Funding a concern in N.M. fight vs. opioids
Local experts: Cuts will hurt ability to expand tactics, as recommended by panel
A commission appointed by President Donald Trump to study drug addiction and the rampant opioid epidemic that has become a national tragedy recently recommended more than 50 strategies to help curb the crisis — everything from prescribing and treatment guidelines to regulating pillmaking machines and expanding treatment in jails. Many of them are already in use in New Mexico.
What the commission didn’t do was determine the costs of these efforts and urge specific federal allocations.
“Without funding,” said Dr. Wendy Johnson, medical director of La Familia Medical Center in Santa Fe, “there is no meaning.”
Raising further concerns among advocates and health care professionals working to curb opioid abuse in New Mexico is the Trump administration’s attempts to cut the Medicaid program.
Data from the Kaiser Family Foundation show that roughly 30 percent of the opioid addiction treatment drug buprenorphine prescribed in the state was paid for by Medicaid in 2016.
“In the context of all of the cuts and all the ways [Trump] is trying to undermine the Affordable Care Act, and all the cuts to Medicare and Medicaid, Johnson said, “… those things will do much greater harm than anything the list of 50-plus things will do.”
New Mexico, second in the nation in per capita opioid overdose deaths just three years ago, fell to eighth in 2015 after the epidemic gained a tighter grip in other states, and likely fell much further in 2016, health officials said last week.
But that isn’t because the state has seen rapid improvement.
The number of overdose deaths in the state remained at about 500 in 2015 and 2016, a rate of 24.8 deaths per 100,000 residents — compared to a national rate of 20 per 100,000 people. The U.S. Centers for Disease Control and Prevention on Friday released preliminary national data showing the number of deaths nationwide surged last year by more than 17 percent over 2015, with drug overdoses killing about 64,000 Americans.
Drug overdoses are now the leading cause of death for Americans under 50, the agency reported.
That’s particularly true in many areas of New Mexico. Santa Fe and Taos counties have overdose death rates well above the state average, both around 32 deaths per 100,000 residents. San Miguel County’s death rate is even higher, at 43.4 deaths per 100,000, and Rio Arriba County, at nearly 90 deaths per 100,000, has the highest death rate in the nation.
While Trump has made no immediate request to Congress since the commission’s report to increase funding for initiatives to tackle the opioid crisis, there has been some momentum among lawmakers. A group of mostly Democratic senators, including New Mexico Sens. Martin Heinrich and Tom Udall, recently introduced a bill that would provide nearly $45 billion to states for addiction treatment, research and other efforts.
One of the strategies recommended by Trump’s opioid commission is equipping all law enforcement officers with the opioid overdose reversal drug naloxone, best known as the brand name Narcan. New Mexico was the first state to launch such an initiative. The state also allows pharmacists to distribute the lifesaving drug without a prescription.
Gov. Susana Martinez signed a bill into law earlier this year that requires local and state law enforcement agencies to equip officers with Narcan kits and provide training. It also requires jails and prisons to offer inmates with a history of drug abuse two such kits upon their release, as well as training on how to use them.
The measure was heralded as cutting-edge legislation. But, like the federal commission’s recommendations, it included no funding to carry out the requirements.
Hundreds of people gathered in Santa Fe last week to discuss the state’s response to the opioid crisis, including the state’s leading physicians, advocates and legislators. State epidemiologist Dr. Michael Landen told the crowd that while overdose death rates have been relatively stable since 2008, “we still have a lot more work to do.”
Democratic Rep. Deborah Armstrong of Albuquerque, chairwoman of the Legislative Health and Human Services Committee, said the summit helped set priorities for lawmakers.
“I’ve seen the wheels turning for a number of legislators, who I imagine are going to try and get bills drafted,” she said.
She said she wasn’t optimistic about new state funding to cover the costs of solutions, but added, “If the federal funds flow, we could do something. … So it’s important to know our priorities.”
Other recommendations by the Trump commission received mixed reviews from advocates and health care professionals in New Mexico.
One recommendation was the widespread implementation of a screening tool — called Screening, Brief Intervention and Referral to Treatment — to identify students in middle school, high school and college who are at risk of substance abuse. Since 2003, the federal Substance Abuse and Mental Health Services Administration has partnered with a handful of states, including New Mexico, to implement the screening system and train people how to use it.
Shelley Mann-Lev, founding director of the Santa Fe Prevention Alliance, was in favor of the possibility of expanding use of the screening tool.
However, she said, the program requires access to intervention and treatment services to be effective. And while some communities in the state have such resources available, Mann-Lev said, “Many don’t.”
According to the presidential report, only five of New Mexico’s 33 counties had an opioid treatment facility in 2016. That same year, the report said, there were 12 counties without a medical professional authorized to prescribe a key opioid treatment drug called buprenorphine.
Local advocates lauded the commission’s recommendation to expand medication-assisted treatment for opioid use disorder within prisons, and they emphasized the importance of medical treatment over criminal punishment.
Johnson, for instance, said she appreciated the commission’s support for drug courts but thinks it should have gone further, recommending the decriminalization of nonviolent drug possession offenses.
Lauren Reichelt, Rio Arriba County’s health and human services director, agreed, saying the priority should be on health issues related to opioid abuse, rather than law enforcement and penalization.
“If we continue to approach this as a law enforcement issue instead of a health issue,” Reichelt said, “we’re going to continue to exacerbate the problem.”