The New York Times asked 30 experts to think big but realistically about solutions to the opioid epidemic, imagining that they had $100 billion to spend over five years. The consensus was that any effective strategy should include funding for four major areas: treatment, harm reduction, and both demand- and supply-focused solutions. The panel spent more money on treatment than anything else. It was the top priority for more than 20 experts. There was substantial disagreement about whether to focus on treating addiction or on trying to prevent the addiction from forming in the first place by addressing underlying social issues that allow opioid addiction to thrive.
The answers suggest that the severity of the opioid crisis is breaking down longstanding divisions between public health officials and law enforcement, with over two-thirds of the panel including increased funding for law enforcement or international interdiction. Most of the panelists are public health and policy experts; others are politicians and law enforcement officials who have dealt with the crisis extensively. No panelist spent any of the hypothetical $100 billion on a border wall with Mexico. For those who emphasized treatment, expanding access to medication-assisted treatment— like methadone and buprenorphine — was at the top of the list. Systematic reviews show they cut mortality rates by more than half. Another large chunk of money went to expanding Medicaid, a primary source of funding for addiction treatment. Everyone thought at least some money should go toward addiction treatment in jails and prisons. Many people who are severely addicted end up incarcerated at some point. Almost 90 percent of inmates with substance-use disorders receive no medical treatment, which experts say leaves them prone to relapse and overdose when they are freed. The primary divide among panelists was treating addiction versus preventing addiction by reducing demand.