When asked to testify before the Maryland legislature on Governor Larry Hogan’s bills to combat the state’s opioid epidemic, I experienced a feeling of panic.
A small circle of former colleagues already knew my story: I’m the former Maryland house member some saw as a rising political star who wound up destitute and homeless. But now, my tale of opioid addiction would no longer be the subject of private conversations at political gatherings along the lines of “Did you hear what happened to that guy?” Instead it would be a very public recounting of a painful recovery process that never ends. This was not how I predicted things would turn out as a 27-year-old freshman legislator — testifying years later before General Assembly hearings about life as a drug addict.
Once I chose to go through that door earlier this year, however, I simply kept walking. Several months later I announced a run for Congress. I’m the first such candidate in the country in open recovery from opioids.
While my story is personal, it is not unique. We’ve all seen the horrific statistics on overdose deaths attributed to prescription “painkiller” opioids and illegal heroin and fentanyl. New Jersey governor Chris Christie’s passionate remarks on the presidential-campaign trail about a fellow law-school student who died of an opioid overdose went viral.
While personal stories of addiction and statistics help us understand the problem, much work remains to find the solution. Events are moving at a rapid pace in Washington, D.C., that will determine how we fight our nation’s worst-ever drug crisis.
Most recently, President Trump declared the epidemic a public-health emergency and announced administrative actions, most notably relaxing Medicaid rules on treatment options available at private rehabilitation facilities. Christie, whom President Trump named to lead a White House opioid task force, will be submitting the commission’s final report tomorrow. Against this backdrop, the president’s nominee for drug czar withdrew his name from consideration two weeks ago following news reports of his involvement in legislation said to curtail Drug Enforcement Administration powers. And another key agency, the Department of Health and Human Services, is without a secretary following the resignation of Tom Price last month.
Most of the policy action centers on the work of the task force Christie leads. Formally known as the Commission on Combating Drug Abuse and the Opioid Crisis, the group has had several meetings with subject-matter experts across the country. Their interim report this summer prompted President Trump’s emergency declaration. With an ample record of public meetings and testimony, there are clear signals of what the task force will be recommending in its final report. It would be a good idea to catch our collective breath at this point.
Even though nobody officially calls this a “war on opioids,” we should make sure our efforts do not morph into one. Under such approaches, seen previously in the War on Drugs and the War on Poverty, billions of dollars are spent, and as former Maryland governor Robert Ehrlich noted in the Baltimore Sun, “tax payers never get to see what actually works.”
President Trump has committed to spending “a lot of money” on opioid addiction. We are already spending a lot of money — most of it on treatment. The Kaiser Family Foundation reports that Medicaid spending on opioid treatment was $9.4 billion, according to their latest data. Covering detox, rehabilitation, and what is called Medication-Assisted Treatment, these numbers are from 2013 — and overdose numbers have spiked since then.
A constant theme of the opioid task force is its support of Medication-Assisted Treatment. Drugs used to treat opioid addiction are not all the same. Some block the “high” altogether, while others are opioids themselves. Rehabilitation centers are not all the same, either, as some advertise becoming sober in a matter of days while others say recovery should last a year or more. Widely divergent opinions exist among addiction specialists on which approaches work best and which work not at all.
Another common theme of task-force meetings is consistent use of the term “evidence-based.” Many like to say it in meetings; relatively few know what it means. Massachusetts governor Charlie Baker, a member of the task force, got to the heart of the matter, raising the question of how to focus federal efforts on “things that work.” He did not receive a clear answer. And neither will parents or other loved ones of addicts find clear evidence of effective treatment options by Googling rehabilitation treatment centers, federal departments, and agencies or medical providers.
We must define as a country what victory actually means and the proper role of the federal government. Everyone agrees that law enforcement plays a key role in curtailing shipments of illegal opioids manufactured in China and sold on the dark Web. Many also agree with the Centers for Disease Control’s prescribing guidelines to doctors for legal painkillers such as Oxycontin.
Many of the most innovative approaches to fighting opioid abuse are at the state and local level.
Many of the most innovative approaches to fighting opioid abuse are at the state and local level, however. In Massachusetts, graduating requirements for students in medical, pharmacy, nursing, and dental schools include passing a core curriculum in opioid therapy and pain management. Governor Baker wants these requirements to be national policy. In Maryland, Governor Hogan’s prevention and enforcement bills, which became law, will help reduce unnecessary doses in opioid prescriptions and increase prison time for drug dealers peddling fentanyl and so-called analogs like the even more deadly carfentanil.
Congressman Hal Rogers, whose rural Appalachian district in Kentucky was among the first to see the current epidemic of opioid abuse, warns policymakers against attempting to find a silver bullet. Rogers and community leaders spearheaded the creation of a local nonprofit organization that reports outcomes on prevention, treatment, and enforcement measures. Perhaps here is a way to direct federal funding to organizations with proven results by acknowledging what works locally, reducing the red tape associated with traditional federal grants and allowing flexibility to meet local needs.
As a recovering addict and someone personally invested in an effective national response to the opioid crisis, I’d emphasize one area where the federal government can avoid an ill-defined “war on opioids”: Develop standards for measuring treatment outcomes. Report the data in a clear and consistent manner so the public can understand it. This is a key step toward victory.