On June 28, 2023, Madison Fields, a fellow with the O’Neill Institute’s Addiction and Public Policy Initiative, testified at a public roundtable on “Combating the Opioid and Fentanyl Crisis in DC,” hosted by the D.C. Council. Fields spoke about how data collection, fiscal redesign, and building a policy bench are essential for developing an effective response to D.C.’s overdose issues. During her testimony, she highlighted the findings of “Transcending MET (Money, Ego, Turf): A Whole Person, Whole Government Approach to Addressing Substance Use Disorder Through Aligned Funding Streams and Coordinated Outcomes.” To aid state and local government officials and policymakers in addressing the overdose epidemic, the report offers the below guiding principles and concrete recommendations to leverage opioid litigation proceeds and federal funds.

Addressing the Opioid Crisis Through Equitable Treatment Solutions

The fiscal redesign framework prioritizes equitable treatment options for individuals from all backgrounds, especially underserved communities, such as Black, Latinx, and Indigenous populations, who have borne the brunt of the opioid epidemic. By addressing disparities and implementing targeted interventions, policymakers can offer culturally sensitive approaches and allocate resources where they are most needed.

Ensuring Governance Accountability and Transparency for Funding

Accountability and transparency in funding are pivotal in effectively tackling the overdose epidemic. The recommended framework underscores the necessity of accountability to ensure allocation of funds for addiction services. By instituting robust monitoring systems and transparent reporting, policymakers can track resource impact and direct them toward the hardest-hit communities. Transparent data collection and reporting also facilitate the identification of disparities and inform tailored interventions.

Building a Policy Bench for Inclusive Decision-Making

Effective addiction policies require diverse voices and perspectives during the policymaking process. The framework highlights the importance of building a policy bench that encompasses individuals from various backgrounds and experiences. Involving stakeholders from different disciplines in policy creation and implementation results in comprehensive, equitable, and effective strategies. This collaborative approach fosters a better understanding of the underlying factors contributing to substance use disorders (SUD) and addiction, leading to more effective interventions.

Disparities in Data Collection and Its Consequences

There is an urgent need for real-time and transparent data reporting on substance use disorders and overdoses. The current delay in data collection and reporting impedes policymakers and communities from accurately understanding the extent of the crisis and crafting effective responses. In recent years, marginalized communities, including Black, Latinx, and Indigenous populations, have experienced disproportionate burdens in the opioid epidemic. Disparities in access to treatment, healthcare, and socioeconomic factors contribute to higher mortality rates within these communities. Collecting and analyzing data that considers demographic factors, such as race, age, class, and geography, will help policymakers understand the specific needs of marginalized communities. This data-driven approach would enable the development of tailored strategies to reduce disparities and promote equitable access to care and support.

The Importance of Care in Incarceration

The intersection between addiction and incarceration is undeniable, and there is an urgent need for adequate care and treatment for individuals with substance use disorders in jails and prisons. The disproportionately high rates of incarceration among Black, Latinx, and Indigenous individuals perpetuate health disparities.

Prioritizing access to evidence-based treatment, continuity of care, and re-entry services are essential components of addressing the opioid crisis within prisons. Strengthening these supports can significantly influence the well-being and recovery outcomes of individuals upon reentry to their communities.

A Whole Person Approach to Care

A holistic approach, as outlined by the Addiction and Public Policy Initiative, underscores the importance of addressing the social determinants of addiction. Factors, such as healthcare access, quality employment, the criminal legal system, housing, and intergenerational trauma, significantly contribute to an individual’s vulnerability to substance use disorder and addiction. By considering these systemic barriers and tailoring harm reduction policies in response, policymakers can better address disparities and ensure resources reach those who need them the most.

Creating an Inclusive Ecosystem of Care

The concept of an ecosystem of care involves collaboration across disciplines to bridge communication gaps. By incorporating diverse voices and leveraging the resources available through opioid settlement proceedings, policymakers can develop a comprehensive ecosystem of care. This includes offering various services, such as screening for SUD; accessible treatment options; counseling; and support for housing, employment, and sustained recovery. Taking a whole person approach and considering individuals’ unique circumstances are key elements in addressing health inequities.


As the rate of overdose death continues to devastate communities across the United States, addressing disparities and promoting an inclusive ecosystem of care is of the utmost importance in reducing or mitigating overdose deaths. The Addiction and Public Policy Initiative’s framework presented by Fields emphasizes evidence-based treatment, governance accountability, and building a diverse policy bench. By focusing on expanding access to treatment, ensuring transparency and accountability in funding, and involving diverse voices in decision-making, policymakers at the state and federal levels can address disparities and provide targeted interventions. Timely data collection, coordinated fiscal responses, and a whole person approach are vital components of creating an inclusive ecosystem of care. By reducing health disparities and addressing the underlying systemic factors driving SUD and addiction, these strategies center the individuals affected in the government’s response to the opioid epidemic, ensuring that no one is left behind.