Agenda for Change: Addressing the Opioid Crisis

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Following up on NewDEAL’s Ideas Summit and in setting the stage for this year’s New Ideas Challenge, we are continuing to spotlight NewDEAL Leaders’ efforts to expand opportunity. Across the country, Leaders are working to stop the tragic loss of opportunity and potential as a result of the opioid crisis, identifying policies to help prevent addiction from continuing to ravage so many families and communities. This month’s Spotlight highlights a few of those efforts.

Addressing the Opioid Crisis

Access to Treatment

Brittany Pettersen
Representative,
Lakewood, CO

Cleaning Up Sober Homes

Dave Aronberg
State Attorney,
Palm Beach County, FL

A City’s Comprehensive Approach

Miro Weinberger
Mayor,
Burlington, VT

Drug Disposal

Josh Shapiro
Attorney General,
Pennsylvania

Accountability for Results

Eugene DePasquale
Auditor General,
Pennsylvania

Access to Treatment

With leadership from Representative Brittany Pettersen, Colorado enacted a series of laws this year to remove barriers to treatment. Efforts include addressing the inability of people using Medicaid to receive the help they need for substance abuse, with the state only allowing Medicaid funds to cover four days of emergency treatment. Pettersen’s legislation, inspired by a personal story, will push the state to change, starting by studying options under Medicaid to support inpatient and residential recovery programs. Other laws enacted this year will provide $1 million for a substance abuse research center at the University of Colorado and start a task force studying opioid addiction.

Why It’s Important

Solving the opioid crisis must include ensuring people who have, or should have, access to Medicaid, can receive the right treatments. Medicaid pays for 1 out of every 4 prescriptions for the addiction treatment medication buprenorphine, according to data from IMS Health. Meanwhile, uninsured individuals living in states that have not taken advantage of Medicaid expansion under the Affordable Care Act are less likely than insured individuals to obtain treatment for mental illness and substance use disorders.

Cleaning Up Sober Homes

In Palm Beach County, State Attorney Dave Aronberg has found that the opioid epidemic has led to the proliferation of hundreds of “sober homes,” which, unlike drug treatment centers, are unregulated. Sober homes are group residences for individuals in drug recovery, but too often are havens for patient brokering, as people with substance use disorder are exploited for their insurance and encouraged to relapse rather than recover. A sober home task force Aronberg established has made 34 arrests since October and his office brought together stakeholders to recommend changes to state law, which has resulted in the tightening of marketing and referral standards, as well as increased state oversight of treatment facilities.

Why It’s Important

People suffering from addiction and their communities must be able to count on quality residential options during and after treatment. Palm Beach County has been ground zero for demonstrating the damage that unscrupulous providers can do through illegal kickbacks and insurance fraud, among other abuses. These illicit providers can be devastating to people on a path to recovery because they operate on what Aronberg calls the “relapse cycle,” counting on clients to return to them repeatedly for treatment that will be paid for by health insurance.

A City’s Comprehensive Approach

The opioid principles established by Mayor Miro Weinberger set a framework for addressing the epidemic in Burlington, including for partnerships with law enforcement and health care providers. Initiatives emerging from the principles include expanding data gathering and analysis beyond Burlington police to first responders in neighboring towns. Police, working with public health and social services professionals, identify and track individuals engaged in risky behavior, and who need treatment, housing, or other social services. The City’s collaborative approach extends to UVM Medical Center, a major local health provider that has agreed to reduce opioid prescriptions and increase public transparency around opioids.

Why It’s Important

The Mayor has emphasized that new analytical capabilities provide a critical opportunity to ensure government officials, doctors, police, parents and patients have full awareness of the risks of opioids and are empowered with the information to more effectively get people the help they need. At a time when opioid-related deaths and arrests are increasing and impacting the whole community, everyone has a role to play in stemming the crisis.

Drug Disposal

Attorney General Josh Shapiro is making hundreds of thousands of safe drug disposal bags available to Pennsylvania pharmacies to reduce the misuse of prescription drugs. Everyone receiving a schedule II narcotic, including Percocet, oxycodone, and fentanyl, at a participating pharmacy will be offered a free disposal pouch, and anyone can obtain a free pouch to safely dispose of unwanted and unused prescription drugs. The drug pouches can deactivate up to 45 unwanted pills when warm water is added and are then safe to put in the garbage.

Why It’s Important

Shapiro has noted that 80 percent of heroin addicts start with the abuse of prescription drugs, and the vast majority of those who misuse these drugs got them from friends, relatives or a medicine cabinet. His program also specifically target 12 rural counties that do not have easy access to drug take-back boxes. In Pennsylvania, the need to address unaccounted for prescription drugs is clear: after the state collected and destroyed 26 tons of unused drugs in all of 2016, an enhanced effort has resulted in finding and destroying 28 tons in the first eight months of 2017.

Accountability for Results

A review fromAuditor General Eugene DePasquale found opportunities for the major state agencies on the front lines of the opioid crisis to make better use of their resources. Recommendations include making treatment-center inspection information on the Drug and Alcohol Programs website easier to find and interpret, expanding effectiveness monitoring beyond just recidivism for all seven corrections treatment programs — only one does so now — and ensuring accuracy of data that Human Services uses to monitor its network of Centers of Excellence, which coordinate addiction treatment services.

DePasquale has also recognized that state efforts need federal support, such as through the proposed Synthetics Trafficking and Overdose Prevention (STOP) Act, which would require mail shipped through foreign postal services to be required to use the same electronic advanced data as private carriers to better screen for deadly synthetic drugs. The electronic data would include who and where it is coming from, who it’s addressed to, where it’s going and what’s in it before it enters the country.

Why It’s Important

DePasquale’s audit of the Pennsylvania Departments of Drug and Alcohol Programs, Human Services, and Corrections showed that “measuring effectiveness is complicated because each agency has a different definition of effectiveness.” In addition, where there are opportunities for progress, like at Centers of Excellence that the state created to coordinate and integrate behavioral and physical health services for people needing treatment and recovery, effectiveness will be limited if the state cannot fully evaluate the progress they make.