The opioid crisis has significantly affected public health, the economy, and communities in the United States. Drug overdoses and deaths rose sharply during the COVID-19 pandemic because of increases in deaths involving fentanyl (a powerful synthetic opioid) and the concurrent use of multiple substances. Although annual opioid-involved overdose deaths started to decline in 2023, they remain historically high. In this report, the Congressional Budget Office describes three types of policy approaches to address the ongoing opioid crisis and assesses their effectiveness and likely budgetary effects.
Reducing the Supply of Illegally Produced Opioids. Limiting the availability of illegally produced opioids by disrupting the illegal drug supply chain has been shown to reduce hospital admissions and overall mortality, although the effects are mostly temporary. Those findings are based on past interdiction efforts; they may not fully apply to the current opioid crisis, which is fueled by synthetic drugs, because of differences in production and distribution.
Reducing the Demand for Opioids. Treating and preventing opioid use disorder (OUD, the compulsive use of opioids despite harmful consequences) is key to reducing the demand for opioids. By enhancing the effectiveness of state prescription drug monitoring programs, the federal government can reduce the use of prescription opioids and the amount of opioids dispensed to new users, which can help prevent new cases of OUD. In addition, policy approaches that increase access to OUD treatment—by, for example, expanding the scope of Medicaid coverage, expanding access to telehealth services, and supporting treatment for individuals involved in the criminal justice system—have been shown to increase treatment and to reduce opioid use and overdose rates.
Reducing the Harm From Opioid Use Disorder. Harm reduction aims to minimize the negative health, social, and legal impacts associated with drug use for people who use opioids and for their communities. Expanding access to overdose reversal medications has been shown to reduce opioid-involved overdose deaths, and availability of those medications does not increase opioid use.
Implementing any of those policy approaches would alter federal spending and, in some cases, revenues. For example, policies affecting coverage or spending among Medicaid and Medicare enrollees would affect federal outlays for those programs. Policies affecting spending among people enrolled in employment-based or nongroup (individual) coverage obtained through the health insurance marketplaces established under the Affordable Care Act would affect both outlays and revenues. Providing appropriations for grants or other programs would add to federal spending.
To the extent that some policies improved health outcomes, spending on federally subsidized health insurance programs would fall because of reduced health care costs from averted medical needs. Increased longevity resulting from fewer opioid-involved overdose deaths would increase revenues through the collection of additional payroll and income taxes and would increase federal spending on Medicare, Social Security, and other federal programs because more people would collect benefits.
