By: Christopher A. Parrella, Esq., CPC, CHC, CPCO Parrella Health Law, Boston, Ma. A Health Care Provider Defense and Compliance Firm

The latest Government Accountability Office (GAO) report, GAO-25-107640, highlights the dire situation around drug misuse and the gaps in treatment options, offering a critical view of current national efforts to combat the escalating crisis. In 2023 alone, about 105,000 Americans died from drug overdoses, with synthetic opioids like fentanyl responsible for approximately 87% of these deaths. The situation remains urgent, as overdose deaths have more than doubled since 2013, impacting not only individuals but also communities and the healthcare system at large.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 49 million Americans aged 12 or older reported substance use disorder in 2023, indicating a staggering need for treatment. However, only about 24% of those needing substance use disorder treatment received it. Contributing factors include financial barriers, limited insurance coverage, and the stigma around seeking help, all of which hinder access to life-saving care. The GAO underscores that treatment should ideally include comprehensive diagnostic services, individualized therapy plans, and, when necessary, medication-assisted treatment. Yet, accessing this level of care is far from reality for many.

The GAO report identifies critical barriers that complicate access to treatment for vulnerable populations, which include those in rural areas and communities disproportionately affected by the opioid epidemic. Notably, insurance-related barriers persist. Low reimbursement rates, limited coverage for certain services, and restrictive prior authorization requirements pose major obstacles. For rural veterans, challenges like transportation further complicate access, as documented in previous GAO findings.

The Office of National Drug Control Policy (ONDCP) aims to address these issues through its 2024 National Drug Control Strategy, which emphasizes expanding treatment accessibility and building a robust behavioral health workforce. Mobile treatment units, for instance, are suggested as a solution to improve access for remote communities, while the use of peer support services—backed by Medicaid in some states—offers an additional layer of support by integrating those with lived experiences into treatment programs.

This GAO report emphasizes the need for systemic changes to address drug misuse and improve access to treatment. Stakeholders—ranging from healthcare providers to policymakers—are encouraged to examine how current policies might better support access to the full continuum of care, which is essential for addressing the long-term impacts of substance use disorder on individuals and communities. As overdose rates remain alarmingly high, it is crucial to advocate for expanded treatment options, eliminate insurance barriers, and support innovative solutions like mobile care units and peer support integration.