State officials are urging the Trump administration and Congress for more funding and federal coordination in order to shore up efforts against the opioid epidemic, naming prevention and treatment programs as top priorities. But Washington has yet to dole out additional funding, leaving state and local communities struggling on the front lines of this crisis.
“[I]nadequate funding and unnecessary constraints have limited our ability to use federal resources in the ways that would be most helpful in New Hampshire,” Gov. Chris Sununu wrote to the Senate Health, Education, Labor, and Pensions Committee in January.
Underfunding for behavioral-health services is not new. There’s been a chronic issue with access to resources for behavioral health, and substance-use disorders in particular, said Kitty Purington, senior program director at the National Academy for State Health Policy.
“Everything I’m saying gets magnified when you move away from urban centers to rural areas,” she said. “They’re going to have the most need, and there’s a lot of counties in the United States that have very few, if any, behavioral-health providers, so there’s just a real lack of service.”
Governors have commended the administration’s move to declare the issue a public health emergency, which was recently renewed, but they say that much more needs to be done.
“Governors urge Congress and the Administration to increase federal funding to states for opioid/[substance use disorder]-related activities and streamline the grant process by coordinating application and administrative processes,” the National Governors Association stated in a list of recommendations released in January.
The NGA listed several priorities for flexible federal funding, including evidence-based programming for youth, culturally specific treatment, operation of drug-monitoring programs, and wider availability of naloxone at the state and local level.
But to bring down the number of deaths related to opioids, one expert suggests, it would require a commitment from Congress to supply $60 billion over 10 years. “I don’t believe that we’re going to see opioids-overdose deaths come down until we build a treatment system that doesn’t exist yet,” said Andrew Kolodny, codirector of the Opioid Policy Research Collaborative at Brandeis University.
“What we want is for someone who is opioid-addicted to more easily access effective outpatient addiction treatment than they can access heroin,” he added.
Several members of Congress told National Journal that it is important to provide more funding for the epidemic, possibly as part of the current budget negotiations.
“It’s just not enough to meet the challenge,” said Sen. Shelley Moore Capito of West Virginia, whose state is one of the hardest hit by the epidemic. “We’ve got the highest-percent overdose deaths per 100,000, so we need more.”
But Republican Study Committee Chairman Mark Walker cautioned that discussions are preliminary, and Rep. Tom Cole said there need to be “topline” agreements first in the funding negotiations.
“Look, there’s broad bipartisan support for opioid funding,” said Cole, who sits on the House Appropriations Committee. “If we get a larger deal, I’m quite convinced that opioids will do very well on any final package. It’ll actually be something that can bring the two sides together. But until you get the topline, it’s just hard to speculate beyond that.”
President Trump highlighted opioid addiction during his first State of the Union Tuesday night, declaring that his administration “is committed to fighting the drug epidemic and helping get treatment for those in need.
“The struggle will be long and difficult—but, as Americans always do, we will prevail,” Trump said.
But a group of Democratic senators say Trump’s actions so far have not been enough. The 19 senators—led by Sen. Elizabeth Warren and HELP Committee ranking member Patty Murray—sent the Government Accountability Office a letter Tuesday requesting reviews of the administration’s efforts.
“Given the severity of the crisis, we have grown increasingly concerned by reports that the President has done little to make use of his public health emergency declaration, leaving state and local communities without the resources they need to fight the opioid epidemic,” the Democratic senators wrote, adding that the White House has not put forward a proposal for authorizing new funding.
The National Governors Association and some experts have argued that coordination within the federal government is important. Last year, the President’s Commission on Combating Drug Addiction and the Opioid Crisis outlined several recommendations, including urging the Office of National Drug Control Policy to establish a system of tracking federally funded initiatives. The report stated, “We are operating blindly today.”
The administration lacks a plan to achieve these recommendations, said Caleb Alexander, codirector of the Johns Hopkins Center for Drug Safety and Effectiveness.
“It’s one thing to say, ‘We’re going to put a man on the moon,’ and it’s another thing to build the spaceship to get the job done,” he said. “I think that the commission’s report gets the science right, but what is missing from the administration activities thus far is a clear road map of how the many very reasonable and important suggestions or recommendations that are made within the report are actually going to be realized.”