treatment facility, out-of-pocket costs could rise to $12,261 a year.” [Business Insider, 6/25/17]

HHS: “If Additional States Chose To Expand Medicaid, Almost 30 Percent Of Those Who Could Gain Coverage Have A Substance Use Or Mental Health Disorder”

HHS: “If Additional States Chose To Expand Medicaid, Almost 30 Percent Of Those Who Could Gain Coverage Have A Substance Use Or Mental Health Disorder.” According to the Department of Health and Human Services, “These data are consistent with other evidence that the ACA’s coverage expansions have been especially important to people with substance use disorders and other behavioral health conditions. For example, ASPE previously estimated that, if additional states chose to expand Medicaid, almost 30 percent5 of those who could gain coverage have a substance use or mental health disorder.” [Department of Health and Human Services, “Continuing Progress on the Opioid Epidemic: the Role of the Affordable Care Act,” 1/11/17]

HHS: “Mental Health Disorders Are Among The Most Common Pre-Existing Health Conditions For Which Americans Might Have Been Denied Coverage Or Charged More For Coverage Prior To ACA”

HHS: “Mental Health Disorders Are Among The Most Common Pre-Existing Health Conditions For Which Americans Might Have Been Denied Coverage Or Charged More For Coverage Prior To ACA.” According to the Department of Health and Human Services, “ASPE also recently estimated6 that mental health disorders are among the most common pre-existing health conditions for which Americans might have been denied coverage or charged more for coverage prior to ACA.” [Department of Health and Human Services, “Continuing Progress on the Opioid Epidemic: the Role of the Affordable Care Act,” 1/11/17]

Medicaid Expansion Cut The Share Of Uninsured Substance Abuse And Mental Health Disorder Hospitalizations By 75%

Medicaid Expansion Brought The Uninsured Share Of Substance Use And Health Disorder Hospitalizations Down From 20 Percent In 2013 To 6 Percent In 2014 Across All States For Which Data Is Available. According to the Department of Health and Human Services, “Across all Medicaid expansion states for which data are available, the uninsured share of substance use or mental health disorder hospitalizations plummeted from about 20 percent in 2013 to around 6 percent by the end of 2014. For the 10 Medicaid expansion states with data available through the third quarter of 2015, the uninsured share fell from 20 percent at the end of 2013 to about 5 percent in 2015-Q3.” [Department of Health and Human Services, “Continuing Progress on the Opioid Epidemic: the Role of the Affordable Care Act,” 1/11/17]

The 5 States With The Highest Rates Of Drug Overdose Deaths – Fueled By The Rise In Opioid-Related Deaths – All Opted To Expand Medicaid Under The ACA

2015: West Virginia, New Hampshire, Kentucky, Ohio, And Rhode Island Had The Highest Rates Of Drug Overdose Deaths, Fueled By Increases In Opioid-Related Deaths. According to the CDC, “Opioids—prescription and illicit—are the main driver of drug overdose deaths. Opioids were involved in 33,091 deaths in 2015, and opioid overdoses have quadrupled since 1999.In 2015, the five states with the highest rates of death due to drug overdose were West Virginia (41.5 per 100,000), New Hampshire (34.3 per 100,000), Kentucky (29.9 per 100,000), Ohio (29.9 per 100,000), and Rhode Island (28.2 per 100,000).” [CDC, accessed 3/10/17]

West Virginia, New Hampshire, Kentucky, Ohio, And Rhode Island All Expanded Mediciad Under The ACA. According to the Kaiser Family Foundation, West Virginia, New Hampshire, Kentucky, Ohio, and Rhode Island all “Adopted the Medicaid Expansion” made available by the Affordable Care Act. [Kaiser Family Foundation, accessed 3/10/17]

Opioid Abusers Tend To Have Multiple Health Problems, So Addressing The Problem Through Medicaid Is A Sensible Approach

Opioid Abusers Typically Had Other Health Problems, Like HIV, Hepatitis C, Chronic Pain Or Mental Health Problems That Required Additional Treatment And Services. According to McClatchy, “But health experts say their 10-year funding request won’t come close to providing the services needed by untold thousands of opioid abusers who are expected to lose their private health insurance and Medicaid coverage under the GOP legislation. That’s because opioid abusers typically have other health problems, like HIV, Hepatitis C, chronic pain or mental health problems that require additional treatment and services.” [McClatchy, 6/20/17]

• American Society Of Addiction Medicine Legislative Advocacy Committee Chair Dr. Corey Waller: “Funding Only Patients’ Substance Abuse Treatment Without Addressing Their Other Needs Would Likely Prove Ineffective.” According to McClatchy, “Funding only patients’ substance abuse treatment without addressing their other needs would likely prove ineffective, said Dr. Corey Waller, who chairs the legislative advocacy committee of the American Society of Addiction Medicine. ‘You can’t treat any medical condition in isolation,’ Waller said. ‘It just seems illogical at every level.’” [McClatchy, 6/20/17]
• Waller: Treating Medical Conditions In Isolation “Just Seems Illogical At Every Level.” According to McClatchy, “Funding only patients’ substance abuse treatment without addressing their other needs would likely prove ineffective, said Dr. Corey Waller, who chairs the legislative advocacy committee of the American Society of Addiction Medicine. ‘You can’t treat any medical condition in isolation,’ Waller said. ‘It just seems illogical at every level.’” [McClatchy, 6/20/17]

Opioids Killed Nearly 100 Americans Per Day As Of June 2017, And Could Kill More Than 650,000 Over The next 10 Years

According To Data Compiled By STAT News, Opioids Could Kill Almost Half A Million People Across The Country Over The Next Ten Years. According to STAT News, “Opioids could kill nearly half a million people across America over the next decade as the crisis of addiction and overdose accelerates.” [STAT News, 6/27/17]

As Of 2017, Drug Overdoses Were The Leading Cause Of Death For Americans Under The Age Of 50. According to STAT News, “Deaths from opioids have been rising sharply for years, and drug overdoses already kill more Americans under age 50 than anything else.” [STAT News, 6/27/17]

As Of June 2017, Opioids Killed Nearly 100 Americans Per Day. According to STAT News, “There are now nearly 100 deaths a day from opioids, a swath of destruction that runs from tony New England suburbs to the farm country of California, from the beach towns of Florida to the Appalachian foothills.” [STAT News, 6/27/17]

Experts Predicted That As Many As 250 Americans Per Day Could Die Of Opioid Overdoses If The Rapid Spread Of Drugs And Long Wait Times For Treatment Continued. According to STAT News, “In the worst-case scenario put forth by STAT’s expert panel, that toll could spike to 250 deaths a day, if potent synthetic opioids like fentanyl and carfentanil continue to spread rapidly and the waits for treatment continue to stretch weeks in hard-hit states like West Virginia and New Hampshire.” [STAT News, 6/27/17]

• At That Rate, Over 650,000 People Could Die From Opioid Overdose Over The Next Decade. According to STAT News, “In the worst-case scenario put forth by STAT’s expert panel, that toll could spike to 250 deaths a day, if potent synthetic opioids like fentanyl and carfentanil continue to spread rapidly and the waits for treatment continue to stretch weeks in hard-hit states like West Virginia and New Hampshire. If that prediction proves accurate, the death toll over the next decade could top 650,000.” [STAT News, 6/27/17]

The Opioid Epidemic Is Poised to Kill As Many Americans As Gun Violence, Breast And Prostate Cancers, And The Entire Span Of The HIV/AIDS Epidemic

Opioids Could Kill As Many Americans In 10 Years As HIV/AIDS Killed In 35 Years. According to STAT News, “In the worst-case scenario put forth by STAT’s expert panel, that toll could spike to 250 deaths a day, if potent synthetic opioids like fentanyl and carfentanil continue to spread rapidly and the waits for treatment continue to stretch weeks in hard-hit states like West Virginia and New Hampshire. If that prediction proves accurate, the death toll over the next decade could top 650,000. That’s almost as many Americans as will die from breast cancer and prostate cancer during that time period. Put another way, opioids could kill nearly as many Americans in a decade as HIV/AIDS has killed since that epidemic began in the early 1980s.” [STAT News, 6/27/17]

650,000 Deaths Per Year Would Approach The Number Killed By Breast And Prostate Cancers. According to STAT News, “In the worst-case scenario put forth by STAT’s expert panel, that toll could spike to 250 deaths a day, if potent synthetic opioids like fentanyl and carfentanil continue to spread rapidly and the waits for treatment continue to stretch weeks in hard-hit states like West Virginia and New Hampshire. If that prediction proves accurate, the death toll over the next decade could top 650,000. That’s almost as many Americans as will die from breast cancer and prostate cancer during that time period. Put another way, opioids could kill nearly as many Americans in a decade as HIV/AIDS has killed since that epidemic began in the early 1980s.” [STAT News, 6/27/17]

Conservative Estimates Projected That By 2027, The Annual Death Toll From Opioids Would Surpass The Worst Year Of Gun Deaths On Record. According to STAT News, “Even the more middle-of-the-road forecasts suggest that by 2027, the annual U.S. death toll from opioids alone will likely surpass the worst year of gun deaths on record, and may top the worst year of AIDS deaths at the peak of that epidemic in the 1990s, when nearly 50,000 people were dying each year.” [STAT News, 6/27/17]