While addiction remains a bipartisan issue, support for treatment and recovery is not guaranteed, according to Andrew Kessler, JD, principal of consulting firm Slingshot Solutions. Speaking at the National Conference on Addiction Disorders in Baltimore, Kessler noted the attention policymakers are giving the opioid crisis.
“Is the opioid crisis a battle and addiction treatment is the war, or is the opioid crisis the war and treatment is the battle?” he said. “For policymakers, it’s the war, but for advocates, it’s the battle.”
Federal and state legislatures have moved forward on funding and programs for opioid treatment and recovery, but resources are still quite scarce. One point of context to consider is the fact that not every addiction is an opioid addiction—deaths related to alcohol misuse still outpace opioids, and in some areas, methamphetamine is on the rise, Kessler said. It also begs the question of how treatment would be skewed for those with other health issues, including hepatitis C and HIV.
He said it’s important for leaders in the industry “to advocate for the disease of addiction,” rather than for the opioid crisis. A number of politicians want to broadcast their support of measures to combat the crisis, but at the same time, some of them are also signing on to proposals that cut funding, as was witnessed in the many attempts by Republican leadership to dismantle the Affordable Care Act.
Addiction remains a political football, and that’s not a good place to be. Some policies serve to be grand gestures but with little practical impact, Kessler said.
For example, the 21st Century Cures Act earmarked treatment and recovery program funding of $500 million in 2017 and $500 million in 2018. States will decide how to spend the money.
“This money goes away after 2018, but the opioid crisis does not,” he said. “When you come back asking for more, everyone is going to tell you that you already got your money.”
Opioid national emergency
Kessler questioned the value of having the president declare the opioid crisis a national state of emergency since no one truly knows how the declaration will play out in practical sense.
“Washington wants to solve every problem as if it’s acute,” he said. “This is not acute.”
It’s possible that top federal health official Tom Price could relax 42 CFR Part 2 regulations or grant state waivers to overcome the IMD exclusion under the state of emergency. Or, it’s possible that rather than taking a public health approach, federal leaders could take a law enforcement approach and use the emergency to reinforce border control.
Kessler also noted that the state of emergency would have to be renewed every quarter.
“The opioid crisis is number one now, but nothing stays number one forever,” he said.