Nearly 30,000 Americans died of opioid overdoses in 2014, deaths caused by overuse of either licit prescription painkillers or illicit heroin. Addiction to these drugs has skyrocketed over the past decade and a half, to the point where about 120 Americans die of such overdoses each day. In light of these frightening numbers, opioid abuse is finally beginning to receive wide-scale attention. And thanks in part to the efforts of one U.S. senator, Congress has for the first time begun to implement a comprehensive strategy attacking the problem.
Senator Rob Portman has been waging a crusade against drug addiction for the better part of the past two decades. This summer, at Portman’s urging, Congress passed the historic Comprehensive Addiction and Recovery Act (CARA), and President Obama signed it into law. Now Portman is offering similar support for the 21st Century Cures Act, a bipartisan bill that will, among other things, dedicate $1 billion in state block grants over the next two years for the prevention and treatment of opioid addiction.
Portman first took an interest in the issue of drug abuse as a representative for Ohio’s second congressional district, where his constituents would frequently ask what he was doing to address addiction within their communities. Once he began to consider the full extent of the problem, he realized that drug addiction affects nearly every aspect of society, from crime rates to welfare programs to the economy.
“It’s a poison coming into our communities and affecting everything,” Portman tells National Review. “And unfortunately, it’s getting worse not better.”
In 1996, Portman founded and chaired PreventionFIRST!, an anti-drug coalition that develops comprehensive solutions to youth substance abuse. In recent years, though, he has honed in specifically on opioid abuse, which presents a unique challenge: Nearly every one of the hundreds of recovering opioid addicts he has encountered has said that shaking the grip of opioids was more difficult than shaking other addictions.
Since Portman began to focus on drug abuse in the mid 1990s, the opioid crisis in particular has spiraled out of control. In the ’90s, before the addictive nature of painkillers was fully understood, there was a surge in doctors’ prescribing them. Since then, prescription-painkiller overdoses have quadrupled, and heroin usage has continued to increase. In 1999, small parts of Appalachia and New Mexico were the only U.S. regions significantly affected by opioid addiction; by 2014, nearly the entire country had been touched by its fatal hand. The problem is particularly acute in Portman’s own state: One in nine heroin deaths nationwide occur in Ohio, where an estimated 200,000 residents are addicted to opioids.
“The story is not as clear-cut as some people like to think,” says Sally Satel, an addiction psychiatrist and resident scholar at the American Enterprise Institute. “It is true that the over-prescription of opioids to patients with pain has definitely been a large part of the increase in painkiller abuse. That’s because it gets more opioids in circulation, and from there they can be stolen and sold by people who are addicts. When pain patients abuse medications prescribed to them, they are typically individuals with a previous or concurrent problem with drug or alcohol abuse, or depression and other psychiatric conditions.”
Portman is hopeful that the resources and programs outlined in CARA will help to alleviate the growing epidemic in Ohio and across the country. The bill funds evidence-based methods for recovery and prevention, decreasing the potential for ineffective government spending. In addition, some non-profits can apply directly to the government for funding, which enables them to deploy solutions targeted to the needs of individual communities.
The Cures Act would build on the $181 million a year outlined in CARA, awarding block grants to states, based on demonstrated need, from a pot of $500 million for each of the next two years. Portman suggests that Ohio might be eligible for somewhere between $20 and $40 million in the upcoming year, given the drastic nature of its opioid problem.
Jessica Nickel, president of the Addiction Policy Forum, believes that both CARA and the Cures Act represent a tremendous step forward, because they offer unique resources and follow a public-health model for treatment and prevention. “CARA for the first time is a comprehensive response to addiction,” Nickel says.
Despite his advocacy for federal funding to combat addiction, Portman believes that communities must take primary responsibility for addressing the crisis. “I don’t think Washington is going to solve the problem,” he says, “but it has a role to play in helping communities be able to deal with it.”
Portman believes that a combination of longer-term treatment and effective law enforcement will be most successful.
There is still a long way to go. For one thing, when federal and state governments began to implement aggressive measures against prescription-painkiller abuse in 2010, heroin-related deaths began to rise steadily. (Heroin is often easier to obtain and cheaper than painkiller prescriptions.) For another, much opioid abuse comes not from individuals overusing their prescribed drugs but from patients who sell some or all of their medication to other addicts.
Portman believes that a combination of longer-term treatment and effective law enforcement will be most successful. He emphasizes that addiction is a disease requiring treatment, rather than simply the result of bad decisions or moral failings, and that getting people to accept as much will reduce the stigma surrounding addicts, leading more of them to feel comfortable seeking treatment.
In his own experience with recovering opioid addicts and their caregivers, Portman has seen that long-term programs such as sober-housing arrangements tend to have the best results. “These types of programs are much more successful at helping people turn their lives around and lead a productive life,” he says. Such an approach also helps to reduce the number of individuals who relapse on release; in some regions, law-enforcement officials report rescuing the same individuals from drug overdose multiples times over the course of just a few months.
#related#Portman believes that strengthening the ability of the criminal-justice system to handle opioid-related offenses with sensitivity, rather than tossing offenders directly into jail, is just as important as emphasizing long-term treatment. Incarcerated addicts will often undergo painful withdrawal symptoms if they are successfully prevented from continuing to take illegal drugs in jail, emerging with the same drug dependency they faced when they arrived. Portman believes that drug courts, which incentivize recovery by mandating detoxification programs that address offenders’ addictions, are a better solution. Such courts tend to have higher success rates because they closely monitor offenders and threaten incarceration as a penalty for failing to pass drug tests.
Though they are not a silver bullet, Portman believes that the Cure Act’s block grants and federal drug courts are another step in the right direction. “I know Ohio will use this funding very successfully because we have so much experience dealing with this problem,” he says.
The House of Representatives passed the 21st Century Cures Act on Wednesday in a bipartisan vote; the Senate will consider the measure next week. With an advocate as dedicated and experienced as Portman on its side, there is reason to hope that this legislation will be the next victory in the long battle against addiction.