The $1.1 billion that New Jersey will receive over 18 years to treat and prevent opioid addiction presents an extraordinary opportunity to manage a public health menace.
So far, the state’s efforts have been disappointing — not least to the state Opioid Recovery and Remediation Advisory Council, which developed criteria for the allocation, only to be ignored by lawmakers the night before they submitted the budget for then-Gov. Phil Murphy to sign in June. The spending plan included a $45 million opioid fund diversion to four hospitals.
As a longtime researcher of state public policy, I’ve concluded that New Jersey’s style of governance has to go. The state needs to rise above its reputation for politics first, good policy last — if at all. Fortunately, the use of the national opioid settlement by the states finally is being closely monitored and evaluated, and that shows promise.
The accountability effort involves Johns Hopkins University and KFF Health News. Oversight is by a tracking project, Payback, that reports expenditures across jurisdictions.
Transparency is at the core of the job.
Payback’s reporting system will create incentives to lessen the political pressures and encourage New Jersey to turn to best policy and practice to prevent and treat opioid addiction.
Indeed, the undertaking bodes well for the solid use of at least $50 billion in opioid settlement funds across the country.
Johns Hopkins University is doing a good deal more, too. Its Center for Mental Health and Addiction at the Bloomberg School of Public Health identifies and publicizes innovations from around the country. This is a massive project, highlighting what works and what doesn’t, and why, and suggesting program ideas to weigh for one’s own state or jurisdiction. States, local governments and tribes have access to evidence-based practices that can help address their most critical issues.
The center hosted a program, “Innovations in Opioid Settlement Fund Spending,” that featured a representative from the National Black Harm Reduction Network, two county-based managers from North Carolina, Minnesota’s public health administrator and a representative from New York. Included was a report from a Georgetown University project that is closely monitoring federal challenges — clearly not an assignment for the faint-hearted.
The panelists offered eye-opening perspectives on effective practices and the rationales and operating principles behind them. New Jersey should pay close attention.
A major focus was racial equity and transparency on decision making. Recognizing that previously marginalized populations can be hard to reach and wary, some jurisdictions made gains by relying on outreach staffers who were more likely to be accepted by those who needed help. Previously, such “funnels” had not existed.
Innovations also included using people who overcame addictions — who bring the value of lived experience — to show those who are struggling that they wouldn’t be penalized for accepting care.
One simple proposition sat well: Listen to people with addictions and deliver on your promises, and seek feedback from participants.
Jurisdictional lines — and authority — are too frequently barriers to doing the work efficiently. In Minnesota, one fiscal host works with partners to decide how to distribute funds and work together.
Another goal is to create wraparound programs, with services in one place. One state was particularly successful with reentry for women prisoners, who are 50 times more likely than men to die from overdoses after releases, according to an Oregon study.
North Carolina is working to reduce addiction’s stigma to prevent discrimination and prompt users to seek treatment. Assuring confidentiality was essential, and so innovations in communication — information by email and a website — is the preferred method for those who fear the consequences of contact.
With 600-plus rural communities, moreover, North Carolina also gathered information on how to meet their needs, which were decidedly different and more difficult to address than in cities.
Most striking, in my judgment, is Minnesota’s collaborative approach, which is as creative as it is unusual — and needed in a state where prospects for success were bleak. With only $2.7 million slated for 18 years, the state’s public health officer eliminated county lines, directed $90,000 to school districts to reach the youngest population at the elementary level and created grant programs for secondary schools. Both those initiatives aimed at early prevention.
Getting people with addictions into consistent treatment is still a significant challenge, and Minnesota set up 4,000 emergency medical service workers as trusted links to treatment in 23 counties. The workers functioned as a secondary — and often primary — support system.
It’s budget season in New Jersey, and the Legislature is conducting hearings on a $60.7 billion proposed spending plan for the fiscal year that starts July 1. New Jersey’s new governor, Mikie Sherrill, has committed to transparency and improving government processes, and there is every reason to expect that our state’s approach to its opioid challenge will be front and center on the governor’s admittedly heavy agenda.
After all, we have to do better.
We must establish programs with input from those with expertise and commitment to meeting the states’ critical needs in the treatment and prevention of opioid addiction. And not least, we must establish the community’s trust in government.
