How one state turned its 'heroin crisis' into a national lesson
| Washington
America鈥檚 opioid addiction crisis, now claiming 78 lives a day, is sweeping aside party lines both at the state level and even in famously gridlocked Washington.
The nation鈥檚 governors, from deep-red Alabama to bluest-of-the-blue Vermont, are moving rapidly to a strategy of treating illegal drug users rather than jailing them.
It鈥檚 a shift that runs deep in , as well. Some two-thirds of Americans now typically say that they prefer providing treatment to long prison sentences.聽
鈥淭his is an area where I can get agreement from Bernie Sanders and Mitch McConnell,鈥� President Obama said at a White House meeting with governors on Monday.聽鈥淭hat doesn鈥檛 happen that often, but this is one. And it indicates the severity of the issue.鈥澛�
But the governors are, in fact, well ahead of Washington on this issue 鈥� as they were on welfare reform in the 1990s and, more recently, sentencing reform.
Gov. Peter Shumlin (D) of Vermont, a leader in the pivot from prisons to treatment, says he got into the addiction fight after talking to people in his state.
鈥淚 found we were doing almost everything wrong,鈥� he told a forum on opioid and heroin addiction in Washington on Friday.
The best hope is to get more people into treatment, he said. And the best time to do that is 鈥渨hen the blue lights are flashing and the handcuffs are on.鈥�
Vermont, like other states in the Northeast, is facing severe opioid challenges. In 2014, Governor Shumlin devoted his annual State of the State address entirely to Vermont鈥檚 鈥渇ull-blown heroin crisis.鈥� Annual overdose deaths from opioids had nearly doubled since 2004. The number of people seeking treatment for opioid addiction had spiked 770 percent since 2000.
What Vermont has done
And so Vermont has taken a hard look at its approach. Instead of jail, nonviolent offenders are given the option of going into treatment. They start in one of the state鈥檚 new central clinics (hubs) and move on to a family doctor, counselor, or therapist closer to home (spokes).
Vermont law also shields people seeking medical help for an overdose from prosecution for manufacturing or selling drugs, not just for minor crimes. It also was the first state to legalize the sale of naloxone over the counter in pharmacies 鈥� a drug aimed at reversing overdoses and saving lives.
Other states have moved toward treatment instead of incarceration, but Vermont has done it on a grander scale, experts say.
鈥淵ou鈥檝e seen some elected officials support legalizing marijuana, some want to reform sentencing, some talk about overdoses, but very few have tied all these together in a comprehensive narrative,鈥� says Bill Piper, senior director of national affairs for the Drug Policy Alliance in Washington.
鈥淰ermont鈥檚 governor is at the forefront, and what makes him unique is that he鈥檚 one of the few elected officials that has connected the dots on the various issues,鈥� he adds.
As a pioneer state, Vermont has also identified some of the limits of a treatment-centric strategy.
鈥淎s you build out treatment, and particularly in rural America, we can鈥檛 get enough docs who are able to meet the demand of our waiting lists,鈥� Shumlin told the president at the White House meeting Monday.
But the most important issue, he told Mr. Obama, is to 鈥渃ome up with a more rational approach to prescribing prescription drugs.鈥�
A bid to rein in prescriptions
Governors see legal prescriptions for drugs like OxyContin as the gateway to heroin. 鈥淥verprescribing of opioid painkillers has fueled the nation鈥檚 addiction crisis,鈥� according to a report from the National Governors Association鈥檚 Health and Human Services Committee.
In a bid to rein in prescriptions, governors on that committee plan to develop a list of protocols to present to the full membership at the next NGA meeting in August.
鈥淭he United States represents 5 percent of the world鈥檚 population and consumes 80 percent of the world鈥檚 opioids,鈥� said Gov. Charlie Baker (R) of Massachusetts, who chairs the NGA鈥檚 Health and Human Services Committee, on Saturday. That鈥檚 鈥渇undamentally flawed.鈥�
When prescriptions are too hard to get 鈥� or too expensive 鈥� addicts switch to heroin.
"Most of the heroin addicts we treat started by using prescription opiates," says Brian McAlister, author of 鈥淔ull Recovery鈥� and CEO of the Full Recovery Wellness Center in Fairfield, N.J.
"Some were prescribed by a doctor or dentist, others were stolen from family or friends' medicine cabinets, and others were purchased illegally just to party 鈥� but the party ends very quickly. These drugs are highly addictive, and when the supply runs out, the problems get worse."
At the national level
The prospect of politicians reining in pharmaceutical sales is a stretch in the halls of Congress. In 1993, the GOP-controlled Congress explicitly barred government from negotiating lower drug prices with drug companies. Last year, Big Pharma spent more than to influence policy outcomes in Washington 鈥� the largest budget of any lobby group in Washington.
Governors could set protocols on prescribing practices for painkillers on their own, Shumlin told the president. 鈥淏ut it takes time,鈥� and 鈥渋t doesn鈥檛 apply to all 50 states.鈥� Instead, he asked Obama to 鈥渃onsider a national approach which simply says, for minor procedures, we鈥檙e going to limit this to 10 pills and after that you鈥檝e got to come back for more.鈥�
鈥淭o be candid, the docs, the AMA [American Medical Association] are resistant to listening to politicians like us talking about how many pills to prescribe. But is there something you could do on a national level that would help us get out of this tragic mess?鈥� he added.
Obama answered, at length, but in the end deferred to the states. 鈥淎 very specific approach to working with the docs, the hospitals, the providers so that they are not overprescribing鈥� can be done at the national level, he said. 鈥淏ut it is most profitably done, I think, if we have bipartisan support from the governors so that by the time it gets to the national level, there is consensus and there鈥檚 not a lot of politics involved in it.鈥�
In a , AMA president Steven Stack called the opioid epidemic a 鈥渄efining moment鈥� for the profession. 鈥淥ur nation is needlessly losing thousands of people to a preventable epidemic, and we must take action for our patients.鈥澛�
