9/11 makes the case for a Department of Treatment and Recovery

Just as 9/11 ushered in a new era of terrorism, the explosion of synthetic opioids such as illicitly manufactured fentanyl has fundamentally changed the nature of the drug trade.

You cannot often pinpoint a single event that changed the course of history, but 9/11 certainly is one. On that fateful day in September 2001, a group of 16 terrorists struck an unexpected blow to the political and economic centers of the United States. Nearly 3,000 people perished in the attacks and many more were exposed to deadly toxins that would later lead to debilitating, terminal illnesses.  

The events of 9/11 shook the consciousness of America unlike anything since the attack on Pearl Harbor and prompted a paradigm shift in Americans’ view of safety and security.

This shift manifested in many ways, including the first major federal government restructuring in a half-century. In 2002, Congress passed the Homeland Security Act by a vote of 90 to 9, consolidating 22 federal agencies under the newly founded Department of Homeland Security. Although some have criticized the decision, it’s hard to argue with its success. Since 2001, there has only been one case of a jihadist foreign terrorist organization directing or coordinating a deadly attack inside the United States.

It’s time we give the drug crisis the same sense of urgency. 

Just as 9/11 ushered in a new era of terrorism, the explosion of synthetic opioids such as illicitly manufactured fentanyl has fundamentally changed the nature of the drug trade. 

Today’s drugs are stronger, cheaper and easier to produce than ever before — they are also incredibly deadly. Drug overdoses are now a leading cause of death among Americans ages 18 to 45, according to the Centers for Disease Control, and have contributed to the largest decrease in U.S. life expectancy in over a century. In the last 12 months, more than 111,000 Americans died from drug overdoses — the equivalent of 9/11’s casualties every nine days — and many more remain caught in the web of substance abuse and addiction. 

This loss of life is staggering, but the real travesty is how many of these deaths could be prevented if Americans had greater access to treatment. In 2021, only 1 in 5 Americans suffering from an opioid use disorder received medically assisted treatment such as buprenorphine or methadone — widely recognized to be the “gold standard” in addiction treatment — despite evidence showing these medications can lower the risk of fatal overdose by 80 percent. To put that in perspective, the best medications to lower cholesterol are 30 to 50 percent effective. 

America needs more substance abuse treatment. A lot more. But how?

One key lesson from 9/11 was the need for more information sharing, collaboration and “unity of effort” across the U.S. government. This was accomplished, in part, by folding multiple agencies into DHS and could serve as a useful antecedent in confronting the drug crisis. As currently constructed, many government agencies engaged in drug treatment are spread across multiple departments, such as the Department of Health and Human Services, Department of Justice and Department of Veterans Affairs, among others. Combining them into a single, unified agency with generous funding and broad authority could help close the treatment gap and set millions of Americans on the path to recovery. 

Imagine, a new DHS for drug treatment and recovery fully empowered to:

• Provide universal treatment to anyone who needs it, free of charge
• Expand treatment for traditionally underserved and vulnerable populations, including minorities, incarcerated people, military veterans, those in rural areas and the uninsured
• Connect treatment systems at the federal, state, local and tribal levels
• Enforce uniform, evidence-based standards for all federally funded treatment programs nationwide
• Ensure accountability and transparency for opioid litigation settlements to maximize their impact
• Train and employ a new cadre of social workers, substance abuse counselors, doctors and nurse practitioners to grow the nation’s treatment ecosystem
• Eliminate outdated barriers to care, including restrictions on methadone prescribing and telehealth
• Improve data gathering and reporting on treatment services

The drug crisis is a complex problem, and policymakers should be wary of any “if-we-only-did-this” solutions. But the existing model clearly isn’t working, and in the meantime, thousands of Americans are literally dying for a change. Expanded access to drug treatment is a moral imperative, and today’s leaders, like those in the past, must have the courage to take action proportionate to the need. 

Almost 20 years ago, with the events of 9/11 still etched into the national psyche, the authors of the 9/11 Commission Report noted, “Americans should not settle for incremental, ad hoc adjustments to a system created a generation ago for a world that no longer exists … Good people can overcome bad structures. They should not have to.”  

Their words still resonate today.

Jim Crotty is an adjunct professor at American University’s School of Public Affairs and the former deputy chief of staff at the U.S. Drug Enforcement Administration.