When you hear 'overdose,' what do you see?
When you hear 'overdose,' what do you see? Is it a tragedy, or is it a person who just wanted to feel okay for one more day? Too often, we reduce overdose to a statistic or a moral failing, forgetting the person at its heart. Many who struggle with substance use disorder are also navigating the heavy weight of mental health challenges—depression, anxiety, trauma, or unresolved grief. For them, substances may feel like the only lifeline, a way to numb the unbearable or find fleeting relief in a world that often offers little understanding.
Substance use disorder doesn’t occur in isolation. It is deeply tied to mental health, poverty, systemic inequities, and the pain of unmet needs. People aren’t using to rebel or self-destruct; they are often using to survive—to escape the unrelenting ache of a mind and body in distress. This doesn’t absolve the risks or consequences of substance use, but it calls for a more compassionate lens. When we respond to overdose with judgment, we miss the opportunity to address the root causes—trauma, isolation, and untreated mental illness.
The Mental Health Crisis in the U.S.
The mental health crisis in the United States is a profound and growing issue, and its connection to the overdose epidemic is undeniable. Millions of Americans struggle with untreated mental health conditions, including depression, anxiety, post-traumatic stress disorder (PTSD), and other mood disorders. These conditions often intersect with socioeconomic factors like poverty, homelessness, and systemic inequities, creating a perfect storm for vulnerability.
One of the starkest manifestations of this crisis is the high rate of self-medication. When mental health needs go unmet due to stigma, lack of access, or insufficient resources, people may turn to substances—alcohol, opioids, stimulants, or other drugs—to cope. For many, substance use starts as an attempt to manage mental and emotional pain. Drugs may provide temporary relief, but they often exacerbate mental health issues, leading to dependency and escalating the risk of overdose.
The statistics are sobering. According to the CDC, over 109,000 people in the U.S. died from drug overdoses in 2022 alone, with synthetic opioids like fentanyl playing a significant role. Many of these individuals were also struggling with untreated or poorly managed mental health conditions. Suicide and overdose are often linked; both can stem from feelings of hopelessness, despair, and isolation, and they frequently occur in the same vulnerable populations.
Systemic barriers compound the issue. Mental health care is still inaccessible for many Americans due to high costs, a shortage of providers, and insufficient insurance coverage. The stigma surrounding mental illness and substance use disorder further discourages people from seeking help. Rural areas, in particular, face significant disparities in accessing mental health and addiction treatment services.
This crisis highlights the urgent need for integrated care that addresses both mental health and substance use. Harm reduction strategies, such as widespread access to naloxone (Narcan) and fentanyl test strips, can save lives in the short term. But long-term solutions require systemic changes: expanding access to affordable mental health care, investing in community-based resources, improving education on mental health and addiction, and dismantling the stigma that keeps people suffering in silence.
Decreased Access to Necessary Services Because of Budget Cuts
For years, programs designed to address America’s mental health crisis and the overdose epidemic have been slashed, while military spending continues to balloon. Instead of investing in the care and support people desperately need. This is not just a budgeting issue—it’s a moral failure. Between 2009 and 2012, states collectively slashed mental health budgets by approximately $4 billion—the largest reduction since the deinstitutionalization movement of the 1970s.
Between 2009 and 2019, the number of adults in the U.S. experiencing serious mental illness (SMI) rose by nearly 26%, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Depression rates surged, particularly among young people, with a 52% increase in adolescents reporting a major depressive episode from 2005 to 2017. Simultaneously, the opioid crisis spiraled out of control. By 2017, opioid overdoses were responsible for over 47,000 deaths, quadrupling since 1999. Synthetic opioids like fentanyl further exacerbated the epidemic, driving overdose deaths to new heights.
Programs that provide mental health services, addiction treatment, and harm reduction are often the first to see their funding cut when budgets tighten. Crisis hotlines, affordable therapy options, substance use treatment facilities, and harm reduction programs like needle exchanges and Narcan distribution have repeatedly been scaled back or eliminated altogether. Many of these services are already stretched thin, leaving countless Americans nowhere to turn. What makes this even harder to swallow is that we know what works. Comprehensive mental health care, affordable treatment programs, and harm reduction strategies have been proven time and time again to save lives and help people recover. Yet these solutions are often underfunded or dismissed in favor of more militarized spending or used as a pawn in political disagreements between parties.
How Insurance Companies Are Failing People with Substance Use and Mental Health Disorders
In the midst of America’s ongoing mental health and substance use crises, insurance companies are playing a critical—and often harmful—role. Despite the growing need for accessible and affordable treatment, many people with mental health and substance use disorders find themselves battling not only their conditions but also the very systems meant to support them. Insurance companies are falling short, creating unnecessary barriers that leave millions without the care they desperately need. In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed to ensure that insurance companies provide the same level of coverage for mental health and substance use treatment as they do for physical health conditions. This legislation was a landmark step, but its implementation has been inconsistent and riddled with loopholes.
Insurance companies often find ways to sidestep parity laws:
Restricting Coverage: Many plans impose limits on therapy sessions, rehab stays, or medication-assisted treatments (MAT), which are essential for treating opioid addiction. These restrictions make it difficult for individuals to access the full continuum of care needed for recovery.
Narrow Networks: Insurers often have limited networks of mental health and addiction specialists, forcing patients to go out-of-network and pay significantly more—or skip care altogether.
Complicated Preauthorization: Patients often face lengthy approval processes for treatment, delaying care at critical moments when time is of the essence. Someone struggling with substance use disorder does not have time to wait, or the willpower to argue with insurance companies to get care. The result? People are left to fend for themselves, often spiraling deeper into crisis because the support they need is either unaffordable or inaccessible.
I have spoken to several mothers as part of this project who shared that their children died waiting to get into rehab because of insurance constraints. Insurance companies requiring prior authorization for substance use disorder treatment are complicit in the deaths of all involved.
The Cost Barrier
Even when insurance plans do cover mental health and substance use treatment, the costs can be prohibitive. High deductibles, co-pays, and out-of-pocket expenses deter people from seeking help. This financial strain disproportionately impacts low-income individuals, who are more likely to experience mental health challenges and substance use disorders but less likely to afford treatment. For example:
A single stay at an inpatient rehab facility can cost anywhere from $10,000 to $50,000 without adequate insurance coverage.
Medication-assisted treatments like buprenorphine or methadone, proven to reduce overdose deaths, can cost patients hundreds of dollars monthly if not fully covered.
Statistics That Speak Volumes
These numbers aren’t just statistics—they represent real people who are being failed by a system that prioritizes profits over lives.
1 in 4 people with substance use disorders report being unable to access treatment due to cost. (SAMHSA)
As of 2020, 56% of adults with a mental illness in the U.S. did not receive treatment. (Mental Health America)
80% of rural counties in the U.S. lack even a single mental health professional, leaving those with insurance unable to find providers within their plans’ networks.
The Human Impact
The consequences of these insurance gaps are devastating:
People with untreated mental health conditions are more likely to experience homelessness, unemployment, and incarceration.
Lack of access to substance use treatment fuels the overdose crisis, with more than 109,000 overdose deaths in 2022 alone, largely driven by opioids.
Families are left to watch their loved ones deteriorate, powerless to help due to financial and systemic barriers.
These are not just failures of the healthcare system—they are failures of compassion.
How We Can Do Better
Fixing this broken system requires bold changes:
Enforce Parity Laws: Strengthen oversight to ensure that insurance companies comply with the MHPAEA and provide equal coverage for mental health and substance use services.
Expand Networks: Require insurers to offer robust networks of mental health and addiction specialists, particularly in underserved areas.
Reduce Costs: Cap out-of-pocket expenses for essential treatments like therapy, rehab, and MAT.
Invest in Prevention: Fund community-based programs that provide early intervention and ongoing support to reduce the need for crisis-level care.
