Bailing for Dollars in Appalachia’s Opioid Problem By Wayne F. Coombs If I walk into my bathroom and my bathtub is overflowing, hopefully my first action would NOT be to get a bucket and start bailing the water out of the tub. I could bail all day long and my tub would still be overflowing at the end of the day. If I had any sense at all, the first thing I would do is turn off the faucet. This is a good metaphor for how we are trying to resolve the opioid problem. We are bailing like crazy but not making any headway and we are not having much success turning the faucet off. Since there are many smart, competent people working hard to end this problem, why are we having such a hard time? I wonder if we might be getting this all wrong about the opioid epidemic. Maybe there are forces working in the opposite direction that really do not want to see this problem solved. There is no doubt that the opioid crisis is a problem. Roughly 130 people a day die from overdoses, that’s almost 50,000 per year. 1 I think it’s safe to say that over the past couple of decades, we have learned that dumping tons of pain killers into distressed communities is a bad idea. The distressed communities of Appalachia are living proof. Historically, as well as currently, there seem to be two primary ways that officials are dealing with this problem…either punishment or treatment. People either do jail time or they get treated medically for their addiction and other co-occurring problems. So, we research and study it, write about it, punish it, and/or treat it but it is not slowing down or getting better. As a matter of fact, it is spinning off into more dangerous drugs and drug combinations. So, what’s going on here? Consider these facts: • Our system of incarceration costs about $182 billion per year. 2 • Of the 2.3 million people locked up in U.S. prisons, 85% were involved with substance abuse. 3 • In 2015, 18% of federal prisoners and 7% of state prisoners were held in private for-profit jails at a cost of $31,000 to $60,000 per inmate per year. 4 • Since 2000, the number of people in private prisons has jumped 50%. 5 • The cost of opioid abuse in America was $78.5 billion in 2013. 6 • The market for addiction treatment is about $35 billion per year and growing fast. 7 • Research funding for addictions is over $1 billion per year. 8