Recently, 100 Days in Appalachia published an interview with Christa Foster, an addiction specialist in West Virginia. Foster spoke at length about what she sees as appropriate and effective policies for combating the opioid epidemic, offering her assessment of some of President Trump’s new proposals, including the necessity for more adequate funding behind the proposed policies, as well as a holistic approach to the problem. Today, the Administration offered some more insight into its understanding of the opioid crisis. According to a press release sent out Monday, nearly $1 billion has been dedicated to combatting the crisis since President Trump took office in January. A vague list of expenditures showed that around $800 million of that budget has been spent on “prevention, treatment, first responders, prescription drug monitoring programs, recovery and other care in communities, inpatient settings, and correctional systems.” This is the only time the word “prevention” has been mentioned in relation to the crisis, in no certain terms. If the numbers reflect the actual funding dedicated to the problem, it could suggest that voices like that of Foster and others working on the ground of the epidemic may not be being heard by the Administration. Experts agree these areas are crucially important, but there seems to be an ongoing misunderstanding from the Administration that the problem could be solved exclusively through after-the-fact intervention. When asked for clarification, the White House Press Office didn’t provide any more details, including the source of funding, or how it was allocated. The press release did acknowledge that the severity of the opioid epidemic has been underestimated in the past. President’s Council of Economic Advisors (CEA) has released a report showing that costs of the crisis to the US economy are much higher than previously calculated. According to the CEA, earlier estimates took into consideration only the opioid-related deaths resulting from the abuse of the prescription drugs. The new study included estimated costs of deaths from other types of opioids, as well as costs of non-fatal opioid abuse. “Using standard economic techniques, the CEA estimates the cost of the opioid crisis in 2015 to be $504 billion, or 2.8 percent of GDP, once the lives lost due to opioid overdoses are accounted for,” stated the press release. The full CEA report can be found here.
In October, President Trump recognized the opioid epidemic as a national public health emergency and promised “aggressive steps” and immediate government actions to counteract the newly diagnosed public health emergency. The solution, Trump asserted, lies in teaching every American that drugs are inherently “bad.”
Frank Ahrens took a closer look at the initial proposals for combating the drug epidemic in his story for 100 Days in Appalachia.
He proposed a “massive advertising campaign” intended to dissuade people, especially children, from taking drugs “in the first place,” in hopes that “they will see the devastation and the ruination it causes to people and people’s lives.” Swiftly denounced as a rehash of the “Just Say No” campaign, critics pointed to the Surgeon General’s report revealing the Reagan era DARE (Drug Abuse Resistance Education) program as a costly failure.
When asked about the difference between the President’s proposal and Nancy Reagan’s “Just say no” campaign of the 1980s, Chris Christie, Chair of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, had this to say:
“It’s much different. You heard the President of the United States up there today say we have no choice, but to help the millions of addicted people in this country to recover, that’s not ‘Just say no.’ Now, prevention is incredibly important. I think the President’s message to make sure that people don’t start is an incredibly important part of this. There’s three legs to this stool. There’s prevention that needs to start, in my view, in the middle schools in this country, in the fifth and sixth grades, before kids get anywhere near high schools. Second, there’s intervention, which the Justice Department is taking care of in form of Law Enforcement, and third is treatment. This President, firmly, loudly and directly, said that all three are necessary.”
100 Days in Appalachia reached out to Christa Foster, an addiction professional who has been working for decades helping those suffering from drug abuse and addiction in Appalachia, to see how Trump’s plans stack up against her experience in West Virginia — one of the states hardest hit by the opioid crisis. Now in private practice, Foster is skeptical of the Commission’s work and chances for any real policy change.
“… I’ve always been on the suffering and recovery side of this equation, and so I can see why a cop would be excited because it gives his people more resources to make a small difference. I can see why a for-profit hospital is excited, because it’s a PR boom and it’s also an opportunity for his hospital to provide more resources to the community. They all have really vested interests in convincing people of their own effectiveness, and convincing themselves of their own effectiveness. I think denial plays a really strong part here. Unfortunately, […] I see the failures of the system. […] And I’m much more pessimistic because I’ve seen people fall through these cracks through six Administrations now. I catch the people who fall through the cracks when the people with vested interests are unable to cash in on what they’re hoping they can do.”
Having directly witnessed the failures of DARE’s ‘Just say no’ approach, Foster points to its inherent challenges. As with any health crisis, she notes that prevention “is the cornerstone of a good public health policy in any disease maintenance… in preventing heart disease, preventing diabetes, preventing substance abuse and addiction. I’m with that idea of prevention. However, when you tell people – particularly young people – to say ‘no’ to something, you must also give them something to say ‘yes’ to. You have to give them after-school programs, you have to give them preventative healthcare, because if people are taking opiates for pain for an injury, or illness, that could have been prevented through a better healthcare program — unless we’re giving people something to say ‘yes’ to, saying ‘no’ is irrelevant.”
“Unless we’re giving people something to say ‘yes’ to, saying ‘no’ is irrelevant.”
She sees very little, if any, attempts by the Administration to provide those alternatives and suggests there are several critical issues with the Commission’s proposals, most notably its lack of funding. At the core of every policy, she said, there has to be the appropriate funding allowing for its implementation.
“We could be on a precipice of a breakthrough, except that there’s no money behind it. As soon as you verbalize policy and you don’t fund it, it is no longer a policy, it’s an idea again,” she said of the apparent lack of a dedicated budget.
“As soon as you verbalize policy and you don’t fund it, it is no longer a policy, it’s an idea.”
There are proposals to shift some funding around and redirect some of the money already assigned to combating the problem towards more urgent needs. However, responsibility for long-term and adequate funding, at least for now, has been placed on Congress. Chris Christie told reporters that it is now on Congress to work with the Administration to put money in the Public Health Emergency Fund.
Beyond the question of funding, Foster raised additional concern for the continuing criminalization of people suffering from addiction and drug abuse. “Once people are in the throws of this illness, they are suffering from a disease — and up until this point, we were treating them as criminals. And that has not been helpful. It is not a criminal justice problem, it’s a public health problem, and we need to change our entire paradigm of how we approach it,” she said.
She doesn’t see drug courts, one of Commission’s recommendations, as a step in the right direction. She argued that by intersecting with the regular court system, drug courts would continue to put a class and poverty stamp on the problem.
Long before Trump’s announcement, Foster perceived the opioid epidemic as a public health crisis, as well as a class and poverty issue.
She notes that people of different age groups, races, socioeconomic status, and professions struggle with opioid addictions that differ slightly from one another. That’s why the approach has to be a holistic one, she said.
“When you have working, middle class, mainstream people struggling with addiction, it looks different…because they have access to different kinds of resources” Foster shared. “People like Rush Limbaugh, who came out about his opioid addiction, have access to doctors, have access to people coming into their home, different resources for gaining the substance… ” she added.
“Now if we’re talking about insurance programs covering treatment, then we are talking again about the ACA (Affordable Care Act) and about parity, mental health and substance abuse parity… So these [proposals] all sound really good but his [Trump’s] other policies are clearly in contradiction to what his Commission has proposed,” argued Ms. Foster.
The amount of suffering Foster has witnessed in Appalachia on a daily basis, after decades of failed policies, has left her skeptical and guarded. She acknowledges she is somewhat biased — It’s the sixth Administration she has watched making promises and drafting policies to help people struggling with drug addiction over the same time period that drug addiction has soared.
Different vantage points have created stark differences in attitudes among different professionals combating the opioid crisis, from the Chief of Police in Knoxville, TN to the neonatalogist in Charleston, WV, both of whom expressed more optimism towards the President’s plan. Of these radically different assessments of the proposals, Foster noted, “it is in having the extremes that we start to find the middle ground.”
Feature Image: In 1986, Harpers Ferry, West Virginia was declared the first “Just say no” town in America at a rally for the Prevention of Drug Abuse targeting elementary school-aged children. Nancy Reagan presented a “Just Say No” t-shirt to Harpers Ferry Bradley Nash during a visit to the town where she warned school children that even small-town America must fight against drug abuse. Three decades later, West Virginia has one of the highest overdose rates in the country. (AP Photo/Bob Daugherty)
Jan Pytalski is a Washington, DC correspondent for 100 Days in Appalachia. Jan is a recent transplant to the United States from Poland, where he began his journalism career working for the Reuters news agency in Warsaw. After moving to Washington, he continued working for Reuters as a stringer, helping with the White House coverage under the Trump Administration. Prior to his work as a reporter, Jan spent over a decade working as a translator with publishers and universities in Poland and the United States.