Worldwide, about 275 million people (or 5.5% of the global population aged 15-64 years) used drugs at least once in 2019. Among them, about 62 million people used opioids. About 36.3 million people suffered from drug use disorders in 2019.(2) Most people dependent on opioids used illicitly cultivated and manufactured heroin, but the proportion of those using prescription opioids is growing.
Of the more than $370 billion that has been appropriated to the U.S. Department of Health and Human Services (HHS) for pandemic response in the past two years, most was targeted to health care providers, with about $140 billion set aside for testing, treatment, and vaccines.35 Continued investment is critical to national and global response and readiness.36 Yet federal inaction on a COVID-19 supplemental funding proposal leaves the country at risk, as it would be unable to continue ongoing surveillance; improvements in air ventilation and filtration; monoclonal antibody treatment; free testing, treatment, and vaccines for uninsured patients; oral antiviral pills and treatments for immunocompromised individuals; and other priorities.37
1.5 Million Americans With Mental Illness Misused Opioids Last Year
Drug overdoses are the leading cause of rising mortality rates among young and middle-aged adults, and more Americans now die as a result of fatal drug overdoses than from car crashes and even gun violence. In April 2021, the number of fatal drug overdoses in the United States over a 12-month period surpassed 100,000 for the first time.63 One of the primary drivers of this substance use epidemic is opioids. According to the 2020 National Survey on Drug Use and Health, more than 9.5 million Americans misused opioids in 2020.64 As a result, more than 70 percent of overdose deaths in 2019 involved opioids, including prescription opioids, heroin, and synthetic opioids such as fentanyl, and the number of annual opioid deaths in 2020 was six times the number in 1999.65
The Supplemental Nutrition Assistance Program (SNAP) provides monthly grocery benefits to more than 37 million people with incomes below 130 percent of the federal poverty level, and 66 percent of households receiving SNAP benefits include children.115 Yet the program is set to expire September 30, 2023.116 Without congressional action to reauthorize the program before then, millions of people already struggling to make ends meet would face severe food insecurity, nutritional deficiencies, and poorer health outcomes.
Coordinating affordable housing, health care, and other social services through supportive housing interventions has proved effective in reducing housing insecurity and improving health for individuals transitioning from institutions, aging, or in recovery, as well as those who are disabled, have mental health issues, or struggle with chronic homelessness.152 However, at least 1.2 million more supportive housing units are needed to serve these populations.153
The relationships and interactions that exist where people live, learn, work, play, worship, and age meaningfully affect their health. Indeed, strong, positive social connections help protect against poor health and well-being.187 Conversely, poor social connections and experiences are associated with more health risks.188 For example, adverse childhood experiences such as exposure to violence and parental incarceration have been linked to chronic conditions, mental illness, and substance use in adulthood.189 Additionally, living in environments where discrimination, prejudice, violence, and stigma are prevalent creates toxic stress that leads to negative health outcomes.190
Systemic racism and discrimination also perpetuate health disparities and inequities in the social systems that affect health. The U.S. system of policing is riddled with inequities that largely affect communities of color and often increases violence within and toward those communities.209 Indeed, the number of fatal police shootings has increased in recent years, and the rate among Black Americans is higher than that of other racial and ethnic groups.210 Research has shown that these fatal shootings and their proximity damage the mental health of Black Americans.211 To reduce violence, improve community relations with law enforcement, and improve the overall mental health of those communities most affected, police reform is necessary. Specifically, police should be less involved in situations better suited for community responders, health providers, and social services professionals.212
Elder abuse is a serious public health problem affecting millions of older Americans each year, with some studies suggesting that as few as one in 23 cases is reported to authorities. Elder abuse is defined as intentional actions that cause harm or create a serious risk of harm to an older person (whether or not harm is intended). Elder abuse encompasses physical abuse, neglect, financial exploitation, sexual abuse, as well as emotional and psychological abuse.
Significant need for treatment optionsThe use of drugs is growing globally. Approximately 300 million people are using drugs.1 Opioids continue to cause the most harm and are the reason for the majority of drug-related deaths.2 The problem with opioid misuse is by far the greatest in the US where about a fifth of those dependent on opioids live.3 A sharp increase in prescription for opioid painkillers during two decades is the primary reason that today there are an estimated 10 million people abusing opioids in the US.4 Approximately 4 million are considered to be in need of treatment. 5 Of these, approximately 1.5 million receive so-called Medication Assisted Treatment, MAT,6 where the most common form of treatment is buprenorphine/naloxone. Fentanyl is prevalent and causing the surge in fatal overdosesThe Covid-19 pandemic, with society lockdowns and social distancing, have fuelled the opioid crisis in the US. According to latest available annual data the number of fatal overdoses surpassed 100,000,7 and overdose is today one of the most common cause of death for people under 50 years. 76 percent of the fatal overdoses were related to the misuse of opioids, foremost synthetic opioids, such as fentanyl.8 Fentanyl supply is accelerating in the US due to a significant increase of illegal manufacturing in Mexico.Large economic burden on the US societyFrom an economic point of view the misuse of opioids is a considerable problem. In addition to loss of life and lower quality of life, large costs are associated with lower productivity, increased healthcare and correctional treatment costs. The opioid epidemic cost the US society a tremendous amount. Additionally the costs continue to rise which can be explained by the growing death toll in recent years and as it includes a broader societal cost of premature death.
In 2015, 20.8 million people aged 12 years or older (7.8 percent of the United States population) had a substance use disorder (SUD) in the previous year.[1] Approximately 75 percent of this group, or 15.7 million Americans, had an alcohol use disorder,[1] 2.0 million had a prescription opioid use disorder (OUD),[2] and about 0.6 million had a heroin use disorder.[1] Since 1999, opioid-related overdose deaths in the United States have quadrupled, with more than 15,000 individuals experiencing prescription drug-related overdose deaths in 2015.[3] Even though evidence-based SUD treatments are effective, rates of treatment receipt are quite low. In 2015, only 18 percent of the population with SUDs, or 3.7 million people, received SUD treatment--a number that has not increased significantly since 2002.[1, 4] Only about 48 percent of patients who enter SUD treatment actually complete it.[5] 2ff7e9595c
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