The opioid crisis in the United States has reached alarming proportions, evolving from a longstanding problem into a full-blown epidemic over the last two decades. According to the American Association of Addiction Psychiatry, opioid overdose deaths have increased by about 200% since 2000. In 2017 alone, the Centers for Disease Control and Prevention (CDC) reported nearly 48,000 deaths due to opioid overdose. The urgency of the crisis has led to increased funding and policy focus at federal, state, and community levels. However, as efforts to combat opioid use disorder (OUD) intensify, some experts worry that other behavioral health conditions are being overlooked.
The Unintended Consequences of Targeted Focus
Matthew Hurford, Chief Medical Officer at Community Care Behavioral Health, highlights the risk of inadvertently neglecting other serious behavioral health conditions while focusing on the opioid crisis. Community Care Behavioral Health, a subsidiary of the University of Pittsburgh Medical Center’s Insurance Services Division, is one of the largest not-for-profit behavioral health managed care organizations in the U.S., helping Pennsylvanians with Medicaid access mental health services.
Speaking at the Payer’s Behavioral Health Management and Policy Summit in Washington, D.C., Hurford noted that the response to the opioid epidemic has created a “displacement effect” in behavioral health services. As the demand for OUD treatment surges, the overall behavioral health workforce has remained largely unchanged, leading to reduced care availability for individuals with other conditions.
The Struggle for Resources and Capacity
The behavioral health workforce shortage has long been a challenge. With the opioid epidemic dominating policy and funding initiatives, those suffering from alcoholism, cocaine dependence, schizophrenia, bipolar disorder, and other mental health conditions are finding it increasingly difficult to access treatment.
Gabe Howard, a mental health advocate with bipolar disorder and a fellow panelist at the summit, expressed his frustration over the redirection of funds. He emphasized that many longstanding behavioral health issues remain unresolved, yet resources are being diverted to combat the opioid epidemic.
For instance, in September, the U.S. Department of Health and Human Services (HHS) allocated more than $1.8 billion to states for opioid crisis intervention. Meanwhile, issues like homelessness—frequently linked to mental illness—have not received equivalent attention or funding, exacerbating existing problems.
The Impact on Alcohol Use Disorder and Other Conditions
Hurford pointed to Pennsylvania as an example of how resource allocation has shifted over time. In 2000, opioid use disorder accounted for approximately 17% of substance abuse admissions in the state’s Medicaid population. By 2016, that figure had jumped to 47%, while alcohol use disorder admissions fell from 47% to 24% during the same period.
This decline in alcohol use disorder admissions does not indicate a reduction in problem drinking. In fact, a 2017 JAMA Psychiatry article revealed that high-risk drinking had increased nearly 30% between 2002 and 2013. The concern is that while opioid addiction justifiably demands attention, conditions like alcohol use disorder are slipping through the cracks, potentially worsening in the absence of adequate intervention.
Balancing Priorities in Behavioral Health Care
Addressing the opioid epidemic is crucial, but it should not come at the cost of neglecting other serious mental health and substance use disorders. The current approach risks creating a cycle of crises, where shifting focus from one issue exacerbates another.
“I don’t see any conversations addressing the initial problem that we started with 50 years or 150 years ago,” Howard said. “I really think this is like charging something on a credit card, and then when the bill comes you’re like, ‘What is this? This is shocking.’”
Moving forward, policymakers, healthcare providers, and community organizations must adopt a more comprehensive strategy—one that expands the behavioral health workforce and ensures that all individuals, regardless of their condition, receive the care they need. Only by addressing behavioral health as a whole can we hope to create a sustainable and effective healthcare system for the future.
