Amid steep increases in overdose deaths, Americans overwhelmingly consider drug addiction a major problem whether they live in the city, country or suburbs.
A recent poll from the Pew Research Center found that 9 in 10 Americans in rural areas consider drug addiction a problem in their communities — as do 87 percent in urban areas and 86 percent in suburban areas. In 2016, the most recent year for which we have full data, more than 63,600 people died from drug overdoses, and preliminary information suggests this has only increased.
Unlike other major issues, such as the economy, we don’t disagree over what the goals should be and it feels inherently apolitical. But there are different strategies to achieve our shared objectives.
John Hudak, a senior fellow of governance studies at the Brookings Institution, a public policy think tank in Washington, D.C., said Democrats see opioids as a crisis of such magnitude that a significant amount of federal funding is required to assist states and localities, whereas Republicans don’t think it requires as much spending.
“We’re talking differences of opinion in the range of $100 billion in some cases. That creates what ends up being gridlock on an issue that would otherwise appear to avoid it,” Hudak told Yahoo News. “In the current political environment, anything that has an opportunity to cause gridlock is ultimately going to win the day.”
Given the severity of the crisis, Hudak continued, Congress has to do something, but the question is whether it responds with serious solutions or mere “window dressing,” which could actually make matters worse. He said members of Congress might delude themselves into thinking they have addressed the crisis and move on — undermining the possibility of significant legislation in the near future. He said there are members of both parties who are serious about fixing the problem and members of both parties who are guilty of “finding something that will pass,” even if it’s is far less meaningful than what is necessary, so they can hang their hat on that “success.”
Americans tend to think the Democratic Party deals with the problem of addiction better than the Republican Party by 43 percent to 27 percent, according to a separate Pew Research Center survey, released on June 20. But it’s not clear that these data are influencing national trends in our election results.
Hudak said the opioid crisis will affect the midterms race by race and candidate by candidate rather than along party lines.
“Where the opioid crisis and opioid policy matters will be on an individual race basis and an individual candidate basis,” Hudak said. “You will probably have a handful of candidates in 2018 who are going to talk seriously about the opioid crisis, and they are going to have a plan that’s convincing.”
Since neither party has cynically exploited the crisis to score partisan points, and there are earnest and insincere people on both sides of the aisle, it appears highly likely Hudak is correct in his assessment that the opioid crisis will be handled on an individual candidate and individual race basis.
Yahoo News reached out to two promising candidates — Democrat Chris Pappas and Republican Andy Sanborn — in one of the states most affected by the opioid crisis: New Hampshire. According to the National Institute on Drug Abuse, New Hampshire had 437 opioid-related overdose deaths in 2016 and opioid-related deaths tripled from 2013 to 2016. This increase was primarily driven by synthetic opioids, such as fentanyl, which caused 30 deaths in 2013 and 363 deaths in 2016. Opioids regularly rank as the most important issue for the state’s voters and was an important topic locally long before capturing national attention.
New Hampshire’s First Congressional District is extremely competitive. The seat for this deeply purple district is now open for the first time in over a decade, during which it has been bouncing between Republican Frank Guinta and Democrat Carol Shea-Porter, the incumbent, who is retiring.
On the surface, Pappas and Sanborn’s proposals have more in common than not. They would both fight for what they consider a fair share of federal funding to confront this public health crisis and would push back against any formula for federal aid tied strictly to population, given that New Hampshire has only 1.3 million residents but a disproportionately large percentage of addicts. They also don’t think there are enough treatment facilities in the state to handle the problem.
They diverge where one would expect Democrats and Republicans to offer different proposals, where treatment collides with fiscal policy, including over the Affordable Care Act (ACA) and Medicaid. But for both of them, solving the issue was more important than scoring partisan points.
“I think this is one area where we’ve got to see bipartisan cooperation. This can’t be a matter of it being a Democratic or Republican proposal,” Pappas said. “We have to look at partners around the country from districts that are similarly impacted to make sure we have allies in this fight going forward.”
New Hampshire sends two representatives from each district to the House. Together with its two senators, New Hampshire’s delegation in Congress has just four people — all Democrats right now. When asked why the Republicans would be better on the opioid issue, Sanborn replied:
“I would love to give you some sort of pithy answer that pits Republicans versus Democrats in this case, but the truth of the matter is that this is more about individual people and their proven ability of [knowing] what we should do.”
Sanborn, a member of the New Hampshire Senate and chairman of the state’s Health and Human Services Committee, described the opioid crisis as a very personal issue for two reasons: He has had to bury employees and close friends, and he spent five years of his life taking “significant quantities of Oxycontin” while undergoing a series of surgeries.
“It’s a conversation we need to have, and I don’t think we’re having it at the level we should be,” he said.
Sanborn endorses the “three-legged stool” approach: prevention, treatment and recovery. To prevent opioid addiction he wants to find a way to make doctors prescribe fewer opioids. As state senator, he tried to establish a rule requiring medical providers to consult with a prescription drug monitoring program (essentially a large database that shows where patients are getting prescriptions and which prescriptions they are getting) before writing a prescription. There would be no requirement to dispense, not dispense or notify anyone — just a database. Six years into his fight, however, it is still not a requirement in New Hampshire, which he thinks is a mistake.
“I fought like heck. And I’m a liberty guy. I want the government so small I can barely see it. I have varied concerns about the size and scope of my government. So if a guy like me is going to put in any government mandate, you know it’s a serious issue,” he said.
For the treatment stage, he thinks there are many different potential approaches to detoxing and getting the drugs out of one’s system but that in general the state doesn’t have enough facilities.
For the final part of this three-pronged approach, Sanborn personally subscribes to and believes in long-term peer-to-peer recovery: gatherings at a community centers where addicts can support each other, receiving and providing guidance as needed.
“We have 1.3 million people in the state. We know that [with] 80 milligrams of Oxycontin for seven consecutive days, many people if not most people will develop a chemical dependency to the drug. We know in New Hampshire two years ago we dispensed enough 2, 3 or 4 class drugs in our state that every single living, breathing person from infant to deathbed would get a hundred-day supply. That is insane,” Sanborn said.
Sanborn said he doesn’t believe in turning long-term recovery into a billable medical product. He said a medium-size city can set up a peer-to-peer recovery center for $200,000 to $500,000 a year. But medically provided peer-to-peer recovery, he said, requires recovering addicts to book appointments sometimes weeks in advance for up to $130 for a 15-minute slot — billable to Medicaid.
“So turn off the faucet, get people clean, keep them clean in a safe, affordable, cost-effective way to do it that we know that works. That’s how we cure this,” he said.
Pappas said that when he stops at recovery centers and treatment facilities throughout the state, a common refrain is that they need a more stable stream of money. He noted that New Hampshire’s delegation secured additional funds but that it still gets shortchanged because it’s a low-population state.
They both want New Hampshire law enforcement better equipped to get illegal drugs off the street and disrupt gang activity. The New Hampshire Troopers Association endorsed Pappas’s campaign on June 24.
Despite some consensus around goals, there are clearly disagreements on how to reach them.
Pappas said it’s important to protect the ACA (commonly called Obamacare) and keep the Medicaid expansion that was authorized in New Hampshire on the books.
He said, “53,000 individuals receive coverage for substance use disorder through Medicaid expansion in our state, and that’s been the best tool we’ve been able to come up with to make sure we build out the network of support we need to create to make sure people can access care. That’s something Republicans, including in this race, have advocated for not continuing.”
Pappas said that right now there aren’t enough residential treatment opportunities, medication-assisted treatments or medical professionals capable of prescribing them. Despite a decrease in the number of opioid prescriptions being written, he said, New Hampshire needs to make sure its prescription drug monitoring program is able to flag those concerns going forward.
“We can’t do it without health care coverage for people. We can’t do it without more resources from Washington. Those are the two areas I will look at to make sure we’re getting what we need to fight this crisis,” he said.
In most regards, Sanborn thinks there needs to be more no-strings block granting because state representatives are much closer to their people and have a good understanding of what their state needs, which might be slightly different from one state to another.
Pappas said President Trump’s declaration of a public health emergency didn’t really mobilize the full resources of the federal government to make sure efforts on the ground in New Hampshire were supported.
He said New Hampshire is experiencing this crisis more profoundly than most states because it had not invested in mental health and addiction treatment for a long time. He said that the state is late in making sure people can get access to the care they need and that it’s ill-served by people who think the government doesn’t have a role to play in the crisis.
Sanborn wants to avoid “government-provided solutions.”
“That’s where this long-term peer-to-peer recovery thing comes in. We find that people like me, politically and ideologically, know it works, know it costs less money and know it’s more effective — so we try to go in that direction,” Sanborn said.
So what the New Hampshire race embodies is a common desire to eradicate opioid addiction, a shared conviction that bipartisan cooperation is needed and overall civil discourse over how to move forward, but very different proposals and priorities. This could change after the primaries in September, but that doesn’t seem likely.
Dante Scala, a professor of political science at the University of New Hampshire, said opioid abuse is singular in New Hampshire in the sense that it seems political elites are more amenable to bipartisanship on that issue and have so far been much more careful about trying to use that issue to score political points.
“I think you’re right that this issue has been bipartisan or even nonpartisan in a way that most aren’t here,” Scala told Yahoo News. “Despite our reputation for independence, we are awfully partisan on a lot of issues. But [addiction] doesn’t tend to be one of them.”
He has been struck by how gingerly candidates approached the issue in 2016. As an example, he recalled that during a heated contest for U.S. Senate between Republican incumbent Kelly Ayotte and Democratic Gov. Maggie Hassan, the National Republican Senate Committee ran an attack ad against Hassan arguing that the opioid epidemic ballooned on her watch.
“It wasn’t over the top negative, but it was critical,” Scala said. “I was struck by how the governor and her campaign took the stance that to go after this issue in a partisan way was somehow beyond the pale and also that Sen. Ayotte basically conceded the point in as much as she didn’t pursue it in her own campaign with any aggressiveness.”
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