There’s a simple way to understand how the opioid epidemic got so bad in America: In the US, it is much easier to get high than it is to get help for addiction.
How this applies at the state level, though, can differ — some states have made an effort to build serious infrastructure around opioid addiction treatment, while others have not. This map, from the health research firm Avalere Health, shows how states are doing in providing a key frontline treatment for opioid addiction, compared to the amount of opioid overdose deaths they have:
The map looks particularly at the number of buprenorphine providers in the state relative to how many opioid overdose deaths a state has. Buprenorphine is a medication used to treat opioid addiction; along with methadone and naltrexone, it’s widely considered the gold standard of care for opioid use disorder, with studies showing medications can cut the all-cause mortality rate among opioid addiction patients by half or more.
So if a state has less access to the drug and a high number of overdose deaths, it’s likely failing at fully addressing its opioid crisis. Based on the map, that appears to be true for states like West Virginia, Ohio, and New Hampshire, where opioid overdose deaths are very high yet access to buprenorphine is low. (One caveat to the map: Some states, like Pennsylvania, have historically undercounted opioid overdose deaths — so they may look better than they deserve in this kind of visualization.)
This doesn’t necessarily mean that the blame falls entirely on these states for letting the opioid crisis continue, because some of them just might not have the resources to deal with the crisis — and train a bunch of buprenorphine providers — even if they want to.
Recently, the New York Times asked experts how they would spend $100 billion over five years — close to the federal domestic budget for HIV/AIDS — to fight the opioid crisis. Nearly half the money, experts said on average, should go to treatment, with an emphasis on medications like buprenorphine.
But some experts also had a dire warning: The $100 billion over five years may not be enough. So as daunting as the hypothetical price tag may already be for states, it might not fully address the opioid epidemic. That’s one reason experts say that this is a national problem that will require a big financial commitment from the federal government to truly tackle.
Consider one of the best-performing states on this map: Vermont. The state has set up a “hub and spoke” system that treats addiction as a public health issue and integrates treatment into the rest of health care. The state was the only one in New England to have a drug overdose death rate that wasn’t significantly above the national average in 2016. (For more, check out my in-depth breakdown of Vermont’s system.)
Much of this came about because Vermont officials put their heads together to seriously address the crisis. But Vermont also managed to build its new system largely with federal dollars, particularly through Obamacare’s insurance expansion and a special Medicaid waiver that states can obtain through the health care law. It’s that kind of federal support that budget-strained states will need to deal with the opioid crisis.
Yet so far, the federal government hasn’t committed the kind of federal money — tens of billions of dollars over the next few years — that experts argue is necessary. We see the results in Avalere’s map, in which high death rates aren’t matched with treatment that could help prevent more of those deaths in the future.
For more on the opioid epidemic, read Vox’s explainer.