Lack of Funding Limits County Officials' Ability to Fight Substance Abuse Crisis

WASHINGTON — Drug overdoses are now the leading cause of accidental death in the United States and heroin overdoses account for more than half of those deaths.

“Counties are the boots on the ground” in the fight against the substance abuse epidemic.

That’s according to National Association of Counties President Sallie Clark, who kicked off the first of two workshop sessions dedicated to substance abuse at NACo's 2016 Legislative Conference in the nation’s capital, which continues this week.

Given the number of jails, 911 call centers, mental health facilities and public health facilities that are financed and operated on the county level, Clark, a commissioner in El Paso County, Colorado, views county governments as the “front lines of the crisis” and acknowledges that it will take “an all-hands-on-deck approach to improve the health and safety for those at risk.”

In keeping with this call for collaboration, NACo announced on Monday that it is joining with the National League of Cities in an effort to fight substance abuse in local communities. The two organizations will create a joint national task force made up of city and county leaders from across the country. “This new initiative will build on our efforts to mitigate this crisis and strengthen the safety and security of our neighborhoods,” Clark said in an announcement.

The need for greater collaboration was a theme that ran throughout both conference sessions on substance abuse. “More than ever we have to be in this together,” said Mary Lou Leary, deputy director of state, local and tribal affairs for the Office of National Drug Control Policy, calling for cooperation across various levels of government.

Beyond multi-level government collaboration, many county officials speaking on the issue emphasized the need for bringing multiple sectors and disciplines into the broader conversation. The era of assuming that responsibility for drug issues falls solely on the shoulders of police departments and prison systems seems to be over.

County officials expressed widespread consensus throughout these discussions that this epidemic needs to be thought of as an issue for public health systems, mental health systems, the education sector, the private sector and others.

“This epidemic can’t be addressed by the justice system or the health system alone but requires a collective and coordinated effort,” said Joan Garner, a commissioner in Fulton County, Georgia, which includes Atlanta.

Medical professionals—particularly those who prescribe painkillers—are one group that must be included in the dialogue on substance abuse prevention measures.

According to current data, painkillers are so heavily prescribed that, if the total number of prescriptions were to be added up, there would be enough to give one to every adult in the United States, a fact cited by Michael Botticelli, the director of national drug control policy, during Monday morning's conference session.

“Doctors get training on pain management in medical school and are taught to prescribe opioids. But they need more education about the appropriate amount to prescribe,” Leary noted, adding that “oftentimes, the medical community underestimates the addictive potential of prescription painkillers.”

In the same vein, Dr. LaMar Hasbrouck, a physician and director of the National Association of County and City Health Officials, argued that simply educating physicians doesn’t go far enough. The patient, as the consumer, must be made aware of the risks of taking this type of medication.

Going beyond the "why" of collaboration and getting into the "how," panelist Thomas Carr, executive director of the Washington Baltimore High Intensity Drug Trafficking Area, encouraged the county officials in attendance to make the exchange of data and information across sectors a priority.

“All of us have to work together to tear down the silos,” Carr said, directing his remarks to the practitioners in the room. “Law enforcement, you have to share information with public health. Public health, you have to share information with law enforcement . . . get the information going back and forth.”

Mike Nerheim, the states attorney in Lake County, Illinois, presented his county, which is located north of Chicago, as an example of another way to prioritize collaboration. He helped form the Lake County Opioid Initiative, which now has 300 members that represent a diverse range of backgrounds–from behavioral health professionals to police officers.

One of the first projects LCOI undertook was to train and equip police officers with Naloxone, a drug that can reverse the deadly effects of an overdose. Since this program took effect at the end of 2014, police officers have used Naloxone to save 56 lives, according to the county.

However Nerheim, along with many other county officials in attendance, acknowledged that Naloxone-based initiatives alone are not enough to fully tackle this crisis. Nerheim emphasized that “the police can save a life, but if that person isn’t put into treatment immediately, that is only a temporary solution.”

County officials agreed that, while evidence-based treatment and prevention are the most important part of tackling the crisis, they are also the weakest links in the current response.

Treatment is more complicated than giving someone a dose of Naloxone and sending them on their way. In his panel presentation, Carr cautioned county officials that treatment “has to be immediate,” and added that treatment takes time. “If you’re trying out two-month programs, forget it. You need a minimum of six months for treatment.”

Unfortunately, many counties don’t have the infrastructure needed for evidence-based treatment, let alone the funds necessary to manage these extensive programs. One audience member in the second part of Monday’s discussion, Wendell Bostick, a commissioner in Curry County, New Mexico, explained to the panel that the wait time for a bed in a treatment facility in New Mexico starts at six weeks, well beyond the “immediate” response Carr recommends.

Matthew Bell, commissioner for Weber County, Utah, said he faced a similar problem. “We all know treatment is the best option,” he acknowledged. But, when discussing the treatment options in Weber County, Bell added, “we just don’t have enough bed space.”

The question of how to finance these treatment options at a scale that matches the current epidemic remains unanswered. The Obama Administration has made this issue a priority by proposing that $1.1 billion of the budget be allocated to treatment and prevention of opioid addiction. Until funding for these programs is found, counties will continue to operate with treatment budgets that simply do not match the level of need.