Governors Step Up to Address Opioid Crises in Their States
The past year has paved the way for governors throughout the northeast to step up and address the growing problems related to the availability of substance abuse treatment for their constituents. This bold move was first taken by Vermont Gov. Peter Shumlin one year ago. In June of 2014, Gov. Mario Cuomo of New York signed legislation that included expanded access to the overdose reversal medication naloxone and improved addiction treatment access, insurability, provider training, community based treatment and longer-term case management. Following in their steps, this past Tuesday in his State of the State address, Gov. Chris Christie of New Jersey emphasized the substance abuse, and specifically the opioid (heroin and prescription pain medicine), crisis. He discussed plans to improve the accessibility and coordination of treatment, including a centralized call-in center, expanded use of naloxone, and expansion of drug court and offender re-entry programs.
CASAColumbia applauds the serious attention devoted by these and other state officials for acknowledging our serious addiction problem and highlighting harm reduction and treatment, rather than incarceration, as the solution. This represents an overdue shift in emphasis from punishing addiction as a moral or criminal problem to treating it as a medical disease. Not only may this shift save lives, prevent family tragedies, and reduce costs to society, it may also chip away at the stigma associated with the disease.
Drug and alcohol overdoses are the leading cause of accidental death among young people in the northeast and other parts of the country. The estimated loss of life is alarming. Over 16,000 people die from opioid overdoses each year and many states have seen death rates rise 50 - 250 percent over three years.
The greater availability of naloxone has already begun to save lives. Although preventing overdose and other forms of harm reduction are vitally important public health interventions, effective opioid addiction treatment is essential to prevent the progression of this disease toward a fatal outcome. There is no scientific evidence that standard care detoxification followed by minimal counseling is effective. Medication assisted treatments are necessary and include naltrexone (oral or injectable), buprenorphine (Suboxone) and methadone. All three medical treatments must become easily available and affordable in all communities.
It is especially essential to extend these treatments to adolescents and young adults before another heartbreaking unintentional death shatters a family. In CASAColumbia’s Addiction Medicine report, we found that only one in 10 addicted people obtain treatment, leaving a gap of over 20 million people in the U.S. This is a national tragedy and one which requires all state governors to move our number one public health problem to the top of their agenda.
Individuals addicted to opioids face numerous barriers to initiating and remaining in addiction treatment. New Jersey has promising programs that may address this problem. In 2014, CASAColumbia completed its multi-year evaluation of one such program - New Jersey’s Medication Assisted Treatment Initiative (MATI). This initiative used community outreach to help enroll low-income individuals into treatment in six New Jersey cities, offering stream-lined intake procedures, choice of mobile medication (methadone or buprenorphine), cognitive behavioral therapy and medically managed detoxification.
Our findings indicated that this intervention was very successful at getting people into treatment (over 50 percent on the first day), and decreasing (two-to-four fold) positive urine drug tests, injection drug use, illegal activity, rates of detention or incarceration, early drop out, and costs.
Preventing overdose deaths is a necessary step, but an incomplete approach to the opioid epidemic. Medication assisted treatments should be as readily available as any other medication that saves lives and allows them to be rebuilt.