An Agenda for Ending the Addiction Crisis: Key Priorities and Considerations for the Biden Administration

As the Biden administration assumes office during an accelerating global pandemic, federal policymakers will also confront an additional ongoing crisis of addiction—one that appears to both be worsening in its lethality and evolving as synthetic opioids such as fentanyl, polysubstance use, and stimulants, play a greater role in overdose deaths. The COVID-19 pandemic has contributed both to an alarming increase in drug overdose deaths and has laid bare systemic inequalities that result in poorer health outcomes for communities of color. Unemployment, isolation, and stressors from the pandemic, along with disruptions in access to care, have compounded existing challenges for people with substance use disorders (SUDs). Difficulties in accessing services have been exacerbated by financial pressures on addiction treatment providers even as providers report an increased demand for services. 

While immediate action is needed to stem the tide of rising overdose deaths, the administration also has a critical opportunity to take on fundamental reforms for an addiction and behavioral health system that is fragmented, inequitable, and often fails to deliver quality care to those who need it most. Developing a long-term agenda for addressing key drivers of the substance use and addiction crisis will entail working closely with stakeholders to examine and address longstanding disparities and barriers to care, make meaningful investments to the prevention, treatment, and recovery infrastructure, and reorient payment and care delivery approaches to support quality, whole-person care. 

To support the Biden administration in addressing these pervasive challenges, the Duke-Margolis Center for Health Policy convened key thought leaders for a December 2020 virtual roundtable with the goal of identifying high-impact action items that the administration could immediately take to address rising overdose deaths as well as priorities for developing a long-term agenda to address the opioid crisis. Taken together, the recommendations presented below reflect a suggested agenda for ending the addiction and substance use crisis based on key priorities and considerations raised by thought leaders across the addiction community, including state and federal officials, academic experts, treatment providers and provider associations, health systems, payers, and addiction advocacy organizations. 

To save lives and develop a long-term agenda for addressing the opioid crisis, key priorities for the Administration include: 

•    Improve alignment and coordination across federal programs and agencies addressing substance use 
•    Identify lessons learned during the pandemic and extend appropriate regulatory flexibilities 
•    Center equity and lived experience in the policy-making process 
•    Strengthen harm reduction and community-based prevention approaches 
•    Reduce regulatory and policy barriers to evidence-based SUD treatment 
•    Develop real-time data system information sharing to inform policy efforts 
•    Expand investments in prevention, treatment, and recovery workforce capacity 
•    Advance payment and delivery reforms that support a whole-person approach to treatment and recovery 
•    Reform the criminal justice system and link justice-involved individuals to quality care