Addiction in America
46 million Americans struggle with addiction, but many don’t get the treatment they need.
It doesn’t have to be this way.
Addiction is a public health crisis.
The addiction crisis is deadlier than ever before.
Overdoses are the #1 cause of accidental death in our country. According to the CDC, there were over 109,000 fatal overdoses in the 12-month period ending in March 2022. That’s the highest number of overdose deaths ever recorded in a single year. Overdose deaths involving synthetic opioids such as fentanyl, psychostimulants such as methamphetamine, and cocaine all increased between 2020 and 2021.
During the COVID-19 pandemic, this tragedy got worse. In some communities, overdose-related emergency calls increased as much as 40% and 42 states reported increases in overdose deaths during the pandemic.
And not all overdose deaths are caused by opioids alone. In 2021, 108,791 deaths in the U.S. were related to alcohol. That makes substance use the third largest cause of death in the nation.
Effective addiction treatment is hard to access and rarely covered by insurance.
Only 1 in 10 people who need treatment ever receive it, and even fewer receive high-quality care that’s rooted in scientific evidence. Medications are one of the most effective treatments we have for substance use disorder but many cannot get them. 60% of residential treatment facilities don’t offer addiction medication and only 1% offer all three types of medications.
Even though addiction is an illness, treatment has long existed outside of mainstream medicine. In a survey of physicians and nurse practitioners, only one in four said they’d received addiction training during medical education.
Treatment for addiction isn’t one size fits all. But health insurance coverage often limits patients’ options. Only 60% of employer-sponsored health plans cover addiction medications. And extra hoop-jumping like prior authorization requirements delay and limit access to lifesaving care.
While much of the coverage of the opioid epidemic has focused on white, rural populations, the epidemic disproportionately affects white, Black, and Latinx people.
In fact, overdoses are rising more quickly among communities of color. The annual growth rate from 2018 to 2020 for Black individuals (16.1%) and Latinx individuals (12.6%) well surpassed the rate of white individuals during the same period (3.8%). Emerging research suggests that Black men have been hit the hardest by drug overdoses in the U.S. What's more, overdoses among Native Americans are above the national average at 27.4%, and the rate continues to grow.
Stigma makes it more difficult to receive compassionate, high-quality, evidence-based care — and racism makes this worse for Black individuals.
Access to treatment dramatically favors white individuals, who are 35 times more likely to receive a prescription for buprenorphine, a medication for addiction treatment shown to increase the odds of successful, long-term recovery.
Researchers recently studied 867,000 treatment occasions, when a patient who was not already on buprenorphine began taking it. They found stark differences between the demographics who were prescribed buprenorphine. About 8.1% of patients were Black, 6.3 percent were Hispanic, 84.1% identified as white. Approximately 1.5% identified as other races or ethnicities.
Black people are more likely to experience negative legal outcomes for drug offenses. Approximately 14% of the US population is Black – and they use substances at similar rates as other populations – but they represent 29% of arrests for drug offenses and 33% of people incarcerated for drug offenses.
People suffering from addiction receive punishment more often than treatment.
Addiction is the only medical illness that’s criminalized, but punishment does not reduce drug use or overdoses.
Approximately 137,000 people are in state prisons or jails in the United States on any given day for drug possession, often for possessing small quantities of illegal drugs. And penalties are doled out inequitably: Racial and ethnic minorities, especially Black and Latinx Americans, are significantly more likely to be arrested and receive stronger sentences for drug-related offenses.
More than half of those in state prisons and two-thirds of people awaiting sentencing in jail exhibit problematic substance use, or meet the criteria for addiction. What’s more, while people with substance use disorders serve jail time, they have incredibly limited access to evidence-based treatments.
It doesn't have to be this way.
Addiction costs our country more than $532 billion each year. And the costs keep rising. We’re hemorrhaging money on this crisis, and all that spending is not doing much to protect our loved ones.
With the science we have today, we could save countless lives — and spend a fraction of that amount —by increasing access to addiction treatment with an approach that’s compassionate, evidence-based, and rooted in public health.
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