The opioid crisis is a major focus of this election cycle, but misinformation about its causes and solutions abound. At the same time, the crisis continues to devastate communities across the United States. With opioid overdose deaths having nearly tripled between 2015 and 2023, accurate information and effective interventions are urgently needed.
One major lifeline in this epidemic is Medicaid, which provides crucial treatment to millions of Americans with opioid use disorder. However, recent budget proposals related to Medicaid policy debates and misinformation falsely linking immigration to the fentanyl crisis perpetuate harmful, inaccurate narratives about Medicaid, threaten to undermine the program’s life-saving support, and divert attention and funds from effective solutions.
Here are five facts that debunk misinformation about the opioid crisis and can be used to shape policies that help more people access needed care for opioid use disorder.
Fact: Medication treatment for opioid use disorder saves lives by lowering overdose risks.
Over the past decade of climbing opioid-related deaths, one enduring misunderstanding is that treatment isn’t effective or that opioid-related deaths are inevitable. But highly effective medication treatment for opioid use disorder is available. There are several ways to expand treatment access to more people, including extending the rule allowing telehealth initiation of buprenorphine treatment before the rule expires at the end of this year.
Most drug overdose deaths involve opioids, even though life-saving naloxone for reversing opioid overdose, such as Narcan nasal spray, is available. There are also three highly effective medication treatments for opioid use disorder—buprenorphine, methadone, and Vivitrol—that have been shown to reduce the number of overdoses, opioid-related use of emergency departments, and overdose deaths. Coverage of these medication treatments is mandated in all state Medicaid programs, with few exceptions.
People with opioid use disorder and their families may find hope in the fact that addiction can be treated successfully. In 2021, 72.2 percent of the millions of adults who reported having had a substance use issue viewed themselves as being in recovery or having recovered (PDF).
Fact: Medicaid, including state expansions, is critical to getting medication treatment to more than 1 million people who need it.
Nearly 80 percent of Medicaid enrollees treated for an opioid use disorder (PDF) received medication treatment in 2021. Of those more than 1.8 million enrollees, more than half were covered by state-level Medicaid expansions under the Affordable Care Act (ACA) that extend coverage to more people with low incomes.
Medicaid enrollment has declined by approximately 18 percent since the end of COVID-19 pandemic policies that prohibited Medicaid disenrollment. If the disenrollment rate is similar for Medicaid enrollees receiving treatment for opioid use disorder, then about 1.5 million enrollees are likely still receiving this life-saving treatment in 2024.
Despite Medicaid expansion under the ACA providing health insurance coverage to millions of people and improving access to needed care like opioid use disorder treatment, reducing Medicaid funding and repealing the Medicaid expansion have long been debated. The ACA faced numerous repeal and replacement attempts before and after its implementation.
Presidential candidate Donald Trump’s statements have fluctuated from proposing renewed efforts to repeal and replace the ACA to seeking “alternatives” to the ACA. Although no alternative has been proposed, both the Republicans’ 2025 budget plan and the Heritage Foundation’s Project 2025 have proposed Medicaid cuts. Project 2025 proposed cutting Medicaid funding by more than 50 percent through block grants or per capita caps and reduced federal matching rates. This could substantially reduce enrollment, especially for people with low incomes. And this may have dire consequences: people with opioid use disorder who are untreated are eight times more likely to die of an overdose than those receiving medication treatment.
In fact, if Project 2025’s proposed 53.7 percent cost cut were to lead to a proportional reduction in Medicaid enrollment, approximately 800,000 of the estimated 1.5 million Americans currently receiving treatment for opioid use disorder could lose access to care. This could exacerbate the ongoing crisis and result in thousands more deaths, placing an even heavier burden on families and communities, state and local governments, and health care providers.
Fact: There is no link between immigration and the fentanyl crisis.
Data show that US citizens are the most likely to bring fentanyl to the US—not immigrants crossing the border illegally, as some have wrongfully claimed. In 2023, more than 86 percent of people sentenced for trafficking fentanyl or its analogues were US citizens.
In contrast, those seeking asylum at the southern border are often fleeing violence, extortion, and persecution, particularly violence caused by drug cartels in Mexico and Central America.
According to US Customs and Border Protection, the vast majority (83.3 percent) of fentanyl seized at the southern border in 2022 was found in vehicles passing through legal ports of entry. In addition, the US Drug Enforcement Administration shows that, even after drugs enter the US, it’s unlikely that individuals are carrying drugs on their person. The most common way to transport illicit opioids is through the interstate system using personally owned or rented vehicles.
Fact: Efforts to intercept lethal fentanyl doses are not enough to stop overdose deaths and need to be part of a broader strategy emphasizing prevention and treatment.
Research shows that stopping fentanyl at the southern border is particularly difficult because the amount of fentanyl consumed in the US is extremely small relative to the volume of legally imported goods. For example, Americans consumed fewer than 10 tons of illicit fentanyl in 2021, which is 100,000 times smaller than the tons of avocado imported that year.
In addition, the most potent forms of fentanyl are increasingly entering the US in ways that are harder to intercept, such as through international mail and express consignment carrier facilities. And fewer than 1 percent (PDF) of international packages suspected of containing illegal substances are intercepted. A 2016 change in border security allowing small items to be shipped from overseas without inspections may also be facilitating illegal drug trade.
This is problematic given that fentanyl can be deadly when consumed—even in small amounts. It’s about 30 times more potent than heroin and 60 times more potent than morphine, and fentanyl analogues can be up to 10,000 times more potent. Even a small amount can be used to produce hundreds of thousands of doses: 1 kilogram of chemicals, about the size of a small sack of flour, can produce 415,000 fentanyl pills. (However, fentanyl is not dangerous to touch, contrary to common misperceptions.)
Although intercepting illicit drugs like fentanyl is important, to effectively combat the opioid overdose crisis, it should be part of a broader strategy focused on prevention, treatment, and regulatory reforms in the health care and criminal legal systems. Harm reduction is essential to such strategies because it can help people avoid overdose until they’re ready for treatment. Meaningfully breaking the cycle of addiction and reducing overdose deaths also requires maintaining and expanding Medicaid to ensure more people receive life-saving care.
As the opioid epidemic persists and misconceptions about it proliferate, elevating these facts is essential for shifting mindsets and ensuring access to effective health care, including medication treatment and harm reduction, for everyone with opioid use disorder.
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