New funding for community-based providers who can treat outpatients with addictions while these individuals continue with work, school, or family life. More housing and job training for New Jersey residents with — or without — drug dependencies. And better data and real-time analysis of the state’s investments to address these concerns.
These elements form the backbone of Gov. Phil Murphy’s approach to addressing New Jersey’s opioid epidemic, which he outlined yesterday following a tour of the Rescue Mission of Trenton, an agency that helps individuals with homelessness, addiction, and other challenges. He was joined by state health commissioner Dr. Shereef Elnahal and human services commissioner Carole Johnson, both of whom were sworn in Monday, as well as Sen. Shirley Turner (D-Mercer) and other officials.
Murphy also provided some specifics on the $100 million for opioid programs in his budget proposal for fiscal year 2019, which starts in July: $56 million for front-line prevention, treatment and recovery programs; $31 million for job training and to address social risk factors like homelessness; and $13 million to improve data collection and other state infrastructure.
The Democratic governor offered little detail on how his plans would impact initiatives launched under former Gov. Chris Christie, a Republican who made addiction a highly public priority in his final years — and who appeared in a major televised ad campaign to raise awareness about the issue. Christie announced plans for $200 million in new anti-opioid investments in September, four months before he left office.
Half Christie money not spent
But Murphy said less than half of the money Christie outlined had actually been spent, and that his priorities would be “guided by facts and data,” not personal preferences. His budget proposal also seeks to suspend other Christie-era opioid programs, some of which were funded by shifting dollars from other accounts.
“If this were a baseball team, you are seeing us evolve from making decisions based on a gut feeling to Moneyball,” Murphy said, referring to the book and movie of that name that explored how detailed statistical analysis can be used to build a successful baseball team. “Let’s figure out exactly what is working, what is not working, in real time,” he said.
While he did not name Christie — whom he praised during his inaugural speech for his leadership on addiction — Murphy made clear his administration would take a different approach. “If you’re a television production firm, you’re going to be disappointed. Because that’s not the way we’re going to go,” he noted.
Opioid addiction killed close to 2,000 New Jersey residents in 2016, the last year for which there is solid data; tens of thousands of New Jerseyans seek treatment each year. The state took a number of significant steps in recent years to reduce the availability of highly addictive pain pills, increase access to overdose reversal agents like Narcan, expand options for Medically Assisted Treatment (which involves the use of prescription drugs to curb cravings and is now considered the gold standard of care) and reduce the stigma around the disease.
But serious challenges remain. The growth of powerful synthetic opioids like fentanyl is driving up the death toll, real barriers to treatment remain, and the cost of care continues to escalate — and at a time when Republicans in Washington D.C. are looking to reduce public spending by trimming federal funding for healthcare programs.
Critiquing the Christie approach
While Christie received widespread praise for his work on addiction and recovery, some experts have said he was overly focused on certain approaches — like expanding access to inpatient care, calling for the addition of 900 psychiatric hospital beds or requiring long-term insurance coverage for residential treatment — when the real need was for more community-based outpatient options.
Murphy’s announcement yesterday suggests a “very exciting change in direction,” said Roseanne Scotti, state director for the national Drug Policy Alliance. For years, advocates have struggled to get good, county-based information on what treatments are available, which providers accept Medicaid, and other key metrics. “What we need here is some real strategic planning,” she said, “and a focus on how to make things better and to get more out of the resources we have.”
Elnahal, with the Department of Health, said the goal is to combine data collected by multiple state agencies to “identify, expand and reinvest” in the best efforts; all strategies are under consideration, including Christie-era efforts that are working. The attorney general’s office has launched a website with some data, but Elnahal said more can be done to track the epidemic in real time and deploy responses immediately. “This is an evidence-based strategy that puts the tools of public health to work,” he said.
The governor said most of the money he allocated to support community-based services, some $38.5 million, will be used to “develop a coordinated and comprehensive approach” to expanding and improving access to this front-line care, as well as MAT services and peer-support recovery programs, a model also embraced by Christie. These efforts will target some of the most vulnerable citizens, Murphy said, including pregnant women, veterans, and individuals who cycle in and out of jail.
Dealing with risk factors
Efforts to address social risk factors, like homelessness and unemployment, are critical to maintaining sobriety or reducing drug use in the first place, Murphy noted. To impact these underlying social determinants, his administration allocated $12 million to fund supportive housing for high-risk families — the Keeping Families Together program, another Christie priority — plus $5 million for housing for individuals with substance use issues, and $5 million for employment training and support.
Johnson, with the Department of Human Services, agreed these investments are critical and noted the fiscal year 2019 budget also includes provisions to expand public transportation and reduce the tax penalty for low-income families. And these programs benefit all residents, not just those facing addictions, she stressed. “The governor’s budget is a road map for recognizing that economic health and access to services, transportation and job opportunities supports the health and wellbeing of all residents,” she said.
Scotti, with the Drug Policy Alliance, said this focus also represented a new and welcome change. “Having a willingness to look at this in and of itself is important and exciting,” she said.
In addition, the proposal calls for $13 million to expand program infrastructure and data-collecting capacity; $10 million of this is dedicated to improving addiction-related programs, including supporting the development of electronic health records among community providers. (Experts said some agencies still track medical data on paper.)
“It doesn’t sound exciting to the average person, but it is so critical,” Scotti noted. “He (Murphy) is really looking at this holistically.”