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White House Opioid Commission Report Echoes NJ Anti-Addiction Efforts

Gov. Christie said president welcomed recommendations, but Trump still mum on details

christie trumpsplains His Candidate's 'Riot'
Credit: WHYY NewsWorks

Gov. Chris Christie’s White House commission has issued many of the same recommendations to combat opioid addiction nationwide that reflects work already underway in New Jersey.

After several delays, the President’s Commission on Combating Drug Addiction and the Opioid Crisis released an interim report early last week that calls on federal officials to work with state and local leaders to expand treatment capacity, particularly for Medicaid patients, improve education for prescribers, boost access to medication-assisted treatment programs and the overdose antidote naloxone, and strengthen prescription databases nationwide.

Christie stressed that there is much work remaining before the panel is scheduled to disband in the fall; the commission was formed by presidential executive order in March. But the governor also said many of the recommendations can be implemented quickly to help reduce opiate deaths, which now claim 142 people each day. To start with, the commission urged President Donald Trump to immediately declare addiction a national emergency, something that is directly within his control.

“You, Mr. President, are the only person who can bring this type of intensity to the emergency and we believe you have the will to do so and to do so immediately,” states the report, which Christie said he wrote much of himself. “Our nation is in a crisis. Your Executive Order recognized that fact. The work of your Commission so far acknowledges the severity of this national problem.”

Good response from president’s team?

At an event late last week in Trenton, Christie said reaction to the report from the president’s team was “universally very good,” and that they found the recommendations to be “strong.” Christie added, “I think you’ll see many if not all of them done by the president,” but noted the decisions might take place “over the course of the weeks coming forward.”

But the White House had yet to act on any of the recommendations by Wednesday and had hardly acknowledged the report at all. At a press event on the opioid crisis late Tuesday afternoon, Health and Human Services Secretary Tom Price and other Trump staff members touched on several of the commission’s recommendations — tightening prescribing practices, expanding access to naloxone, and tweaking privacy laws to enable more effective treatment — but didn’t mention the commission or its work. In fact, Price suggested a national emergency declaration might not be necessary.

Trump himself thanked Price for his efforts on the issue, but didn’t reference the commission in his remarks. The president acknowledged addiction had become a “tremendous problem in our country” that affects all ages, races, and social groups; he also promised “we’re going to take care of it.” But the approach he outlined shared little in common with the Christie report.

A law enforcement approach

Instead, Trump stressed the need for stronger law enforcement – both to prevent drugs from entering the country, especially along the southern border, and to prosecute those charged with drug crimes. He also called for a greater focus on prevention, especially among children. “If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off,” he said, stressing the need to tell kids that drugs are “not good for you.”

Addiction and recovery experts underscore that addiction is a disease — a notion Christie has embraced — and arresting those with substance-use disorders is not likely to help them get and stay clean. (In fact, Christie has prioritized efforts to expand “drug court,” a system that enables nonviolent offenders with addiction issues to enroll in treatment instead of jail, and has created what may be the nation’s first “treatment prison” with a suite of anti-addiction services.)

A 420-page report released in November by the then U.S. Surgeon General Dr. Vivek H. Murthy outlined a more modern approach to recovery, with a focus on evidence-based treatment and medication-assisted treatment, or MAT, which uses opiate-replacement drugs like Suboxone to help reduce an addict’s craving. Murthy also said that prescribers must be held more accountable and suggested addiction be considered a public health emergency.

In line with surgeon general’s report

The findings of the Christie-led commission echo many of the recommendations in Murthy’s report. The group urged the president to commit federal funds to expand MAT and help track the outcomes nationwide; to help increase treatment capacity, in part by changing a Medicaid rule that now prevents these funds from paying for care in larger facilities; and to assist states in coordinating their opioid prescription databases and sync these with the Veterans Administration system. (Incidentally, the VA embraced the report and shared its own best practices in a public release.)

In addition, the commission called on the federal government to work with state and local entities to expand access to naloxone, or Narcan, at local pharmacies and ensure medical and dental professionals are better trained and regularly updated on safe-prescribing practices. The report also urged better coordination among federal agencies seeking to prevent drug trafficking and recommended testing prevention messages to identify the most effective.

“We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals in every state in our nation,” the commission wrote, urging the president to work with the National Institutes of Health to find new treatments for both substance-use disorder and pain itself. “The nation needs more options to treat those already addicted and can help to prevent addiction in the first place by avoiding the prescription of opioids.”

Many of the tools outlined in the commission’s report are already at work — or under discussion — in the Garden State. With help from the Legislature, the state’s Prescription Monitoring Program has become stronger and is now connected to systems in more than a dozen other states. Narcan is distributed to first responders and available at a growing number of drugstores, and efforts to improve access to Suboxone and other MATs are underway.

In addition, Christie is seeking to add nearly 900 treatment beds to accommodate those with mental health and addiction issues, a common dual-diagnosis. And in February, the governor signed a law that places a five-day limit on opioid and other addictive prescriptions for new acute-pain patients, considered the strictest law of its kind nationwide.

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