Suicide rates rise sharply across the United States, new report shows

Suicide rates rise sharply across the United States, new report shows

  •  Health Blog •

This article was originally published by The Washington Post.

This post has been updated.

Suicide rates rose in all but one state between 1999 and 2016, with increases seen across age, gender, race and ethnicity, according to a reportreleased Thursday by the Centers for Disease Control and Prevention. In more than half of all deaths in 27 states, the people had no known mental health condition when they ended their lives.

In North Dakota, the rate jumped more than 57 percent. In the most recent period studied (2014 to 2016), the rate was highest in Montana, at 29.2 per 100,000 residents, compared with the national average of 13.4 per 100,000.

Only Nevada recorded a decline — of 1 percent — for the overall period, although its rate remained higher than the national average.

Increasingly, suicide is being viewed not only as a mental health problem but a public health one. Nearly 45,000 suicides occurred in the United States in 2016 — more than twice the number of homicides — making it the 10th-leading cause of death. Among people ages 15 to 34, suicide is the second-leading cause of death.

The most common method used across all groups was firearms.

“The data are disturbing,” said Anne Schuchat, the CDC’s principal deputy director. “The widespread nature of the increase, in every state but one, really suggests that this is a national problem hitting most communities.”

It is hitting many places especially hard. In half of the states, suicide among people age 10 and older increased more than 30 percent.

Percent change in annual suicide rate* by state, from 1999-2001 to 2014-2016 (Centers for Disease Control and Prevention)

“At what point is it a crisis?” asked Nadine Kaslow, a past president of the American Psychological Association. “Suicide is a public health crisis when you look at the numbers, and they keep going up. It’s up everywhere. And we know that the rates are actually higher than what’s reported. But homicides still get more attention.”

One factor in the rising rate, say mental health professionals as well as economists, sociologists and epidemiologists, is the Great Recession that hit 10 years ago. A 2017 study in the journal Social Science and Medicine showed evidence that a rise in the foreclosure rate during that concussive downturn was associated with an overall, though marginal, increase in suicide rates. The increase was higher for white males than any other race or gender group, however.

“Research for many years and across social and health science fields has demonstrated a strong relationship between economic downturns and an increase in deaths due to suicide,” Sarah Burgard an associate professor of sociology at the University of Michigan, explained in an email on Thursday.

The dramatic rise in opioid addiction also can’t be overlooked, experts say, though untangling accidental from intentional deaths by overdose can be difficult. The CDC has calculated that suicides from opioid overdoses nearly doubled between 1999 and 2014, and data from a 2014 national survey showed that individuals addicted to prescription opioids had a 40 percent to 60 percent higher risk of suicidal ideation. Habitual users of opioids were twice as likely to attempt suicide as people who did not use them.

High suicide numbers in the United States are not a new phenomenon. In 1999, then-Surgeon General David Satcher issued a report on the state of mental health in the country and called suicide “a significant public health problem.” The latest data at that time showed about 30,000 suicides a year.

Kaslow is particularly concerned about what has emerged with suicide among women. The report’s findings came just two days after 55-year-old fashion designer Kate Spade took her own life in New York — action her husband attributed to the severe depression she had been battling.

“Historically, men had higher death rates than women,” Kaslow noted. “That’s equalizing not because men are [committing suicide] less but women are doing it more. That is very, very troublesome.”

Among the stark numbers in the CDC report was the one signaling a high number of suicides among people with no diagnosed  mental health condition. In the 27 states that use the National Violent Death Reporting System, 54 percent of suicides fell into this category.

But Joshua Gordon, director of the National Institute of Mental Health, said that statistic must be viewed in context.

“When you do a psychological autopsy and go and look carefully at medical records and talk to family members of the victims,” he said, “90 percent will have evidence of a mental health condition.” That indicates a large portion weren’t diagnosed, “which suggests to me that they’re not getting the help they need,” he said.

Cultural attitudes may play a part. Those without a known mental health condition, according to the report, were more likely to be male and belong to a racial or ethnic minority.

“The data supports what we know about that notion,” Gordon said. “Men and Hispanics especially are less likely to seek help.”

The problems most frequently associated with suicide, according to the study, are strained relationships; life stressors, often involving work or finances; substance use problems; physical health conditions; and recent or impending crises. The most important takeaway, mental health professionals say, is that suicide is an issue not only for the mentally ill but for anyone struggling with serious lifestyle problems.

“I think this gets back to what do we need to be teaching people — how to manage breakups, job stresses,” said Christine Moutier, medical director of the American Foundation for Suicide Prevention. “What are we doing as a nation to help people to manage these things? Because anybody can experience those stresses. Anybody.”

The rates of suicide for all states and the District of Columbia were calculated using data from the National Vital Statistics System. Information about contributing circumstances for those who died by suicide was obtained via the National Violent Death Reporting System, which is relatively new and in place in only 27 states.

“If you think of [suicide] as other leading causes of death, like AIDS and cancer, with the public health approach, mortality rates decline,” Moutier said. “We know that same approach can work with suicide.”

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08 Harvard Study puts Puerto Rico Hurricane Maria Death Toll in the Thousands

 

Last week, a Harvard T.H. Chan School of Public Health study made headlines by estimating the actual number of deaths in Puerto Rico associated with Hurricane Maria as 4,645. While the official government count, which only includes deaths directly attributable to the storm itself, is just 64 the Harvard study estimated that anywhere between 793 and 8,498 deaths (4,645 is the median between these two figures) were likely caused by the storm, mostly due to delayed medical care stemming from the slow recovery response.

 

While the potential range may be wide, there is additional evidence that the botched response to Maria did lead to large numbers of potentially avoidable deaths, and these other estimates do fall within the range identified by the Harvard researchers. University of Puerto Rico statistician Roberto Rivera, along with colleague Wolfgang Rolke published an analysis in February concluding that in the first six weeks after Hurricane Maria, the death count was between 605 and 1,039. Other researchers have also estimated a death toll in the ballpark of 1,000, including the New York Times. Months ago, the government in Puerto Rico commissioned a study to examine the death toll by the George Washington University Milken Institute School of Public Health. That study is ongoing.

 

Either way, one thing is certain. Hundreds, and potentially thousands of Puerto Ricans died — many unnecessarily — because of a lack of preparedness and a lack of urgency in our nation’s response to the island’s crisis. And while we don’t have specific figures on the number of these deaths related to delayed care involve HIV, we know that Puerto Rico was already struggling to keep up with the need for HIV services before the hurricane. The island has over 20,000 people living with HIV, placing it squarely in the top 10 U.S. states and territories for total HIV cases.  Puerto Rico fares even worse in health outcomes, with the highest HIV death rate in the country. In that environment, it’s hard to imagine a scenario in which major interruptions to medical supply chains and service provision wouldn’t devastate residents living with HIV.

 

We reached out to AIDS United partners working on the island, Anselmo Fonseca and Rosaura López-Fontánez to get their take on these new figures and to give us an update on what they’re seeing on the ground.  Here’s what we heard back:
Recognizing that [Hurricane] Maria was an unprecedented natural disaster, the local, state, and federal governments all share equal negligence for the loss of human life and perpetuated devastation. This was criminal!

– Anselmo Fonseca, President, Pacientes de SIDA pro Política Sana; Chair, Cero VIH Puerto Rico; Ryan White Part-B Community Co-Chair (San Juan, PR)

Hurricane Maria not only devastated our country, she demonstrated to the world and ourselves that our island is a territory controlled by the United States, that has always looked at us with indifferences, with disrespect and consideration at every level.  The survey accomplished by [Harvard]  University…demonstrates a reality that the government of Puerto Rico at 9 months of the passing of Maria continues avoiding.  Hurricane season began on June 1st, and with it, families continue without electricity and a roof over their heads, people living in their vehicles, unattended by the local and federal agencies called to ensure their social welfare… finally they have left us with no hope.

I ask myself: Where are the people that govern my country?  To whose interest do they respond? Why and what are the reasons for their continued indifferences? Puerto Rico continues in national mourning.

– Rosaura López-Fontánez, MSW/LCSW, Executive Director Puerto Rico CoNCRA

After 37 Years We Can Finally End the HIV Epidemic. The Question Is, Will We?

SLOGAN 1

With one now very big exception, nothing really notable happened on June 5, 1981. The then little-noticed exception was found in the publication of the CDC’s Morbidity and Mortality Weekly Report which noted that a rare form of pneumonia had been diagnosed among five “active homosexuals” in Los Angeles. The report said that the men were treated at 3 different hospitals and that two of the men had died. Three of the men had been previously healthy according to the report.

There was little immediate reaction in the public to the MMWR report here in the United States or around the world. The Associated Press and the Los Angeles Times filed stories about the report on June 5th and the San Francisco Chronicle ran an article on June 6th. This may seem strange today, when “Breaking News” is a daily feature of our lives and social media can make even the smallest news item known worldwide instantly. The New York Times, the “paper of record,” did not do an article following up on the report until a month later, in its July 3rd issue. The Times article reported on what by then were 41 cases of a rare form of cancer among homosexual men in New York and California. Reading the article that day on the eve of the July 4th holiday as a gay man living in New York City, I thought it was a strange story, but had no idea that my world, and indeed the whole world, was about to change drastically. I certainly had no idea that I was witnessing the beginning of what would become one of the worst pandemics in history.

The immediate reaction to the June 5threport was slow but the pace of varied responses and reactions built up quickly. By mid-August Larry Kramer pulled together a group of gay men that raised immediate funds and led to the formation of Gay Men’s Health Crisis (GMHC) in January 1982, the nation’s first community-based AIDS service provider. Along with that activist response, there was fast-growing fear among many gay men, increased stigmatization of gay men and of gay sex (including internalized stigma) and stigmatization of injection drug users and of drug use in general, increased discrimination, and blindness to the impact of the emerging epidemic on women who did not have a history of drug use, gay and bisexual men of color, and other men who have sex with men.

There was also much hope and optimism in those early years that a cure for AIDS would be found quickly. However, the more dominant reaction among the general public and most levels of government was the willful and shameful ignorance of the emerging AIDS epidemic and neglect of, animosity towards, and abhorrence of people living with and dying of the newly recognized disease. The stigma, discrimination, and neglect all but extinguished the hope of a cure inspired by the active and activist response to AIDS. When I was 41 years old and diagnosed with HIV infection in 1989, I was convinced that I would be dead before my 50th birthday.

Hope and optimism in the fight against AIDS and HIV infection was rebounding by the 15th anniversary of the AIDS and HIV pandemic on June 5, 1996. The growing proof of the effectiveness of highly active antiretroviral therapy (HAART) in saving lives of people living with AIDS heralded a new era of HIV treatment. The theme of that year’s International AIDS Conference, “One World, One Hope,” articulated the resurgent optimism.

The revival of hope and optimism was soon challenged by the clear inequities and gaps in access to the new, effective drug therapies and gaps in access to HIV prevention education and services. The themes of the 1998 and 2000 international conferences were “Bridging the Gaps” and “Breaking the Silence.” The June 5th anniversaries of the HIV pandemic were grim reminders of the toll that HIV disease had taken on our lives and on our communities. The light at the end of the tunnel provided by effective treatments was eclipsed by continued stigma, discrimination, and the blatant lack of sufficient political will to conquer HIV infection and disease within governments here in the United States and around the world. Progress and the ensuing hope and optimism were being kept alive by the magnificent courage and determination of people living with and affected by HIV, health care and service providers, HIV-focused researchers, and HIV advocates.

June 5, 2018, the 37th anniversary of the HIV pandemic is now here. We are still counting the years of HIV disease. We have at least two generations of people who have never known a world without AIDS. But we do have the proven and effective treatment and prevention tools to end the HIV epidemic here in the U.S. and globally. We have powerful messages such as “Treatment is Prevention” and “U=U.” I recently celebrated my 70th birthday and I’m more worried about my back than I am about being HIV positive. And I am certainly not the only long-term survivor; there are many thousands of us.

But there is also far too many multiple thousands of people who remain vulnerable to HIV infection or whose HIV infection is undiagnosed or not successfully treated. Yes, there are numerous factors that account for those realities. For me, the salient factor is the continued lack of sufficient political will to end the HIV epidemic. We have a president and an administration that have made little public effort to highlight the priority of ending the HIV epidemic. We have an administration and a congressional majority that work to undermine health care and the various safety nets and entitlement programs that are crucial to Americans, including those of us living with HIV. Thankfully, there are tenacious federal leaders and workers who are moving forward to maintain a strong federal response to HIV. Thankfully, the courage and determination of people living with and affected by HIV, providers, and advocates that have kept hope and optimism alive in the past continue their efforts. But the challenges and barriers posed by the lack of sufficient political will is daunting.

We enter the 38th year of AIDS and HIV still counting. We can end the epidemic, but will we? If the political landscape does not support our efforts, then we must work together to change it; to elect leaders that have the political will to move us forward and not backward. The June 5, 2019 anniversary can be a marker on the countdown to ending the HIV epidemic. Yes, we can. More importantly, we must.

Posted By: Ronald Johnson, Policy Fellow, AIDS United – Monday, June 04, 2018

HRSA Awards $2.8 Million in Grants to Community-based Organizations to Help Americans Get HIV/AIDS Care and Support Services

Congress is hyperfocused on opioids. Is it focusing enough on addiction?

Controversy over one bill that could fragment care for people with substance use disorder raises serious questions.

Still life. Oxycodone. Oxycodone is a narcotic pain reliever. Oxycodone has a high abuse potential and is prescribed for moderate to high pain relief associated with injuries, bursitis, dislocation, fractures, neuralgia, arthritis, and lower back and cancer pain. OxyContin, Percocet, Percodan, and Tylox are trade name oxycodone products. (Photo by: Education Images/UIG via Getty Images)
STILL LIFE. OXYCODONE. OXYCODONE IS A NARCOTIC PAIN RELIEVER. OXYCODONE HAS A HIGH ABUSE POTENTIAL AND IS PRESCRIBED FOR MODERATE TO HIGH PAIN RELIEF ASSOCIATED WITH INJURIES, BURSITIS, DISLOCATION, FRACTURES, NEURALGIA, ARTHRITIS, AND LOWER BACK AND CANCER PAIN. OXYCONTIN, PERCOCET, PERCODAN, AND TYLOX ARE TRADE NAME OXYCODONE PRODUCTS. (PHOTO BY: EDUCATION IMAGES/UIG VIA GETTY IMAGES)

Congress is trying to pass legislation that addresses the opioid crisis in an election year, so they’re moving fast, passing a bill through committee Thursday that would free up Medicaid dollars for opioid addiction treatment in institutionalized care. But it could be more harmful than lawmakers realize.

Rep. Greg Walden (R-OR) is aiming for the House to take up legislation in June. So to keep with schedule, the House Committee on Energy and Commerce — on which Walden serves as chairman — advanced 32 bills on Thursday, after unanimously advancing another 25 bills last week. The Senate health committee passed its legislative package in April

While lawmakers agree it’s critical to address an epidemic where more people died of a drug overdose in 2016 than the aggregate of the Vietnam War, they don’t always jibe on how.

A question some lawmakers and journalists often ask is whether Congress is too closely targeting opioids, as the epidemic is a problem of polydrug misuse. Bloomberg’s editorial board warned “lawmakers need to take benzodiazepines seriously, before it’s too late.” (Overdose deaths associated with benzodiazepines are fewer than opioids, but still eight times what it was in 1999.)

“I’m concerned that here in Congress we’re so focused on opiates as the drug de jure, if you will, and that in five years or so when this crisis ends or abates or tapers that we’re going to have a bunch of federal programs that are specifically aimed at a problem that may not be as significant,” said Sen. Lisa Murkowski (R-AK) in April.

This point was raised again on Thursday when House members debated, largely along partisan lines, whether to advance the bill to allow Medicaid dollars to be used for opioid addiction treatment in certain treatment facilities.

“With 115 Americans dying each day, we have to focus on the opioid crisis,” said Rep. Mimi Walters (R-CA), the bill’s sponsor. “While we agree that all substance use disorders are important, we’re prioritizing our resources to address the opioid crisis.”

Walters was immediately met with resistance from Democrats.

“I’m troubled that this bill would expand treatment only to people with opioid use disorder as opposed to those with other substance use disorders like alcohol, crack-cocaine, methamphetamine,” said Rep. Jan Schakowsky (D-IL). “This bill is not only blind to the reality faced by people suffering from substance use disorder but it’s also discriminatory.”

Given that the bill exclusively helps those struggling with opioid use disorder, lawmakers are making it clear they only care when white constituents are dying, said Rep. Bobby Rush (D-IL).

“Too often, Mr. Chairmen, this committee and this House have paid attention to issues only when they affect the majority — the majority of the white population,” said Rush. “This leaves too many Black Americans behind.”

The measure would partially and temporarily repeal Medicaid’s Institutions for Mental Disease (IMD) exclusion, meaning it would allow federal Medicaid dollars to pay for opioid use disorder treatment up to 30 days in facilities with more than 16 beds. It would only repeal the ban until December 2023.

Currently states seek federal permission, by waiver, to relax the IMD exclusion for substance use disorder (SUD) treatment. Ten states have these waivers, with California being the first in 2015 to get the okay from the Obama administration.

“We don’t yet know what the utilization of this service looks like, as the program is so new, but it’s worth noting that the IMD exclusion exemption in California’s program is just one piece of a larger system,” said senior program officer at the California Health Care Foundation Catherine Teare, who worked extensively on the state’s waiver. “It’s not specific to opioids or any other particular substance, and it’s embedded within a system that provides access to a full continuum of evidence-based SUD services — based on the American Society of Addiction Medicine criteria.”

Sometimes that care is residential, and sometimes it’s not. People might start their recovery process in inpatient rehab, but then need community-based services to maintain sobriety. In 11 California counties, Medicaid not only pays for residential treatment but a host of other services:

Screenshot of The Drug Medi-Cal Organized Delivery System Pilot Program
SCREENSHOT OF THE DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM PILOT PROGRAM

It also forced relationship-building between primary care, mental health, and substance use treatment providers.

This is another reason why health experts are wary of Walters’ bill.

“I’m fine with paying for the residential component of care, but only if linked to an enduring care plan, such that a person would get more than that,” said Keith Humphreys, a drug policy expert at Stanford University. “Otherwise I think we’ll just spend a lot of money on expensive inpatient stays that don’t have any follow-ups, and the history of that is it’s actually worse than nothing because a person loses their tolerance and they’re even at a higher risk for overdosing than they were when they started.”

It just doesn’t work to build a system where people cycle in and out of institutions, Humphreys added.

Various Republican lawmakers pointed out during the hearing on Thursday that it took months for states to get the federal government to approve their waivers — which is concerning given how many people die a day on average from drug overdoses. For example, West Virginia applied in December 2016, but didn’t get approved until October 2017. For that, Republicans reasoned it just makes sense to lift the ban altogether.

But it’s also important to remember that Congress only has a limited amount of money dedicated to this drug crisis, and IMD repeal could be expensive.

“The cost of inpatient care typically ranges from $6,000 for a 30-day program to $60,000 for 90-day programs, while community-based outpatient services cost around $5,000 for three months of services. That means that any repeal of the IMD would require significant offsets,” according an analysis by the Center on Budget and Policy Priorities (CBPP). Experts at CBPP don’t support a repeal.

Hannah thank you for saying like it is.

Hannah Katch@hannahkatch

Repealing ‘s restriction against payment for institutional care, known as the “IMD exclusion,” would not solve the epidemic — it would risk worsening care for people who need treatment. @JudyCBPP and I explain: https://www.cbpp.org/research/health/repealing-medicaid-exclusion-for-institutional-care-risks-worsening-services-for 

Repealing Medicaid Exclusion for Institutional Care Risks Worsening Services for People With…

Opioid use caused over 42,000 deaths in 2016, and drug overdose deaths rose by statistically significant amounts in 27 states that year, according to the Centers for Disease Control and Prevention….

cbpp.org

The Congressional Budget Office is reportedly working on a score for the bill, but a GOP committee aide told Modern Healthcare that the agency has said repeal is in the “low single digit billions.” IMD exclusion for both mental health and SUD services without day limits would cost up to $60 billion over 10 years.

The worry is money will go to measures that further fragment care for people with substance use disorder, rather than investing in the continuum of care model. Alternatively, for states to secure a SUD waiver, they need to show how inpatient and residential care will supplement community-based services. This can work really well, just look at Virginia.

The House Committee on Energy and Commerce did pass several measures that seem small, but could do a lot of good. Some even addressed fentanyl, which is now the dominant cause for drug overdoses, with fentanyl-laced cocaine potentially becoming the next wave of the opioid crisis. For example the STOP Fentanyl Deaths Act of 2018 authorizes grants for federal, state, and local agencies to create or operate public health laboratories to detect the illicit, synthetic opioid.

Humphreys’ advice: Congress should pass targeted bills addressing the supply side of opioids — but aim for more comprehensive bills when it comes to treatment.

After a Big Buildup, the Trump Administration’s Drug Pricing Plan Doesn’t Deliver

 

Last Friday, President Trump and Secretary of the Department of Health and Human Services Alex Azar unveiled the administration’s plan to lower prescription drug prices, but health policy experts are warning that the proposals fall short of the promises he made on the campaign trail and will do little to address the root causes of the issue. The plan received criticism for being too easy on pharmaceutical companies for their role in the seemingly exponential recent rise in drug prices. President Trump, who once accused the pharmaceutical industries of “getting away with murder” sang a more sympathetic tune last week. Several central tenets of his plan actually support the industry by aiming to increase competition and negotiating power – though not, however, directly for Medicare Part D, as then-candidate Trump touted as his plan during his campaign.

Secretary Azar further clarified the President’s plans in a speech Monday, focusing mostly on the role of Pharmacy Benefits Managers (PBMs), companies that act as middlemen in drug negotiations between insurers and manufacturers. Azar will seek to restrict how much and from where PBMs can collect revenue during their negotiations. The lack of action regarding pharmaceutical manufacturers comes as no surprise to most, considering Secretary Azar’s history as a former industry leader himself.

Also as a part of the administration’s overall efforts to decrease drug prices, the Food and Drug Administration released new data on Thursday about which pharmaceutical companies were potentially “gaming” the drug pricing system by blocking access for other corporations to develop generic (and cheaper) versions of their products.

This national conversation about drug pricing is one that has been ongoing in the HIV community for years, from the creation of the AIDS Drug Assistance Program to subsidize exorbitant HIV medication costs in the 1980s to the prohibitively high cost of one of the only FDA-approved PrEP drugs, Truvada. Most people living with and at risk for HIV are able to get the medications they need thanks to what HIV activist Tim Horn terms the “patchwork of coverage” in place to pay for HIV-related treatments; however, AIDS United will continue to monitor any legislative or regulatory changes proposed by this administration regarding drug pricing and will work to ensure access to these lifesaving drugs is only increased.

In Congress’s Rush to Pass Opioid Legislation, Funding Falls by the Wayside

Over the past week, committees in the House and Senate have advanced large swaths of legislation aimed at addressing the opioid crisis that has become one of the most pressing issues on Capitol Hill as of late. Keen to show the American public that there is indeed a sense of urgency in Congress to tackle rising levels of problematic substance use that took the lives of 63,600 Americans in 2016, both the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Energy & Commerce Health Subcommittee advanced an overwhelming amount of opioid-related legislation, with 56 bills advancing in the House alone.

In contrast to some of President Trump’s more punitive approaches to ending the opioid crisis, the legislation advanced this week in Congress was largely public health-centered and addresses a number of very real needs. Included in the raft of bills that were advanced this week is legislation that would ensure that all CHIP plans fully cover mental health and substance use treatment, revamp the way the federal government distributes grants to focus on the areas hardest hit by the opioid epidemic, and partially repeal the Institutions of Mental Disease exclusion that prevents Medicaid from reimbursing for substance use disorder treatment in facilities with more than 16 beds.

Unfortunately, any joy there is to be gleaned from the quantity of bills that have been put forward this week and their individual merits is more or less snuffed out by the absence of any new funding in the House and Senate legislative packages. With only about 1 in 10 Americans who are in need of substance use disorder treatment being able to access it and a series of temporary and insufficient fixes like the 21st Century Cures Act that only provide funding for 1 or 2 years, no amount of regulatory change will be able to end the opioid epidemic. As Rep. Kathy Castor (D-FL) put it earlier this week, “We’re tinkering around the edges — we’re not tackling this public health crisis.”

The primary alternative to the legislation being offered by the Senate HELP Committee and House Energy & Commerce Health Subcommittee is the Comprehensive Addiction Resources Emergency (CARE) Act of 2018, which has been submitted by Senator Elizabeth Warren (D-MA) and Representative Elijah Cummings (D-MD 7). The overall structure and intent of the CARE Act of 2018 should be very familiar to HIV advocates, as it is modelled on the Ryan White CARE Act and looks to emulate the tremendous success it has experienced in providing comprehensive, effective, wrap-around care for people living with HIV in America.

The CARE Act of 2018 would provide an additional $100 billion in opioid response funding over 10 years to states and localities to help them institute evidence-based strategies to reduce fatal overdoses, increase access to substance use treatment, and address the infectious disease consequences of the opioid crisis. More so than any previous piece of opioid-related legislation, the CARE Act of 2018 fully embraces and champions the kinds of community-based harm reduction programs that are so vital to any effective response to this issue.

AIDS United strongly endorses the CARE Act of 2018 and will keep you up to the date on all of the latest news regarding the bill, as well as other opioid-related legislation in Congress.