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In an era when public health discussion is dominated by the COVID-19 pandemic, it’s easy to lose sight of another nationwide epidemic that shows little sign of easing: 93,000 annual deaths from opioid and other drug overdoses. Overdose is among the biggest killers of Americans—in fact, for people under 50, it’s the leading cause of death, according to the CDC. Today, much of the overdose problem is fueled by the use of fentanyl, an incredibly dangerous synthetic opioid that’s 50 to 100 times stronger than morphine.

Michael Bloomberg has been one of the few mega-donors to tackle the overdose crisis, notably through Bloomberg Philanthropies Opioids Overdose Prevention Initiative. Bloomberg started that program in 2018 with $50 million, focusing initially on the two hard-hit states of Michigan and Pennsylvania. The funder worked with government leaders and others, each state testing out more than 20 overdose prevention programs. (For more on the Bloomberg overdose initiative, check out this Inside Philanthropy article.)

The big news this week is that Bloomberg’s going even deeper into the fight, with a $120 million expansion of the overdose initiative into five new states: Kentucky, New Jersey, New Mexico, North Carolina and Wisconsin.

Essentially, Michigan and Pennsylvania served as laboratories to test the programs. And the data from the investments in Michigan and Pennsylvania appears positive, said Kelly Henning, who heads Bloomberg’s public health program.

CDC statistics show that prior to the start of the COVID pandemic, overdose deaths in the two pilot states actually decreased, no doubt partly a result of the programs the Bloomberg initiative enabled. Although the pandemic’s effects caused opioid and drug-related deaths to increase about 30% in 2020, mortality from those causes in Michigan and Pennsylvania increased by a much smaller 16%.

Given the severity of the overdose threat, why not fund work in even more states? Bloomberg is taking a measured approach, it appears, and getting these programs up and running takes a lot of hands-on work. “It’s a big step up for us and we want these states to be successful and to have projects that other states can take on board. The idea is to spread this practice,” said Henning.

One of the Bloomberg overdose initiative’s key tactics is to expand the availability of medical interventions. Michigan, for example, launched an online portal to enable access by mail to the overdose-treating drug naloxone, which can reverse the effects of opioids if administered in time. In Pennsylvania, all prisons now provide buprenorphine, a drug used to help people withdraw from opioid use.

“We know that medication treatment for opioids is highly effective, the most effective way forward, so we want to make those medications available,” said Henning.

The five new states joining the overdose initiative will each receive $10 million in support over the next five years. Pennsylvania and Michigan will also receive an additional $4 million for the next three years. The initiative will support work to scale existing efforts and implement new programs, and advocate for federal policies to expand access to treatment and harm reduction, toward the goal of accelerating reductions in overdose deaths. Bloomberg’s partners in the initiative include the CDC Foundation, Global Health Advocacy Incubator, Johns Hopkins University, The Pew Charitable Trusts and Vital Strategies.

The work Bloomberg’s backing appears to have yielded tangible benefits in Michigan and Pennsylvania. Where it makes sense, programs from those first two states should be adapted for use in the initiative’s five new states—and eventually throughout the rest of the country. Tens of thousands of lives could be saved. But the Bloomberg initiative doesn’t tackle some of the less quantifiable parts of the overdose equation.

As we’ve discussed before, Bloomberg Philanthropies’ avowed data-driven approach to giving, both here and in countries around the world, has led the organization to successfully address major public health threats, from tobacco use to road safety. Data made Mike Bloomberg’s fortune in the first place, and relying on data has led him and his organization to become one of the most prominent philanthropic forces on earth. It’s understandable that a pragmatic giver like Bloomberg would focus on problems where results can be measured in clear numbers.

At the same time, drug use is a hairy problem, with roots in mental health and individual psychology, as well as in socioeconomic vulnerabilities like poverty and an inadequate healthcare system. Overdose is the endpoint of a lot of issues, and efforts to prevent it must ultimately go beyond direct medical interventions.

Perhaps taking on these thorny and less easily quantifiable matters hasn’t been Bloomberg’s style so far, but that doesn’t mean this energetic billionaire philanthropist can’t or shouldn’t. The numbers may be harder to line up, but major public health threats like substance use disorder demand the attention of donors with Bloomberg’s financial firepower—both at their often tragic endpoint and along the path leading there.

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