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opioid epidemic
To Ensure Health Equity, Congress Should Renew the Affordable Connectivity Program
As a physician delivering telemedicine-based addiction care to rural and low-income communities, the program has been the essential linchpin for creating access to lifesaving medications for opioid use disorder.
Apr 03, 2024
In an ironic twist, people recovering from opioid addiction recently gained permanently expanded access to telemedicine services through a new federal policy—but many are likely to be among the 22 million low-income households losing access to affordable internet.
The Federal Communications Commission recently began to wind down the Affordable Connectivity Program, the country’s largest, most successful internet affordability program. This government-sponsored benefit program, introduced during the pandemic, provides low-income Americans with a one-time subsidy to purchase an internet-capable device and monthly subsidies for broadband services.
As a physician delivering telemedicine-based addiction care to rural and low-income communities, the Affordable Connectivity Program has been the essential linchpin for creating telemedicine access to lifesaving medications for opioid use disorder.
I urge Congress to renew funding for the Affordable Connectivity Program and pursue legislative pathways to permanently expand internet access to all.
Substance use disorders are life-threatening chronic conditions, but they’re treatable. More than 70% of people with substance use disorders transition into recovery. However, early recovery is fragile. When people are ready to engage in care, low-barrier, rapid access to care is vitally important to support treatment success, especially during reentry from incarceration when the overdose risk is up to 129 times greater than community-based populations. Nearly half of people using opioids in rural areas were recently incarcerated, emphasizing the need for expanded rural access to treatment.
Yet, in-person addiction care is disproportionately limited in rural communities, requiring long drive times to access care. This is simply not an option for most of my patients, particularly those in early recovery. Most are trying to rebuild their lives while confronting significant financial debts incurred during past periods of expensive, prolonged substance use and incarceration. Stigma locks them out of high-earning positions, effectively segregating them to low-wage positions with limited opportunities for advancement and usually no access to benefits like paid time off to engage in care.
Many of us can get a leg up during hard times from family or peers. However, most patients in early recovery are at the starting line of repairing social relationships weakened by trust lost during active substance use and prolonged absence during incarceration. Often, the social supports they can access are facing similar resource-limited circumstances, with minimal ability or bandwidth to help with transportation or finances.
Every day, my patients choose what they can afford from a menu of necessities.
What will you have today?
- Food
- Transportation to work
- Cellphone access
- Savings toward rent
- Fees to obtain a driver’s license
Rarely can they cover more than one or two at a time. How could expensive, time-intensive travel to distant healthcare ever compete?
It shouldn’t have to. And thanks to the relaxation of telemedicine rules and the Affordable Connectivity Program, it hasn’t had to.
While the Affordable Connectivity Program’s $30 monthly subsidy sounds inconsequential, the true value of costs saved is much higher, as the collateral costs (e.g., transportation, lost-wages) of in-person services are avoided. With reliable access to data plans, my patients attend their medical appointments from their worksites during their lunch breaks or easily negotiate alternative breaks with their bosses, who are more willing to be flexible because work can quickly resume when patients remain on-site. This has allowed patients to consistently receive addiction treatment without incurring lost wages and transportation costs during the two-to-four-hour long process of in-person care. With their financial distress tempered, my patients have more quickly transitioned from survival mode to future planning.
The Affordable Connectivity Program also enabled internet access to key social resources that promote health and stability. My patients have taken online classes, searched and prepared for jobs, and built healthy social connections with online recovery communities, the latter particularly key for rural patients with limited in-person social options.
Funding for the Affordable Connectivity Program is projected to run out in April unless Congress acts quickly to renew funding. Amidst the Affordable Connectivity Program’s wind down, my team has begun switching patients to the remaining alternative telecommunication benefits for low-income households, like the Lifeline program. However, this inferior program provides only $9.95 monthly toward internet service—insufficient to cover the entire cost of a plan—and limited options of qualifying service providers. For my patients battling homelessness living in tents, cars, and motel room rentals while working tireless hours to survive and endeavor toward stable thriving, a $20 increase in monthly expenses is insurmountable.
The communities with significantly limited internet access—rural, low-income, Black—are also disproportionately impacted by the opioid crisis and low access to in-person treatment. Their precarious internet access falsely positions the internet as a luxury, rather than an essential resource for healthcare, education, employment, transportation, and social belonging. Internet access is a health equity issue.
I urge Congress to renew funding for the Affordable Connectivity Program and pursue legislative pathways to permanently expand internet access to all. Without swift action, I fear that losing the Affordable Connectivity Program will lead to more lives lost to treatable substance use disorders.
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Families Rally for Opioid Accountability as Supreme Court Hears Purdue Case
"I don't want their money," one woman who lost a son to the opioid crisis said of the Sackler family. "I want them in prison."
Dec 04, 2023
At the U.S. Supreme Court on Monday, families whose loved ones are among the tens of thousands of Americans who have died of opioid use disorder each year over the past two decades rallied to push the nine justices to reject a proposed bankruptcy plan that would give the former owners of Purdue Pharma legal immunity—with many joining the U.S. Justice Department in arguing that the company should not be released from accountability for the opioid epidemic.
Purdue Pharma filed for bankruptcy in 2019, as the number of Americans killed by opioids hit 50,000 and the OxyContin manufacturer faced thousands of lawsuits alleging its aggressive marketing of the addictive painkiller had fueled the rising death toll.
The company agreed to settle the lawsuits for $10 billion, with the Sackler family—which oversaw Purdue when OxyContin was introduced and flooded communities across the U.S.—contributing $4 billion. In exchange, the Sacklers would be shielded from future lawsuits.
The bankruptcy plan—which now includes $6 billion from the Sacklers following a push from lawsuit plaintiffs—has been approved by state and local governments, tribes, and families and individuals who would be entitled to money.
But the U.S. Trustee Program, a watchdog at the Justice Department, has joined some families in arguing that the Sacklers should not be shielded from liability for the opioid crisis.
"No Sackler immunity at any $$," read one sign held by a woman outside the Supreme Court on Monday, while another said, "My dead son does not release Sacklers."
The issue at hand in the case, Harrington v. Purdue Pharma, is whether it is legal to give a third party—the Sackler family—legal immunity in a bankruptcy case even though they themselves have not declared bankruptcy, also known as nonconsensual third-party release.
A lawyer for groups and individuals told the court that families and governments are highly unlikely to get any more out of Purdue and the Sacklers than the money the company and family have offered as part of the deal.
The plan would include $161 million in a trust set aside for Native American tribes and $700 million to $750 million in a trust for families and individuals who were able to file claims, with payouts expected to range from about $3,500 to $48,000. Governments would use the money to set up addiction treatment centers and other programs to mitigate the opioid crisis.
"Forget a better deal—there is no other deal," lawyer Pratik Shah told the Supreme Court on Monday.
Curtis Gannon, representing the U.S. Trustee Program, noted that the Sackler family already showed that a "better deal" could be possible when it offered $6 billion for the plan instead of $4 billion. The Justice Department is advocating for a new settlement that would not include nonconsensual third-party releases, saying the current bankruptcy deal violates federal law.
"We do hope there is another deal at the end of this," said Gannon.
The justices appeared split on the case, in which a ruling is expected next summer. Justice Ketanji Brown Jackson noted that appeals courts do not allow bankruptcy plans that take away the rights of alleged victims to sue parties that have not declared bankruptcy.
Outside the court, Alexis Pleus, who lost her son to opioid use disorder, told Aneri Pattani of KFF Health News that many families, including hers, will not be entitled to money under the current deal because they are required to provide records such as the original opioid prescription.
Beth Macy, author of the book Dopesick, told CNN Monday morning that while some families "are divided" about whether the bankruptcy plan and payouts should move forward, as the U.S. Trustee Program "has pointed out, only 20% of the families who were eligible to vote on [the proposal], even voted."
"I don't want their money," Jen Trejo, whose son Christopher was prescribed OxyContin at age 15 and died of an overdose when he was 32, told Pattani. "I want them in prison."
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Critics Push Back Against Biden Revival of Failed 'War on Drugs' Approach to Fentanyl
"Over 100,000 of our loved ones being lost to avoidable overdoses a year is not because of a lack of enforcement, it's a direct result of it," the director of the Drug Policy Alliance argued.
Feb 07, 2023
U.S. drug policy reform advocates condemned President Joe Biden's commitment to "accelerating the crackdown on fentanyl trafficking" as part of his administration's strategy for tackling the opioid crisis, a policy the White House announced in a preview of Tuesday night's State of the Union address.
Although the SOTU preview says the administration will be "expanding access to evidence-based prevention, harm reduction, treatment, and recovery," the document says Biden will "work with Congress to make permanent tough penalties on suppliers of fentanyl," fentanyl analogs, and fentanyl-related substances (FRS).
The outline states that Biden "looks forward to working with Congress on its comprehensive proposal to permanently schedule all illicitly produced FRS into Schedule I," the most severe Drug Enforcement Administration classification.
"The push to place all fentanyl-related substances in Schedule I is unfortunate and misguided. Schedule I is supposed to be for substances that we know to be harmful and not helpful."
"Traffickers of these deadly substances must face the penalties they deserve, no matter how they adjust their drugs," the preview asserts.
In response to the SOTU preview, Maritza Perez Medina, director of the office of federal affairs at the Drug Policy Alliance, said in a statement that "we are glad to see President Biden continue to call for increased access to evidence-based treatment, harm reduction, and recovery services."
"But, his support for harsher penalties for fentanyl-related substances—which will result in broader application of mandatory minimum sentencing and disproportionately harm Black, Latinx, and Indigenous communities—in the same breath is incredibly counterproductive and fails to recognize how we got to this place to begin with," she asserted. "Over 100,000 of our loved ones being lost to avoidable overdoses a year is not because of a lack of enforcement, it's a direct result of it."
\u201c\ud83d\udea8BREAKING\ud83d\udea8 @POTUS' State of the Union Comments on Fentanyl-Related Substances Run Counter to Commitments on Public Health and Criminal Justice Reform \ud83d\udce2 FULL QUOTE from @DrugPolicyOrg @DPA_OFA Director @MariPerMed IN THREAD \ud83d\udc47 https://t.co/kGYX8kQ1tx\u201d— Matt Sutton (@Matt Sutton) 1675810566
Gregory Dudley, who chairs the chemistry department at West Virginia University, argued that "the push to place all fentanyl-related substances in Schedule I is unfortunate and misguided. Schedule I is supposed to be for substances that we know to be harmful and not helpful."
"We don't know which of these substances would be harmful or helpful, and how could we without testing them?" Dudley asked. "Some of these substances could be lifesaving opioid antagonists like naloxone, or better. This proposal prioritizes criminalization over healthcare."
Susan Ousterman, who lost her son Tyler to an accidental overdose in 2020 and subsequently founded the Vilomah Memorial Foundation, said that "it's incredibly disheartening to see the president co-opting the grief of mothers like me in an attempt to increase penalties, rather than prioritizing the health measures that are desperately needed to save lives."
"Increased penalties for people who use or sell drugs, including fentanyl-related substances, would not have kept my son alive or the countless children of other mothers I have met," Ousterman stressed. "In fact, it's policies such as these that created the increased stigma and fear that kept our children from accessing help, and it's what has led to the increasingly dangerous drug supply that resulted in their deaths."
"It's time for the president and other policymakers to prioritize the lives of all humans by embracing a health approach rather than engaging in politics that only perpetuate this disastrous war on drugs," she added. "As a person who understands the profound impact both substance use and child loss have on families, I expected more."
Biden was one of the architects of the 1980s escalation of the War on Drugs. He coined the term "drug czar" while advocating the establishment of the cabinet-level position and was a key supporter of the 1994 Violent Crime Control and Law Enforcement Act, legislation that accelerated U.S. mass incarceration.
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