Philanthropy is critical to a flourishing democratic society, one in which a vision for solving intractable problems and empowering people to thrive is shared by most, if not all. Among other things, philanthropy has been a driver of some of the greatest breakthroughs in the public health area, including the discovery of a vaccine for polio and the development of antiretroviral therapy to address the scourge of HIV/AIDS. Yet as we consider the most urgent public health crisis in America today — the disease of addiction and the threat posed by the opioid epidemic to our communities and families — we are at a loss to explain the glaring absence of a robust philanthropic response.
Overdose is the number-one cause of accidental death in the United States, its impact felt across every demographic and zip code. Opioid overdoses alone kill more people in a weekend than the worst hurricane, and yet there has been no emergency-like response, from philanthropy or government. With a few notable exceptions, foundations and grantmakers focused on health and social issues have gone AWOL, leaving much-needed solutions desperate for funding support. Just recently, for example, the Conrad N. Hilton Foundation, one of the few foundations to focus on substance use disorders, announced that it will be phasing out its grantmaking in this area.
Throughout our careers, we have worked alongside some of the sharpest philanthropic minds and leading substance use experts and have come to believe that if more funders were to direct their resources to solving the opioid epidemic and addressing the addiction crisis in America, it would, at a minimum, catalyze a badly need response from government, business, and the private sector and lead to better health outcomes for millions of people.
Of the numerous recommendations put forward by experts in the field of addiction, there are six where foundations and individual donors, without having to reinvent themselves, could focus their resources and expertise and have real impact in terms of reducing the number of overdose deaths in America.
1. Reduce the level of opioid prescribing. Foundations and individual donors can start by supporting groups working to advance medical and healthcare protocols and practices designed to reduce the unnecessary prescribing of opioids, which will go a long way to reducing the number of people who develop opioid addiction.
2. Expand access to treatment. To curb the epidemic, government and the private sector must work together to significantly expand access to evidence-based treatment, something philanthropy has played a role in delivering for other health issues. And to be most effective, a large-scale rollout of addiction treatment should be integrated into mainstream health care so that the 90 percent of people with substance use disorders who today do not receive treatment are reached.
3. Scale local harm reduction efforts. Philanthropy can play a key role in scaling up harm-reduction efforts such as syringe services programs, fentanyl testing, and drug user health facilities — all of which have been proven to improve the health of individuals who suffer from opioid use disorder while reducing overdoses and transmission of bloodborne disease.
4. Raise awareness and end stigma. To enhance treatment, prevention, and recovery supports for people with opioid use disorders, philanthropy should follow the roadmap it created for the scourge of cancer. Foundations can do much to raise public awareness of the fact that addiction is a chronic, recurring condition requiring ongoing social supports, including housing, behavioral therapy, and steady employment.
5. Scale promising practices. Regional foundations have become expert at scaling initiatives. Foundations can play a game-changing role in ending the opioid epidemic by intentionally seeking out opportunities to work with others to scale promising practices in at-risk communities.
6. Take risks. Solving a problem of this magnitude requires taking some risks, and foundations are well positioned, in a way that government and the private sector are not, to do that. While there are evidence-based practices that have been shown to be effective in reducing overdose deaths, foundations should also invest in cutting-edge programs with the potential to result in even bolder and more effective solutions. One example is fentanyl-testing programs, which help people with opioid use disorders avoid using the illicit and deadly opioid fentanyl.
7. Offer hope. Unfortunately, the growing number of overdose deaths has created a sense of hopelessness among some who think the problem is too big to take on. We know much more about substance use disorders today than we did twenty years ago, however. And just as we have learned how to effectively treat, manage, and prevent diabetes, we can do the same with all forms of substance use disorders. The number of individuals dying from drug overdoses — more than sixty thousand in 2016 — should shock us. These deaths are preventable if we frame and treat addiction as a disease, one that has an early onset and can be prevented and treated. Foundations can do much to advance the science that shows addiction is not a moral failing, and to broaden the discussion about addiction to include the underlying causes of substance use disorders.
Foundations are instrumental in helping society navigate and develop solutions to our most complex challenges. The opioid epidemic cuts across many issue areas, including economic development, access to health care, employment, discrimination, trauma, and stigma. Foundations must lead on this urgent issue and do more to build the infrastructure needed to address substance use disorders and prevent the further loss of life.
Rain Henderson is the founder of Elemental Advisors, which advises private- and social-sector leaders on how to contribute to the health and well-being of Americans using evidence-based models, market structures, and metric. Regina LaBelle of LaBelle Strategies advises nonprofits and the public-sector agencies on strategies for effectively addressing the opioid epidemic. From 2009 to 2017, she served in the Obama administration as chief of staff and senior policy advisor in the White House Office of National Drug Control Policy.