Opioid overdoses have skyrocketed during COVID-19 but states are slashing addiction treatment budget

By AMY SOKOLOW

JULY 16, 2020

WASHINGTON — Drug overdoses have skyrocketed and demand for addiction treatment medicine has soared as the coronavirus pandemic continues. But many cash-strapped states are nevertheless slashing budgets for opioid crisis programs.

Oregon is poised to slash $69 million from the state’s 2021 budget for behavioral health services. Colorado has already cut $26 million from its own. Georgia, New Jersey, Florida and Utah have also slashed millions for future substance use disorder programs, and in Minnesota, shortfalls in fees collected from pharmaceutical giants will translate into service reductions, too. Other states are paring back Medicaid funding that, nationwide, supports about 21% of the country’s spending on substance use disorder programs. Though the federal government earmarked $425 million for behavioral health in its emergency coronavirus relief package, experts say the help won’t come close to filling the hole.

The budget cuts — many spurred by state budget shortfalls wrought by the economic consequences of the coronavirus pandemic — will hit behavioral health services when they are needed most, addiction treatment advocates told STAT. At least 35 states have reported increases in opioid mortality rates. Relapses, overdoses, and the use of dangerous and unfamiliar synthetic drugs are also on the rise. Treatment facilities have had to cut capacity to adhere to social distancing requirements — increasing demand for the fewer spots available and squeezing facilities’ budgets at the same time.

“It was already a significant issue for cities to support this. Post-Covid, you have higher rates of opioid use and overdoses and less resources,” said Sue Polis, director of health and wellness for the National League of Cities. “It’s almost a perfect storm in terms of cities’ capacity and readiness.”

It’s hard to calculate exactly how the coronavirus pandemic has changed the landscape of addiction in the United States, but early data — and interviews with treatment providers across the country — paint a picture of a worsening crisis.

“We are more full than we’ve ever been,” said Stephen Loyd, formerly Tennessee’s top addiction policy official, who is now the medical director at treatment facilities in Tennessee, Kentucky, and Florida.

“The demand for treatment has grown exponentially,” agreed Dan Lustig, who runs the Haymarket facility in Chicago, a substance use disorder clinic that serves 12,000 patients annually, many of whom are low-income and experiencing homelessness.

Loyd, Lustig, and other addiction medicine providers agreed that losing their funding would be an “Armageddon-type situation” right now, as Loyd put it. But those cuts are coming: The Center for Budget and Policy Priorities projects that states will face a $555 billion shortfall through fiscal year 2022, which would be even larger than the shortfalls from the Great Recession.

And mental health services are often among the first to be slashed. During the last recession, states cut at least $4.35 billion from their mental health budgets between fiscal years 2009 to 2012. The longer the pandemic continues to dry up state revenues, the more funding will likely be cut from these budgets, according to Anna Bailey, a policy analyst at CBPP.

“Policymakers are faced with impossible choices,” said Jodi Manz, project director for chronic and vulnerable populations at the National Academy for State Health Policy. “Leaders are being put in situations where they thought they had really significant revenue from the prior year, and just overnight were faced with a very, very different revenue situation.”

So far, Georgia has cut $5.7 million from substance use disorder programs, including residential treatment facility expansions. Oregon’s $69 million cuts to behavioral health services includes a $2 million reduction for outpatient programs in particular. And Colorado’s plan to invest in training for medical professionals to identify individuals at risk of substance use disorder will take a $1 million cut. In late June, Florida Gov. Ron DeSantis, a Republican, vetoed over $12 million in behavioral health funds meant to go toward initiatives such as substance abuse prevention programs, crisis intervention programs, and a long-acting injectable buprenorphine pilot program.

Experts worry that these funding cuts may take aim at programs for especially at-risk populations, such as those who are incarcerated or formerly incarcerated. Manz said that these programs are often cut to relieve deficits because they’re expensive and are not covered by Medicaid. Without these programs in correctional facilities, nearly three-quarters of those with opioid use disorders relapse within three months of their release, according to a study published in the journal Addiction Science & Clinical Practice.

Another “low-hanging fruit” for lawmakers intent on slashing budgets, according to Regina LaBelle, director of the Addiction and Public Policy Initiative at Georgetown University’s O’Neill Institute, is harm reduction programs, like needle exchanges, largely because they’re already underfunded. Since the pandemic started, 43% of syringe service programs surveyed by the North American Syringe Exchange Network reported a decrease in available services. Many cited a lack of available personal protective equipment as prohibitive to their ability to operate normally during the pandemic.

These programs are critical to keep HIV infection rates at bay and reduce the risk of overdose, according to studies published by the CDC and in the journal Substance Use & Misuse.

But programs like these, according to Manz, are often cut simply because they’re newer innovations. “They’re things that don’t necessarily have the history of evidence … they just haven’t been ingrained in our assumptions about what treatments for recovery or prevention should look like,” she said. “It’s easy to look at those things as extras, even though sometimes they are imperative.”

Rob Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors, sees a starker picture when states decide where along the opioid response continuum, from prevention to treatment, to cut funds. “The prevention part of that continuum can be overlooked because on the other side of the equation, people are literally dying,” he said.

Taken together, the cuts destabilize an already vulnerable population, according to Loyd, who runs the treatment centers in the South. He said he has never seen an economic crisis affect his patients so swiftly, forcing some of them to take virtual addiction treatment appointments from their cars with their children asleep in the back seat. “It’s the United States. I can’t believe that,” he said.

Opioid crisis cuts are “taking an already at-risk population and really cutting the legs off from under them,” he said. “If you don’t have money to treat these folks, there’s really only a couple of places they can wind up. One is, unfortunately, dead.”

Correction: An earlier version of this story incorrectly identified Haymarket Center President Dan Lustig.