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Amid plague of opioids, a chasm over how to act

Three years after Congress set aside $60 billion to repair damage from Hurricane Sandy, which claimed 285 lives the previous fall, an effort is building in Washington to set aside $600 million to deal with a more insidious emergency that claimed 26,648 lives nationwide in 2014 and upward of 300 in Erie County alone since then: the opioid epidemic.

But it’s an effort that could fall into the same chasm between Democrats and Republicans that has derailed so many legislative proposals in recent years.

Proof of that can be found in the conflicting comments of Sen. Charles E. Schumer, D-N.Y., and Rep. Chris Collins, R-Clarence.

Schumer came to Buffalo on Thursday to push the emergency anti-drug funding, saying: “Endless Senate speeches and authorization bills won’t mean more beds at treatment centers to curb addiction – only emergency funding and resources to combat this crisis will do that. It’s time for Congress to walk the walk and pass the desperately needed emergency funding that will really make a difference in this fight.”

But when asked to react to the proposal that Schumer was pushing, Collins said: “Throwing $600 million at this problem is not a financially feasible plan for success and is not going to change the underlying factors that have created this epidemic.”

With local police officers responding to a rash of heroin overdoses – including that of off-duty Buffalo Police Officer Michael R. Moffett, 26 – and drug treatment facilities complaining of a shortage of beds and staff, the legislation that Schumer is backing would allocate emergency federal funds to reach localities.

The bill could bring more than $10 million to Western New York, Schumer said on a visit to Horizon Health Services Terrace House, a Buffalo drug-treatment facility.

“I think it’s going to happen,” Schumer said as he stood in front of several Buffalo-area residents whose children had died of opioid addiction. “It’s going to be very hard for people to vote against this.”

‘Destroying’ communities

However, Collins indicated that a more comprehensive and deliberative approach to the problem would be more effective than a sudden infusion of federal funds.

“The heroin and prescription drug problem has been destroying our communities for years,” Collins said. “If we are going to successfully eradicate this epidemic in our communities, we need the cooperation of all levels of government and a comprehensive plan which focuses on improving opioid prescribing practices, providing additional treatment options, and adopting a long term view to substance abuse treatment.”

Nevertheless, Anne D. Constantino, president and CEO of Horizon Health Services, said that additional federal funds would be helpful because local drug-treatment facilities find themselves overburdened with more addicts than they can handle.

For example, at Horizon Village in Sanborn, a 75-bed, long-term residential facility operated by Horizon, there is currently a waiting period of two to three months for admission. The state’s Office of Alcoholism and Substance Abuse Services recently approved 50 new beds in the region, and organizations such as Horizon are submitting bids to develop a facility for those beds, which would be for long-term residential treatment.

Schumer said the legislation he is promoting would set aside $225 million just for drug treatment and prevention “to help places like Horizon.”

It also would allocate $200 million for grants to state and local law enforcement agencies to fund prosecutions, drug courts, enforcement efforts and drug abuse prevention and education programs. That could be important because local law enforcement agencies have been overwhelmed in responding to calls about opiate overdoses, which claimed 23 lives in just 11 days in Erie County in late January and early February.

Schumer said Congress should treat the opioid epidemic as a national emergency, which would allow lawmakers to allocate federal funds without accompanying moves to pay for the new spending.

He said he hopes that the bill setting aside those funds can be attached as an amendment to a bill called the Comprehensive Addiction and Recovery Act, which has widespread bipartisan support and will reach the Senate floor next week.

That bill would allow federal agencies to expand their grants to states, localities and agencies to fight the drug crisis, but does not set aside the funds to do so.

The idea of adding $600 million in federal cash to the anti-drug effort has won support from one key Senate Republican so far: Sen. Kelly Ayotte of New Hampshire, which has the worst per capita opioid problem in the country.

But even if the Senate agrees to set aside the anti-drug funding, it could run into problems in the House, where budget-minded Republicans have, in recent years, been reluctant to set aside emergency funding.

That’s because emergency funding – unlike other new federal spending – doesn’t have to be offset with other budget cuts or new revenues. In other words, it’s borrowed money, and many House Republicans – such as Collins – fear that the government has already borrowed so much money that it will endanger the nation’s financial future.

Local law enforcement sources and those involved in drug treatment also advocate other changes in addition to more funding, including:

• Passing a proposed federal law that would allow nurse practitioners and physician assistants to prescribe Suboxone, a drug that weans addicts off heroin and suppresses the urge to further abuse opiates. At present there is a shortage of doctors federally certified to prescribe the medication.

• Providing addicts who are committed to long-term recovery with life coaches, who can work with them through the ups and downs of staying drug-free.

• Easing insurance company roadblocks when it comes to prescribing costly medications that can block brain receptors that allow the high from opiates to occur.

• Improving case management and establishing more community-based programs to assist addicts after they leave inpatient facilities.

• Mandating training of doctors to avoid prescribing patients into addiction and to spot the signs of addiction.

This wide-ranging approach, treatment experts said, is necessary because, unlike other diseases, drug addiction can take years to overcome and each recovery is different.

“People get better at different rates. In fact the expectation is that people will have periods of activity and inactivity,” Constantino said. “The goal is for people to remain connected for a long enough time for stable recovery and that can take several years. That is something not being talked about that needs to be said.”

In commending Schumer for drawing attention to the epidemic, another treatment community leader said attitudes need to shift from the focus on financial costs to placing the well-being of addicts first.

“One of the issues we have is payment. What insurance do you have? We don’t ask that if someone is diagnosed with cancer or diabetes. We need to stop asking the financial questions first. We need to ask how we can help,” said Jodie L. Altman, director of the Renaissance campus in West Seneca, which maintains 62 beds for people from 12 to 20 years old.

Government response slow

Altman says that when one impediment is eliminated in delivering care to addicts, another often surfaces, such as the resistance by some health insurance companies to paying for medications that reduce the craving for opiates and block the highs the drugs produce.

“Vivitrol is one of those drugs, and a monthly injection costs $1,500, and it cannot be abused,” Altman said. “But the average person can’t afford $1,500 a month.”

With all those changes needed, Avi Israel, whose son Michael took his own life in 2011 while in the throes of opiate painkiller prescription addiction, said he was angry at the slow pace of every level of government in tackling the epidemic.

Noting that President Obama recently asked for more than $1 billion in new funding in his fiscal 2017 budget to combat opiate addiction, Israel said: “The president took seven long years to ask for an appropriation.”

The $600 million infusion Schumer is seeking – which was originally proposed by Sen. Jeanne Shaheen, D-N.H. – would get more money to localities, perhaps as soon as this summer, if Congress approves, which is several months sooner than the money Obama is seeking. And that’s good news to Israel, who said:

“We need some action right now.”

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