In recent weeks, what almost everyone has acknowledged to be a national crisis — the deaths of 64,000 Americans from drug overdoses in 2016 alone, more American deaths than in the entire Vietnam War — has begun to get the attention a national crisis deserves.
The President, in his 2019 proposed budget, requested $5 billion to combat the opioid epidemic — a pittance compared to the scale of the problem, but perhaps a sign that the administration now recognizes the need to act. Purdue Pharma, whose aggressive marketing got many Americans hooked on opioid pain pills in the first place, announced that it would stop promoting OxyContin to doctors and would cut its sales staff in half.
And a federal judge in Ohio appointed a special master to oversee 16 federal lawsuits filed against opioid makers in Ohio, Alabama, California, Kentucky, Illinois, West Virginia and Washington State, while 115 additional lawsuits in state and local courts make similar claims: that opioid makers and sellers exaggerated the benefits and downplayed the addictive power of their drugs.
These responses are welcome, but late and limited. Overdose deaths rose 22% in 2016. The influx of deadly fentanyl likely drove those numbers higher still in 2017. To turn the tide, an all-out fight is needed, with institutions in every sector playing critical roles.
Fixing a problem this massive will take a large-scale mobilization — a nationwide version of the multi-sector approach our affiliate launched last year on Long Island.
Hospitals need to retool their emergency room protocols. Doctors need to be recruited, trained and supported to prescribe buprenorphine — the most effective opioid treatment, which only a tiny fraction of opioid users receive.
Schools need to hire and train drug counselors and improve peer-to-peer support among students. Recovery groups need to scale up successful innovations in peer recovery coaching.
Employers need tools to hire, retain and support workers dealing with opioid addiction and related challenges. Bureaucratic barriers between substance use treatment and treatment of other mental health disorders need to be dismantled.
Local congregations need to become more skilled at assisting congregants at every stage of substance abuse challenges.
Who will pay for this multibillion-dollar mobilization? The most useful parallel on this question is one that might not leap to mind: the cleanup of our nation's toxic waste sites. We propose an Opioid Superfund — analogous to the fund created by Congress in 1980 for environmental cleanups. That fund was based on a simple "polluter pays" principle: It was created by a tax on the oil and chemical industries, which had used swaths of land across America as their dumping grounds.
The polluter, in this case, is the opioid industry. Let the manufacturers of addictive pain pills like Purdue Pharma pay for the opioid cleanup they made necessary by falsely marketing their products. Let the distributors and retailers — which reaped enormous opioid profits and then successfully lobbied to undermine government's authority to regulate their operations — put some of those profits toward a solution.
Purdue Pharma alone has reaped an estimated $35 billion from a single opioid pain pill, OxyContin. The company made $2.4 billion from opioid sales just in 2015. They have the money.
Lawsuits face a long and uncertain path. And even if, after years of litigation, billions are extracted from the industry, there is no guarantee that those dollars will be targeted to the work needed going forward. The national tobacco settlement of the 1990s is a cautionary tale; billions were diverted to expenditures that had nothing to do with the fight to reduce smoking.
A faster path, with more tightly targeted outcomes, is available. With bipartisan leadership from members of Congress — whose districts are all decimated by this scourge — and from the White House, an Opioid Superfund can be created to pay for the urgent and long-term project of reversing this epidemic. Congress should take Gov. Cuomo's proposal to levy a two-cent-per-milligram tax on opioid manufacturers and double it, and then add levies on the distributors and retailers as well.
The scale must be significant: large enough to serve as a vehicle for settling the lawsuits brought by affected states, counties and municipalities, and large enough to pay for the all-out mobilization needed over the next decade.
Citizens will need to ensure that such a fund is used expeditiously and effectively, and that Congress resists pressures to simply extract revenues from one industry (opioids) only to subsidize another (opioid treatment). All money will need to be earmarked for evidence-based approaches.
But with bottom-up and top-down leadership, this approach can marshal the resources we need now for this life-and-death fight.
Pollach is the rector of St. John's Episcopal Church in Cold Spring Harbor and co-chair of Long Island Congregations, Associations & Neighborhoods. Morris is an organizer with the Metro Industrial Areas Foundation.