Connecting state and local government leaders
“Declaring a health emergency without offering any additional resources is akin to saying ‘I want to get a job’ but I don’t send in a resume and I don’t go for interviews.”
WASHINGTON — The local officials who serve as the boots on the ground in the fight against the nationwide opioid crisis are running out of ways to say the federal government isn’t giving them enough money.
City and county officials gathered on Capitol Hill Tuesday for a briefing on the role they play in ending the epidemic, and the undercurrent of the event was clear: We can only do so much with current level of funding.
Each of the officials present acknowledged the Trump administration’s recent actions on the epidemic. But while these officials see Trump’s public health emergency declaration and the White House’s opioid task force recommendations as steps in the right direction, those steps remain essentially meaningless in their eyes until new federal resources are provided to back those actions up.
“Declaring a health emergency without offering any additional resources is akin to saying ‘I want to get a job’ but I don’t send in a résumé and I don’t go for interviews,” said Phyllis Randall, who chairs the Loudoun County Board of Supervisors in Northern Virginia, adding that “we actually have to put money behind this.”
Randall, a mental health therapist who spent her career working with substance-abusing offenders in an adult detention center, speaks about the opioid epidemic from experience, peppering her policy talk with personal anecdotes informed by that work. And to her, there’s just no sugar-coating the fact that federal partners are not putting their money where their proverbial mouth is.
Mayor Lydia Mihalik of Findlay, Ohio agrees. Speaking with Route Fifty following the briefing, Mihalik referred to the final report from the opioid task force saying “these recommendations that have come out, I think it’s good that they’re taking a look [at the issue], but a task force report is a task force report.”
“If you don’t take those recommendations and actually put money and funds to them, and implement them in the communities that need them most, then you’re never going to make a difference,” Mihalik added.
The opioid epidemic is costing Mihalik’s city, and not just in terms of lives lost. Out of Findlay’s $26 million general fund budget, $16 million is going to fire and police, a trend the mayor attributes, at least in part, to the growing impact of the drug crisis.
Mihalik cited two programs Findlay has undertaken that she’s particularly proud of—one that sends a three-person response team to do outreach to those who’ve experienced an overdose within 24 hours of the episode, and another program that trains laypeople on how to recognize the physical appearance of an overdose.
“We spend millions of dollars every year battling this epidemic,” Mihalik said, “and we’re just one city, in one state. It’s all over the country.”
Progress Costs Money
Dr. Michael Kilkenny, the physician director of the Cabell-Huntington, West Virginia Health Department didn’t want to focus on doom and gloom in his remarks during the briefing—even though there’s plenty of that in his jurisdiction. In 2015, in the city of Huntington, overdose was the third leading cause of death. Kilkenny’s state as a whole is second in the nation in terms of hepatitis C, and first in the nation when it comes to babies born with Neonatal Abstinence Syndrome.
But, Kilkenny maintains there’s also plenty of work to be proud of. The city’s naloxone program—which focuses on getting the opioid overdose-reversing drug into the hands of first responders and trained community members—appears to be working. According to preliminary data, in 2017 to date, emergency personnel and ordinary citizens are saving more people than the city is losing.
The county’s syringe exchange program, which was the first sanctioned needle program in the state, is seeing meaningful results. Kilkenny reports that injection drug users who frequent the clinic self-report as being much less likely to share needles than when the program first started. In 2015, when the program was in its infancy, 28 percent of the first-time clients of the exchange reported sharing needles. Last-year, 16 percent of the exchange’s first-time clients said they were sharing needles—showing that the clinic is having a positive secondary effect on the injection drug user community, even with the people they hadn’t reached directly before.
And, among drug users who have visited the exchange at least once? Only 4 percent of those people reported sharing syringes.
But, it’s impossible to forget that these initiatives cost money. A lot of it.
The Cabell-Huntington syringe exchange is lucky. The program received federal funding in the form of a grant from the Appalachian Regional Commission—with the promise of matching dollars from the state—but that money is only for one year. Once those dollars dry up, they could be back to relying almost exclusively on private donation to pay the bills.
Even with federal funding there are limitations. While a decades-old ban on federal funding for needle exchanges was lifted by Congress last year, a rule remains in place that bars federal dollars from being used to actually purchase syringes. The money can be used on staffing, administrative and operational costs—but not on needles—a fact that Kilkenny says makes running these programs a big challenge.
The naloxone program, too, has its funding difficulties. Kilkenny estimates that his county’s EMS will respond to as many as 2,000 overdose calls this year alone. And, oftentimes, they pay as much as $50 for every dose of naloxone they administer.
Kilkenny believes in the capacity of local officials and departments to battle this disease. “The federal government can use us,” he emphasized, adding, “we just want you to call on us. Drive some resources down to us and make us strong enough to really affect this public health emergency.”
Additional Funding Isn’t Likely—for Now
When the Trump administration chose to declare a public health emergency without a funding stream, they essentially punted the task of coming up with a federal source of dollars to Congress.
But there are fewer than twenty days remaining in the Congressional calendar for 2017, and almost all of the political oxygen on Capitol Hill is being spent on the Republican tax reform legislation.
That means, it’s extremely unlikely Congress will manage to create that funding stream local officials so desperately want before the year is over.