President Trump recently vowed to “spend a lot of time, a lot of effort, and a lot of money” combatting America’s opioid epidemic, but — at least so far — he hasn’t followed through on his pledge. From skimping on federal resources to pushing to repeal the Affordable Care Act to allowing Attorney General Jeff Sessions to jump-start a war on drugs that’s been failing for decades, Trump has done next to nothing to address a public health disaster that’s been especially bad for many of the states that put him in office.
It doesn’t have to be this way.
In late July, Trump received a blueprint for attacking the opioid crisis from Chris Christie, whom he appointed in March to lead a special White House commission on the problem. While the New Jersey governor is wildly unpopular in his home state, with an approval rating of just 15 percent as recently as July, he’s made the opioid crisis his signature issue.
Christie wants Trump to make treatment drugs like Suboxone more widely available, to step up enforcement of rules that require insurers to provide equal coverage for drug treatment, and to enable more first responders to carry the overdose antidote naloxone. He also asked Trump to declare a national state of emergency, which would unlock more than $1 billion in disaster relief money and expedite several key rule changes at the federal level, including rolling back a Medicaid policy that restricts access to inpatient rehab for low-income people.
Many of the things Christie wants Trump to do have already been tried in New Jersey. In January, the governor declared his own state-level emergency, then promptly signed legislation that requires insurers to cover a minimum of six months of addiction treatment. Christie has tried to find alternatives to incarceration for low-level drug offenders and reduced the stigma of addiction by talking candidly about how it has affected people close to him.
Now, for better or worse, Christie is in a position to influence Trump. To learn about the governor’s successes and failures — and what his experience means for Trump’s national response — VICE News spoke with people across the Garden State, including treatment providers, social workers, policy experts, and pain patients. (Christie himself declined our request for an interview.)
Even his harshest critics concede he’s at least trying to help, and the course of action his commission proposed to Trump left experts impressed. At the same time, however, Christie’s detractors say his response to the opioid crisis in New Jersey has been plagued by bureaucracy, underfunded, too focused on supply, and too little too late.
There are no simple answers to the opioid crisis
For the most part, New Jersey advocates offered a mix of praise and criticism. At the very least, they said, Christie seems to understand that drug users should receive treatment instead of time behind bars. (A former federal prosecutor, Christie has long been a proponent of drug courts, which try to divert people with addiction problems from the criminal justice system, and he also created the first addiction program for New Jersey inmates.) Trump, on the other hand, recently declared, “Strong law enforcement is absolutely vital to having a drug-free society.”
“[Christie] wants to do something,” said Jass Pelland, clinical director of Hunterdon Drug Awareness Program, a nonprofit that offers addiction treatment in the area northwest of Princeton. “I do believe that. But I think he’s in a quandary of what to do. Sometimes I think people look for simplistic answers, and it’s not any one thing.”
“We’re not going to come up with a big, new, national drug policy.”
Christie drafted the recommendations to Trump with Massachusetts Gov. Charlie Baker, North Carolina Gov. Roy Cooper, former Rhode Island Rep. Patrick Kennedy, and Dr. Bertha K. Madras, a Harvard Medical School professor who specializes in addiction biology. The plan isn’t a direct copy of what he did in New Jersey, partly because it’s largely focused on getting Trump to commit more federal resources as quickly as possible. But to decide which resources to dedicate and how, experts said it’s worthwhile for Trump to look at the states.
“We’re not going to come up with a big, new, national drug policy,” said Frank Greenagel, a Rutgers professor and social worker who specializes in addiction treatment. “We’re going to look at states that are doing a good job and follow them.”
A painkiller crackdown could make the epidemic even worse
In addition to New Jersey, Maryland, Massachusetts, Alaska, Arizona, Virginia, and Florida have all declared some form of public health emergency in response to rising overdose deaths. These states have been able to tap reserve funding, increase the availability of naloxone, and, most commonly, restrict opioid prescriptions.
Since many new heroin users — 80 percent, according to an estimate cited by Christie’s commission — get hooked after misusing pills, reducing the supply of pills has been central to Christie’s approach to the opioid crisis as governor, and it’s a key component of his commission’s recommendations to Trump.
Earlier this year, Christie enacted the nation’s toughest restrictions on painkiller prescriptions, limiting new patients to a five-day supply. The Justice Department under Sessions has already made targeting doctors who illegally dispense pain pills a priority, but Christie’s commission wants Trump to go even further, requiring new training for opioid prescribers and increasing information sharing between state prescription monitoring programs.
Christie’s report to Trump cited the statistic that “four out of every five new heroin users begin with nonmedical use of prescription opioids,” but data also indicates that clamping down on prescriptions not only fails to stop overdoses but actually causes more deaths, since people who can no longer get pills end up switching to heroin and fentanyl. It also makes life miserable for chronic pain patients who need medication in order to function.
“It’s typical,” said Dennis Kelsey, a retired New Jersey dock builder who takes pain medication for multiple injuries he sustained over 25 years the job. “They think they’re doing the right thing but they’re actually making it tougher for people with legitimate problems. There are people in actual pain who aren’t abusing this shit.”
Experts agree the priority for states and the federal government should be getting more people access to medication assisted treatment, where doctors prescribe buprenorphine (commonly known as Suboxone or Subutex) and other drugs that ease cravings for opioids and reduce the risk of relapse. Last year, a Surgeon General’s report found that only about 1 in 10 people with addiction problems receive any type of specialty treatment. Under federal law, only 32,000 doctors are authorized to prescribe buprenorphine while nearly 1 million can prescribe painkillers like OxyContin. Christie has urged Trump to reevaluate the restrictions on buprenorphine, while also pushing for expanded prescription monitoring programs designed to shrink the pill supply.
Fighting the opioid crisis will be very, very expensive
Of course, fighting the opioid epidemic will cost money — and Trump hasn’t done much to ease the burden. In April, the Department of Health and Human Services announced a plan to split $485 million worth of opioid crisis grant money among all 50 states. That’s a relative drop in the bucket; Ohio alone now spends nearly a billion dollars annually on opioid-related initiatives. (Last year, Obama signed the 21st Century Cures Act, giving states $1 billion over two years to address the opioid crisis and other drug problems; CDC researchers have put the total annual cost of the epidemic at more than $78 billion.)
With New Jersey in dire financial straits — the state could face a budget deficit of $3.6 billion within six years — Christie has relied heavily on federal money to fight the opioid crisis. New Jersey expanded Medicaid under the Affordable Care Act, adding health coverage for nearly 500,000 people in the state, and increasing the number of people who received taxpayer-funded addiction treatment from roughly 3,000 in 2013 to 20,467 last year. It’s difficult to overstate how important Medicaid has been to opioid response so far. The program now covers roughly 11 million low-income people in 31 states, and about 29 percent of them have mental health or addiction problems.
Frank Jones, founder of Recovery Reform Now, a New Jersey-based nonprofit, expressed the widely held view that the GOP plan to repeal and replace the healthcare law would “have a devastating effect, not just in New Jersey but across the country.”
Christie has also tried to make private insurers pay for treatment. His commission called for Trump to enforce the Mental Health Parity Act, a federal law routinely flouted by insurers that requires equal coverage for drug treatment. Jones said more government oversight is crucial, since people with addiction problems don’t have the wherewithal to take on huge corporations when they are denied access to care.
“People have sued, but the problem is most people in recovery are looking at this as David and Goliath,” he said. “They’re like, ‘Who am I going to sue? Aetna?’ The [insurance] carriers absolutely know that, and they take advantage of it.”
“They do a good game of talking, they do a lot of reports, but when it comes to actually funding things, there’s nothing there.”
Greenagel, the Rutgers professor, has lambasted Christie’s handling of the opioid crisis, describing his approach to funding as “a lot of robbing Peter to pay Paul.” He pointed to a Christie initiative that set aside beds for young people seeking inpatient addiction treatment, explaining that it doesn’t create any new space at treatment centers, so older people not covered by the policy face longer waits to get help.
“They do a good game of talking, they do a lot of reports, but when it comes to actually funding things, there’s nothing there,” Greenagel said of Christie’s administration. “That’s such an old political trick to say you support something and then there’s no appropriation, no money set aside for it. That’s something they’ve done over and over again.”
The same could be said of the Trump administration. The top recommendation from Christie’s commission to Trump was to declare a national state of emergency. On Aug. 10, while Christie was away from New Jersey on vacation with his family and Trump was at his country club in Bedminster, less than an hour’s drive from the governor’s mansion in Princeton, the president announced his intent to make the declaration. Nearly a month later, he still hasn’t filed the paperwork to make it official.
Keegan Hamilton is U.S. editor for VICE News.