By Tamarra Kemsley
When the Trump administration released its preliminary 2018 budget in March, analysis of the document immediately centered on its many cuts. Among the few items spared the chopping block was the fight against opioid addiction. In fact, the budget pledged to increase funding by $500 million above 2016 levels.1 But as Vox reporter German Lopez quickly pieced together, supporters of the move may have former President Barack Obama to thank — not Donald Trump.2
Together with Congress, Obama passed the 21st Century Cures Act in December 2016.3Aimed at improving current therapies for a range of diseases, the bill earmarked $1 billion to support states in the fight against opioid misuse — half to be dispersed in fiscal year 2017 and half in 2018. Health and Human Services Secretary Tom Price later affirmed Lopez’s and others’ suspicions that this was the “increase” listed in the new budget when asked directly about it by U.S. Rep Katherine Clark (D-MA).4 This was later followed by a Health and Human Services press release stating that the funding is that “provided for in the 21st Century Cures Act.”5
Politics aside, the step is a welcome one for states, which currently stand on the frontlines in the fight against opioid addiction.
In Massachusetts, for example, officials say they plan to use their $12 million allotment to continue subsidizing a program for those entering recovery and treatment. Called Massachusetts-Access to Recovery, it helps individuals create personalized recovery plans for which they are given vouchers. Those vouchers can then be used to access services from private providers. Originally set to end in September, the program, which averages $1,500 per client, estimates it will be able to work with an additional 5,800 people over the next two years thanks to the increased funding.6
Pennsylvania, where opioid addiction claimed more than 3,300 lives in 2015, said it plans to use the $26.5 million apportioned it to offer integrated treatment to 6,000 under- and uninsured individuals.7 Meanwhile, Kentucky will focus on “priority populations,” such as pregnant women and those completing prison sentences. “Additionally, these funds will help us implement strategies for preventing opioid abuse and overdoses Practices for opioid abuse treatment — particularly Medication Assisted Treatment — and increased access to treatment and recovery support services,” Doug Hogan, spokesperson for the state cabinet for Health and Family Services, told the Kentucky paper Journal-Times.8
Dr. Glen Hanson is the director of the Utah Addiction Center and the former director of the National Institute on Drug Abuse. He agrees the current epidemic requires additional funding, but is hesitant to endorse this kind of piecemeal approach.
“The government has done this before, bless its heart,” he told Black Bear Lodge in this exclusive interview. “It throws money after problems and thinks that is going to solve them.” Yes, money can help, he argues, but only to the extent that it is applied to a “well integrated plan.”
“I know there’s the argument states should have the right to use money the way they want to, and I guess there’s some value to that argument. But there’s also a lot of money that’s squandered because there isn’t any way to implement it. You just write them a check and tell them go out and do good and there’s a temptation to use it for things that it was never intended to be used for, or to use it for things that have already been shown to be ineffective.”
Sure enough, dig a little deeper into the plans laid out by the states and one finds examples of money from the act being put forth to fund treatment for all kinds of addiction, not only opioid misuse. This is even true in the case of Massachusetts’ Access to Recovery. All told, 40 percent of those the program currently services cite substances other than opioids as their primary problem.9
“I don’t want to send the message we’ve totally wasted our money,” he said. “I don’t think that’s true at all.” As evidence, Hanson points to efforts to educate policymakers on a state and federal level regarding the medical side of drug misuse. The result is “the vast majority of policymakers and the public no longer believe that drug abuse is the result of bad people doing bad things.”
Missing still is a system in place to anticipate and prevent drug epidemics in the first place. To get there, Hanson says we must understand the reasons people make the decisions that lead to addiction in the first place. “That’s getting at the core of the problem. We’re still treating the symptoms. But I think we’re getting there.”
In the meantime, Hanson agrees there is a great deal to be gained by funding actions tailored around educating both practitioners and patients regarding safe and effective pain management. For example, opioids, while useful in treating short-term pain, often lose their effect over time. There’s also the issue of people storing their medications in insecure locations. “They’re putting them in their medicine cabinets along with their toothpaste and other toiletries.” He further notes that those with prescription misuse dependency tend to have “a fairly high success rate” when treated properly. This is true regardless of whether a person enters voluntarily or because they are forced, either by law enforcement or because they’re afraid of losing their children or a job.
“The hope is some of this money can be used in that regard.” Whether or not that happens is really “going to be up to the local agencies.”
1 https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/2018_blueprint.pdf
2 https://www.vox.com/policy-and-politics/2017/3/16/14944072/trump-budget-opioid-epidemic
3 https://www.washingtonpost.com/news/powerpost/wp/2016/12/07/congress-passes-21st-century-cures-act-boosting-research-and-easing-drug-approvals/?utm_term=.9135b7112c11
4 https://www.youtube.com/watch?v=q6tQyxcks60&feature=youtu.be&t=1h53m11s
5 https://www.hhs.gov/about/news/2017/04/19/trump-administration-awards-grants-states-combat-opioid-crisis.html
6 http://www.masslive.com/politics/index.ssf/2017/04/federal_grant_will_let_massach.html
7 http://www.readingeagle.com/news/article/pennsylvania-to-get-265-million-to-fight-opioid-addiction
8 http://www.journal-times.com/news/kentucky-to-receive-million-to-fight-drug-epidemic/article_95ddd1be-2a89-11e7-abc7-1bdf6d203edd.html
9 http://www.masslive.com/politics/index.ssf/2017/04/federal_grant_will_let_massach.html