by Michael T. Flaherty, Ph.D., Chair, Annapolis Coalition on the Behavioral Health Workforce
Despite increased funding for services, increased access to medication assisted treatment, and ever-growing community efforts into harm reduction practices, drug overdoses in the U.S. were estimated to be 100,306 in the 12-month period ending April 2021, a record high (1). This is a 28.5% increase from 2020’s 78,056 overdose deaths. Such deaths have account for over one million Americans dying between 1999 and 2021. While COVID-19 has seemed to have had a more negative effect on elderly Americans, adults aged 35-44 are the segment of the population most impacted by overdose and overdose death, up 33% since 2020. In 2021, among the 18 to 45 age group in the U.S., overdose deaths exceed deaths to COVID-19 by 38% (2). Increased availability of illicit fentanyl, a powerful synthetic opioid, as well as increased availability of cocaine and methamphetamines, have been the central chemical contributors in these trends.
“The cause for the rise in deaths is complex and is a reflection of individuals’ social determinants of health” stated Janet Stanek, Kansas Department of Health Secretary (3). Complicated by a pre-existing opioid epidemic and then the COVID pandemic, those who had the worst health access, especially minority groups and the poor, have been most impacted just as in other previous major disasters and pandemics (4). America’s overdose deaths, like COVID-19 deaths, expose deep inequalities and disparities in health access and recovery.
Leaders from all walks of life are deeply concerned. In a January 4th, 2022 Blog, Dr. Nora Volkow, Director of the National Institute on Drug Abuse, called for a “nationwide, coordinated response that a tragedy of this magnitude demands.” Sadly, she noted, only 13 percent of the people with drug use disorders receive any treatment and only 11 percent of those with opioid use disorders receive one of the three safe and effective medications that could help them quit and find recovery. Treatment, she wrote, should be more pragmatic and realistic for the illness; perfect should not be the enemy of the good (5). Some success is beginning to appear when communities themselves unite, design a community coordinated plan, and lead their community to collectively address increased interdiction, prevention, treatment, overdose, and recovery (6). Still, with the ever-increasing numbers of overdose and death, there is a need for more “out of the box” solutions (5).
Behavioral health workforce shortages and turnover also remain critical challenges (7,8). Prior to COVID -19, the addiction treatment workforce was suffering from annual turnover rates ranging from 13-52% with nearly half of all agencies operating with significant staff shortages and low recruitment and retention success. Telehealth has opened and enhanced access to new populations and increased further the demand for services and skilled behavioral health workers. Still, far too many workers are continuing to leave the field for higher paying and less demanding work. Trainees often fill jobs until they are eligible for higher paying private practice.
The Annapolis Coalition presented recommendations for addressing the workforce crisis to SAMHSA in early November. Also in November, the National Council for Mental Wellbeing published and disseminated a “Short-Term Policy Relief (paper) to Enhance the Workforce.” Beginning by describing the current “crisis”, the “Issue Brief” offers 5 broad recommendations for states to address workforce today. While summarized elsewhere in this newsletter, the brief may be read in its entirety at CoE Office Hour: Short-Term Policy Relief to Enhance the Workforce – National Council (thenationalcouncil.org).
Clearly the current overdose death numbers remain numbing. Still, they cannot be overlooked or overshadowed by the Covid pandemic. Beyond expanded intervention, prevention, treatment and recovery support, solutions seem to be demanding each community design and implement increased efforts to reach those out of treatment at-risk populations and find ways to meet each individual in need where they are. Too many remain out of treatment; treatment remains too traditional and institutionally centric; the existing workforce, while incredibly dedicated, remains too small-scale and too traditional. Any solution must be community centric, robust and immediate, with frequent monitoring and adjustment to the diverse populations in it. While indeed numbing, we cannot allow or accept this epidemic and its trends.
Michael T. Flaherty, Ph.D., Chair, Annapolis Coalition on the Behavioral Health Workforce
- Ahmad, FB, Rossen LM, Sutton P: Provisional drug overdose death counts. National Center for Health Statistics, 2022. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
- MacGuill, D: Did Fentanyl Overdose Become TOP Cause of Death for Adults Aged 18-45 in the US? Snopes. December 21, 2021. com
- Carpenter, T: Report: Kansas documents 54% surge in drug overdoses fatalities in early 2021. Kansas Reflector, January 6, 2022. https://www.Kansasreflector.com
- Flaherty M, Thompson, K: Coming Out of Covid: Creating a Better New Normal, The Pennsylvania Psychologist, June 2021. papsy.org or [email protected]
- Volkow N: Making Addiction More Realistic and Pragmatic: The Perfect Should Not be the Enemy of the Good. January 2, 2022. Blog at https://www.drugabuse.gov/about-nida/noras-blog/2022/01/making-addiction-treatment-more-realistic-pragmatic-perfect-should-not-be-enemy-good
- Flaherty M, Stuby P, Kose W: Addressing the Opioid Epidemic in Rural America. Psychiatric Services, 2018:69:1114; doi: 10.1176/appi.ps691004.
- Brabson L, Harris J, Lindhiem O, Herschell A: Workforce Turnover in Community Behavioral Health Agencies: A Systematic Review with Recommendations, Clinical Child and Family Psychology Review, 23, 297-315, February 26, 2020.
- Ryan, O., Murphy, D., Krom, L. (2012). Vital Signs: Taking the Pulse of the Addiction Treatment Workforce, A National Report, Version 1. Kansas City, MO: Addiction Technology Transfer Center National Office in residence at the University of Missouri-Kansas City.