“I Must Be A Bad Person Because I Use Drugs”

I attended a press conference today at Damon House in New Brunswick, NJ today where Congressman Frank Pallone announced a package of bills that he would be introducing to the floor of the House of Representatives on Monday. His bills address heroin and opiates and not only provide some new laws and programs, but also real funding for existing programs. I’ll provide my reaction to those proposals in a future piece. Mr. Pallone also acknowledged the pioneering work of my former boss and mentor, Lisa Laitman. Ms. Laitman spoke about the Rutgers Recovery House and the need to continue to provide recovery support services. Joel Pomales also spoke at the press conference about his own addiction and recovery. I was immensely pleased with his speech, and he has agreed to let me publish it here (with a few edits). I’ve known this young man for a few years, and I’m pleased to call him a friend and colleague.

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12004755_830009683785119_1444082530848246478_nMy name is Joel Pomales and I am a recovery advocate here in the state of NJ. I am an advocacy leader with NCADD-NJ and YPR-NJ. I am also a person in long-term recovery since July of 2011. Which means I have abstained from using alcohol as well as all other illicit substances. Recovery for me also means replacing old negative attitudes and behaviors with positive healthy new ones.

Recovery was the solution to my problem and I didn’t know it existed for a long time. This is because I was misinformed and uneducated on Substance Use Disorders (SUD). It was not until I was in treatment for the second time at 25 years old that I learned that I had an illness that needed to be treated. For most of my life I thought drugs are bad, people who use drugs are bad, and I must be a bad person because I use drugs.

A big part of addressing the epidemic our society is facing today is education on SUD across the board, from medical professionals, to elected officials, law enforcement, community leaders, educators, parents and students.

Now I was asked to come share a bit of my personal experience and also talk about the need for expanded access to treatment and recovery support services. One of the major problems with access to treatment is the lack of parity we face with insurance companies not providing necessary coverage for treatment. My first time in treatment I was 15 years old. The health insurance my family had only covered me for 8 days out of the recommended 28 day treatment stay, surely not enough to treat my illness adequately. When I was discharged I was told to go to 12-step meetings and was provided with no other recovery support services. I maintained recovery for 40 days and relapsed.

I wish there had been a recovery high school for me to go to rather than my old school. I wish there had been a recovery community center that I could have connected with to help me in my recovery. But there wasn’t.

I was introduced to recovery again 10 years later. Unfortunately, during those ten years I went on to get arrested nine more times. I was arrested twice before my first stay at treatment. I was never arrested for anything other than either possession or possession with intent to distribute. The distribution came from me having to support the amount I was using. I was never arrested for a violent crime. Not assault, not theft or burglary. Nothing other than drug charges. Not once during my many arrests was the option given to me to go to treatment. Never the option, let alone was it ever even suggested. It was always fines, probation, or serving time in the county jail.

We need to continue moving toward treating this illness as a public health issue rather than criminal justice issue. I was a sick person who needed treatment, not a bad person who needed punishment.

There are a few major problems we need to address, I touched on insurance parity and SUD education. We also need oversight of treatment facilities to ensure quality care is being provided, this issue doesn’t fall solely on insurance providers. A major issue we face is on the back end here. The majority of individuals who are in treatment at this very moment, easily 70%, have already been to treatment before. Which means they are either not receiving appropriate treatment, or they are not being provided the recovery support they need when they leave. We need to move towards a recovery oriented system of care.

The length of inpatient treatment needs to be increased, and we need long term aftercare programs combined with recovery housing for individuals for up to one year. The acute care model of treatment needs to be abandoned for a long-term care model which is going to empower individuals to sustain long term recovery form their illness.

11988679_1680350598867653_7284280807196407630_nWe need recovery housing for individuals. We also need recovery high schools in every county. We need recovery community centers, where individuals will be provided with services which will equip them with the tools to sustain long-term recovery.

And lastly we need to address the stigma associated with this illness. We need an entire shift in public perception. It is crucial for people to know SUDs are an illness and not a behavioral or moral issue. We all need to work together: law enforcement, community members, insurance companies, and treatment providers. Once we have people properly educated on this illness, and when people have access to treatment as soon as they need it, once we have recovery become part of the culture and a part of society, then you will see a major shift in the epidemic we are facing. We need people in the public eye living and promoting drug free lifestyles, making it attractive, making it cool, and we will see change.

The American Heroin Epidemic, Volume I: The Pharmaceutical Industry

Sam Quinones’s Dreamland was published by Bloomsbury in 2015. It provides a complete history of the opiate epidemic and examines the roles of the medical industry, Big Pharma, drug traffickers, law enforcement, drug users, their families, and the government. Last month, Bloomsbury gave me permission to reprint a chapter from his book on the History of Heroin. A central theme of Dreamland is the collapse of American towns and the sense of community. Mr. Quinones was born in Claremont, CA and earned his BA in economics and American history from Berkeley. He wrote for the LA Times from 2004 to 2014. Dreamland is his third book. I interviewed him over the phone on December 14, 2015.

I had originally intended to have Addiction Professional publish this, but they said it was too long (just under 10,000 words) and too steeped in policy. I offered it to Hazelden, but they said it conflicts with their own publishing house. After some thought, I have decided to publish it as a series on my site throughout the winter of 2016. This is the first of eight articles from that interview. We discussed the role of the pharmaceutical industry in the current American opiate epidemic.

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Frank Greenagel: The history of pharmaceutical marketing and the work of Dr. Sackler was fascinating. It’s astonishing that he was able to use the money he made from marketing to buy a drug company. Years after his death, his company released Oxycontin in 1996. When I present on opiates, I talk about how Purdue Pharma, which clearly overstated the benefits and understated the side effects of Oxycontin, had to pay a $600B+ fine in 2007 but did not really change their behavior. I also mention that Purdue makes Subutex strips and I leave it up to the audience to form their own opinion about that. How much blame, and I know you can’t put a percentage here, but how much blame should be placed on Purdue and Big Pharma for the current opiate epidemic in America?

Sam Quinones: If it was only one company doing this, we would not have the problem we have today. Let’s put it that way. They were greatly helped by pain specialists who appeared to be independent, who were saying that we were a country in pain, an epidemic pain. They stated that these pills were now virtually non-addictive when used to treat pain. I really believe had it not been for that message being broadcast by pain specialists, Purdue would never have been able to convince doctors that these pills were virtually non-addictive. That said, it’s also very clear to me without the money, essentially the megaphone of Purdue Pharma, without use of techniques that are probably far better suited to over-the-counter medication, that the message of the pain specialists would also never have gone anywhere. Let me just say this also, though. I believe they happen to hit at a time when Americans really, really wanted to hear the message, which was that we were entitled to a life without pain. Americans, health consumers, patients, really wanted to hear that. It sounds great when a doctor says “now we know that these are non-addictive, so don’t worry. You can take these for any pain that ails you.” Americans also did not feel the need to be accountable for our own health decisions. A doctor might say part of your pain comes from the fact that you’re obese and you don’t get enough exercise and you eat poorly and you smoke. It was easier not to hear that and hear that “now we have a pill that will take care of your problem and we know now that it’s virtually nonaddictive.”

Frank Greenagel: The marketing of the pill, do you think that the benefits were pushed so much that the doctors were encouraged to not even look at the behavioral issues? Or do you think that ignoring the behavioral issues was just a fallout of the fact that they were overworked and didn’t have enough time to work with the patients and patients didn’t want to hear that anyway?

Sam Quinones: I think all of that is correct. I hate to be skimping or shrinking from the question, but it’s true. All of that is correct. There were patients with pain problems that were taking huge amount of time from doctors, time that doctors didn’t have. There was a feeling that this was a way of getting them out of the office, it was what the patients wanted to hear. I’ve got a solution for pain. Thank God, finally, I’ve got a solution for my pain. Let me put it this way. This is a nationwide thing. It goes from Maine, to southern California, to Alaska, to Atlanta. The only way you’re going to be able to create that kind of blanket response and therefore blanket problem that we’re now facing today is when a whole lot of factors come to play. It’s not one boogeyman. What I set out to say in my book was that there are a lot of factors in this. Hollywood is used to showing us one bad guy who is very easily identified. That’s not the way, I think, a lot of social problems work, particularly not one that goes all across the country and effects millions, if not tens of millions. That doesn’t mean that individuals don’t play an extraordinarily important role, and I tried to find that as well, but I’m also not believing that a problem of this magnitude, this widespread, is caused by one small factor. It’s a combination of factors, all of them working together to produce what we’ve got here.

Frank Greenagel: One follow-up on the Purdue question is that I’m sure you’re aware of the law suits that were filed by Santa Clara and Orange County and then the City of Chicago last year. Basically, they sued the biggest five pharmaceutical companies, of which Purdue Pharma is one of, for exaggerating the benefits and understating the harms of these drugs. It seems like the government’s come out at least with a boogeyman and I think part of it’s that city and county and state budgets are all suffering and they’re saying our workman’s comp costs are really over the top and our healthcare costs are over the top, so we’re going to go after you. Do you have an opinion on those law suits or do you have any thoughts about what’s going to happen with them?

Sam Quinones: I don’t. I was waiting to see what would happen, if they proceed. At that point, I was going to find out more about them basically. To me, it felt like I’d seen this before and they’d all been stymied. Frequently, they’ve been stymied, these law suits, and so I was just going to wait and see. Here’s the issue. This is a classic example of corporate welfare, where the profits accrue to a small number of private companies and the costs are borne by the public sector, coroners, jails, courts, public health offices, county hospitals, etc, etc. You can go on and on. Therefore, I would imagine that they will see more of those kinds of law suits I would think.

Frank Greenagel: Now, when someone says corporate welfare, conservatives get very upset about that notion and they’re not able to hear it, so is there another way that we can phrase this so that members of that party would be able to hear it and address it better or do you think it only gets addressed when…

Sam Quinones: No I don’t care. I really don’t care how they want to hear it. Really. This is a classic example of capitalism twisted, where the real price … Here’s the issue. If you’re a true conservative, you want truth in pricing. The real price of those drugs is astronomical if you consider the cost of what’s happened because of their marketing in this way. These are not cheap drugs. They may be cheap … Their price looks cheap, but their real cost, if we were to really factor in all the costs that have been borne by people who had to pay in a variety of ways, taxpayers and other folks, who had to pay for what this has created. It’s a classic example of the risks being pushed onto the public sector and benefits being accruing almost entirely to a few companies in the private sector.

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Part two will be published next week and is entirely on the topic of race and drug policies. Mr. Quinones talks at great length about how the current heroin epidemic is very different from the crack epidemic of the 1980’s.

American Pariah – Dr. King’s Last Lonely Year

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Dr. Martin Luther King Jr. was assassinated on April 4, 1968 in Memphis, Tennessee. He had traveled down there to fight for better conditions and wages for sanitation workers (people who work on garbage trucks) in that city. He was mourned and lionized after his death, becoming more and more popular in the years that followed. President Reagan signed a bill that made Dr. King’s birthday a national holiday in 1983 (it would not be celebrated by all 50 states until 2000*).  What many people don’t know is that he was quite unpopular for the last year of his life. This piece is about that final year and how his teachings are incredibly relevant today (his words appear in black bold throughout this article).

A nation that continues year after year to spend more money on military defense than on program’s of social uplift is approaching spiritual death.

These are the most well known lines from his April 4, 1967 speech at Riverside Church in NYC where he came out very strongly against the war in Vietnam. With this speech, he alienated President Johnson, turned off much of the black middle class, lost a number of his civil rights allies and was lambasted by the media. This did not surprise him – his advisers told him it would happen. Dr. King wrestled with whether or not he should speak out – he had won a Nobel Prize, had worked with the President on major civil rights legislation and had the respect and goodwill of a large number of Americans. After an internal debate, Dr. King decided to give the speech because he felt obligated to lead people in a direction that he felt was morally right, even if it came at great personal and professional cost.

When one sits down and comprehends Dr. King’s work and travel schedule, it is only then that one can see how authentic, passionate and tireless he was. Make no mistake, for the last several years of his life (and especially his last year), the man was exhausted. He would visit with regular people, meet with officials and speak in front of groups all in the same day, and he traveled to several different cities and states most weeks (but he tried to be in Atlanta for his Sunday sermon as much as he could). Dr. King did all of this without keeping any donated money (Coretta unsuccessfully lobbied him to set aside some to help with the bills and provide for the children’s education).

Dr. King traveled to cities like Chicago and Newark, where he spoke and marched and organized for improved housing conditions for the underprivileged, equal education, and better employment conditions while fighting against and raising the awareness about racial profiling and police brutality. This was in the 1960’s. It’s mindnumbing to reflect on those issues in Chicago and Newark in 2016.

There is a very dangerous development in the nation now to equate dissent with disloyalty.

Dr. King uttered these words about Muhammad Ali. In late April of 1967, Ali rejected induction into the US Army saying that “ain’t no Vietcong every called me nigger.” He was stripped of his titles, banned from boxing and sentenced to prison. Ali was able to avoid prison but he was held out of the ring for 3 1/2 prime years of his career. Some people called Ali a traitor. This deeply disturbed Dr. King. Criticism and dissent are quintessential American traits and rights. When people label their opponents as disloyal, they seek to silence other citizens, limit opinion, and lower the quality of public discourse. This has continued (and possibly gotten worse in the last 50 years), and it is behavior that both Republicans and Democrats currently engage in.

…less than 1 percent of the Negroes of our country have engaged in riots. More than 99 percent of the Negroes have remained nonviolent tactically.

He spoke these words on Meet the Press in response to the question about whether civil disobedience inevitably leads to civil disorder. Today, these words can be applied to Americans that are currently being unfairly demonized for the actions of an ultra-tiny percentage: latinos, latinas and Muslims.

Don, you’ll never know how easy you and Jackie and Campy made it for me to do my job by what you did on the baseball field.

Dr. King said this to Don Newcombe, a pitcher for the Dodgers and one of the first black players to play in the majors. Mr. Newcombe was stunned by those words and told Dr. King that he just played baseball and wasn’t the one that had dogs sicced on him, was beaten or thrown in jail. Dr. King responded by telling him that the baseball players led and he followed. This is particularly inspirational for me, because no matter the heights Dr. King attained, he acknowledged the legacy of others that came before him and paid them great homage.

Tell them not to mention that I have a Nobel Peace Prize – that isn’t important. Tell them not to mention that I have three or four hundred other awards – that’s not important. Tell them not to mention where I went to school. I’d like somebody to mention that Martin Luther King Jr. tried to give his life serving others. I want you to be able to say that I tried to be right on the war question…say that I did try to feed the hungry. I won’t have any money to leave behind. I won’t have the fine and luxurious things of life to leave behind. But I just want to leave a committed life behind.

This was part of Dr. King’s sermon to his Atlanta congregation on February 4, 1968. He was speaking about his eventual death and how he wanted to be remembered.Two months later, he would be killed at the age of 39. Today, I am a few months older than Dr. King was at the time of his murder. He has been, is and will continue to be one of the great role models of my life. I believe it to be a very worthy goal “to leave a committed life behind.”

 

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* Arizona and South Carolina were among the last states to acknowledge it as a holiday. To this day,  Alabama, Arkansas and Mississippi call the day Dr. Martin Luther King/Robert E. Lee Day.

One additional note: I’ve read a number of books and articles on Dr. King, but this piece owes a heavy debt to Tavis Smiley’s Death of a King, which is about the last year of Dr. King’s life and was published in 2014.

Blah Blah Blah – The Soaring Rhetoric and Empty Promises of Governor Christie’s State of the State Address

As his favorability numbers continue to plummet in NJ and his polling numbers hover in the single digits in New Hampshire, Governor Christie gave a State of the State address in Trenton today that was full of his typical bluster and bravado and soaring rhetoric and devoid of specifics. I am only going to respond to his statements about addiction and mental health policies in this piece, as I’ll let other experts react to what he said about the economy and education in their respective forums. I’ve been a critic of this Governor for a long time, and I went public with those criticisms after he delayed the release of the NJ Heroin and Opiate Task Force Report. I’m going to look at this piece by piece. The Governor’s words will appear in bold black.

Today, I’m asking you to join me in doubling down on our state’s fight against drug addiction. There are few things that I’ve worked on harder as Governor or that I believe in as strongly as this.

I can’t speak to whether he believes super strongly in the fight against drug addiction, but I fervently disagree that he has worked hard on this. The following list is damning:

1) In 2012, he vetoed the Good Samaritan Law. It would take lots of ground work by community activists like Paul Ressler, Patty DiRenzo and Linda Surks, dozens of editorials and the near overdose of Bon Jovi’s daughter in NY state to convince the Governor to change his mind and sign the Overdose Protection Act in May of 2013. In between his veto and signing, several hundred people died from overdoses.

2) His office did not provide any help when a group I was a part of (from 2010 – 2012) tried to open a Recovery Charter High School in Newark. Despite getting $500,000 from the federal government, his office was unresponsive to our requests for help. When the department of education denied us for a 2nd year in a row in 2012, we reached out to his office again and received no response.

3) He has neither visited nor acknowledged nor helped raise money for the NJ Recovery High School in Union, NJ. I can only guess this is because it is championed (and named after) by a nemesis, Democratic State Senator Ray Lesniak.

4) In fact, the Governor recently vetoed an overwhelmingly popular bill that would have established 3 state-sponsored recovery schools.

5) The Star Ledger’s Tom Moran wrote that “the number of addicts admitted to treatment has dropped on his watch, according to the “daily tracker” run by his own Division of Mental Health and Addiction Services. State spending on addiction has dipped as well.”

In 2013 we brought in the drug court program to provide mandatory treatment to first-time, non-violent, non-dealing drug offenders.

There is some lying, some exaggerating and an omission here. Drug Courts have existed in NJ for over a decade. Governor Christie did sign off on a bill that expanded the eligibility to more offenders, but he also did not provide additional funding (read that last sentence again).

Narcan has now been administered more than 7,500 times through this program – and we’ve achieved the first decline in overdose deaths in our state in four years.

I’m a huge fan of Naloxone (the drug that is in Narcan) and I’m glad it is getting distributed more and more. Again, this distribution was made possible by local activists and forward thinking law enforcement leaders. The Governor dragged his feet on this. And opiate-overdose deaths increased from 741 in 2013 to 781 in 2014, so there hasn’t been a decline. Unless the Governor already has the data from 2015 handy (if so, that begs the questions (a) why hasn’t it been released and (b) how come he was able to get this data so easily when he claims everything else takes so much time), it’s obvious that Christie lied.

And last July, we instituted a single point of entry for people to gain access to treatment, and more than 30,000 calls have already been made by people looking to connect with drug treatment programs. Not dozens of calls to try to find help; just one call, to one place. Now that’s the way government should work for those in need.

That’s true. This was proposed in our Task Force Report that was delivered to the Governor in the fall of 2013. The vice-chair, Eric Arauz, wrote that recommendation and it was carried out by the NJMHA. The report was published in 2014. It took the Governor 16 months to implement a phone line – is that “the way government should work for those in need?”

Today I’m announcing an expansion of one of our most promising anti-addiction efforts, the Recovery Coach Program. This month, the Department of Human Services is launching a treatment intervention pilot program in hard-hit counties for people recovering from drug overdoses. The specialists leading these interventions are often in recovery themselves, and they’re deployed to emergency rooms so they can provide guidance, support and referrals for treatment. With the benefit of their own experiences on the path to recovery, these recovery coaches can step in at the moment when victims of drug use are often at their most vulnerable and when support is most needed.

Stephen Stirling of the Star Ledger reported that “this program was spearheaded by the Ocean County Prosecutor, and began last year.” So he’s taking a lot of credit here that shouldn’t go to him. Also, I’m a bit wary of Recovery Coaches. Their current prescribed role of helping people that have been hospitalized after a Naloxone reversal find treatment is perfect. However, Recovery Coaches are a cheaper, less educated, less professionalized, and less experienced group than the Licensed Alcohol and Drug Counselors (LCADCs). Recovery Coaches require little training and no supervision – it is imperative that they be used for very specific purposes with clear guidance. There is a shortage of LCADCs in the state and it has an effect on the quality of treatment.

Today, I’m very proud to announce a historic financial commitment of more than $100 million to increase access to care for mental health and substance use.

This is the most significant point. He should have led with this. The big question is if it is $100 million additional dollars per year (this would be .2% of the state budget, a pittance, but totally acceptable to me), or is it $100 million over 3 years, or 5 years or 10 years (over several years is more likely). He didn’t get specific. Specifics are the Governor’s Kryptonite.

We’re going to provide more competitive reimbursement rates for services and providers. Nearly two years ago I commissioned Rutgers University to analyze the characteristics of our most expensive Medicaid patients. What they found was totally clear. Within the top 1 percent of the most-expensive Medicaid patients, more than 86 percent have a mental illness, substance abuse issue, or both. If we can help people get access to coordinated care for their physical conditions, mental health and addiction issues, we can deliver more effective treatment and lower the long-term cost to the state.

Good. My friend Glenn Duncan wrote an amazing piece about the problems of Medicaid reimbursements and how programs can’t provide treatment to a huge number of people who need it. Increasing the amount of money that Medicaid pays for inpatient and outpatient treatment will help thousands of people in NJ who have mental health and/or addiction problems. The “coordinated care” for all of those issues is straight out of Obamacare. Straight out of it (I took a health care policy class in the fall of 2014, and we spent half of the semester on the Affordable Care Act). Christie likes this aspect of Obamacare. Too bad he’s too much of a coward to tell the GOP primary voters that.

I propose today that we re-open Mid-State as a fully dedicated, certified drug abuse treatment facility for New Jersey prison inmates. The victims of addiction deserve treatment, whether they’re in the community or incarcerated. If we can break the cycle of addiction anywhere, we should break it.

Awesome. We can’t look at drug policy issues without looking at criminal justice issues. The GOP is going to be more effective on criminal justice reform than Democrats (who have always feared appearing soft on crime). I just don’t want to see the Governor turn the running of it over to a for-profit company. The half-way houses that Governor Christie’s friends own are rife with problems. Let a non-profit or the state run it. It can be modeled after the program Governor Jim McGreevey runs up in Jersey City. Governor Christie and Governor McGreevey are buddies.

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Last summer, I wrote about Governor Christie’s failures and how Romney’s campaign in 2012 was horrified with how Mr. Christie acted like he was Tony Soprano. Several political experts have written about how Christie has no shot at the Presidency, and I agree with them. That said, he will continue to be our Governor for another 2 years, and here are some specific tasks and programs that can actually address the addiction scourge and mental health problems that plague our state (I wrote about some of these in that aforementioned late summer piece as well):

(1) Expand the drug courts and fund them.

(2) Develop and implement a prescription drug education program to be taught to students throughout NJ, starting at age 10.

(3) Decriminalize marijuana.

(4) Mandate the prescription drug monitoring program (recently, he signed a bill that requires providers to check it every 3rd time, which is actually real progress).

(5) Consider early release of non-violent drug offenders who were given harsh sentences for possession of drugs (the Vera Institute of Justice estimates that it costs NJ between 50 and 60 thousand dollars to incarcerate someone here).

(6) Incentivize the creation of supportive housing for people with mental health and/or addiction disorders. Those houses need to be licensed or regulated though, as otherwise they’ll be full of abuse and neglect and will just add to the current problems.

(7) Speak out on behalf of the NJ Recovery High School in Union County. It bears Senator Ray Lesniak’s name (they hate each other), and by doing so it would show that the Governor can rise above petty feuds. It will also help get the word out about the school, which is suffering from low enrollment, despite the obvious need for it to exist.

At first glance, Governor Christie talks a good game. But a closer examination reveals that Mr. Christie appears to have issues with the truth, a poor memory, questionable follow through and a predilection for hurling personal insults at people. His speech today was more for the people of New Hampshire than New Jersey. In February, they’ll show him that they believe him as little as Garden Staters do. We all deserve better.

Injectable, long-lasting Suboxone to be reviewed by the FDA on January 12

Tomorrow, the FDA will review drug-trial data on Probuphine. This is an injectable Medication Assisted Therapy (MAT) that consists of buprenorphine and naloxone (the same medications that make up suboxone).This is far better than suboxone pills or strips, as it guarantees the patient is getting the proper dose and is not diverting it. The success rate reported in the clinical trials (which must always be taken with some skepticism) are incredible, and I very much hope to see that this drug will become widely available.
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This medication, like Suboxone or Vivitrol, should be accompanied with weekly drug tests and counseling. Currently, one can be prescribed those medications and not have to get drug tested or counseling. Suggesting, rather than requiring, drug testing and counseling is the central failure of the 2000 Drug Abuse Treatment Act (which brought Suboxone to the US market).
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UPI reported on this today. Some highlights from the article:
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Probuphine contains buprenorphine and naloxone and is implanted for treatment for six months. Dosage can be personalized for each patient, allowing a continuous stream of medication to help counteract cravings while treating an addiction. Researchers reported that during the six-month trial, 88 percent of participants had not been found using illicit opioids.
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“It’s the same idea of putting a disease in remission. We want people to have a good quality of life and that always takes a little bit of conscious thought and effort,” Dr. Michael Frost, an addiction medicine physician, told The Intelligencer. “Medication at the end of the day is just medication. And in the absence of developing skills and lifestyle modification, medication is not enough just on its own.”

Politicians and the Addicts in Their Families

Ever since I was named to the Governor’s Council in 2011, I have increasingly thought about how politicians and the media influence and impact public perception (and thus, public policy) on addiction. I initially had high hopes for Governor Christie, as he was a former prosecutor who had talked about expanding the Drug Courts and the importance of treatment. As time went by, I saw that he talked a good game but neither provided additional funding to prevention/treatment/recovery services nor signed off on forward thinking bills. After his office delayed the NJ Heroin and Opiate Task Force report for over a year, I became a vocal public critic of the Governor. Last July, I wrote about how Mr. Christie has no shot at becoming President (and I listed his scandals and failures with lots of references) and offered advice about how he can be more effective in his remaining two years in office, with a particular focus on addressing substance addiction and recovery.

Last November, a speech by Mr. Christie in New Hampshire about his mother’s tobacco use and his law classmate’s addiction went viral and sent the political media into a tizzy (even liberal pundits said they were impressed). Mr. Christie talked about how it was a public health issue and that people with addictions should get treatment, rather than be arrested. I appeared on NPR with Brian Lehrer to discuss Mr. Christie’s speech and whether his policies match his rhetoric (spoiler alert: they don’t). That said, empty rhetoric is better than no rhetoric. From 2011 to 2015, I attended the Rutgers Edward J. Bloustein School of Public Policy and I spoke with multiple professors about my problems with Governor Christie and his empty rhetoric. Their responses can be summed up easily:

1) No one wins or loses elections talking about mental health or addiction policy

2) Even if a politician doesn’t actually do anything about it, the fact that he or she is talking about these issues brings it to the fore and allows for greater public awareness

In mid-December, I interviewed Sam Quinones, the author of Dreamland, which provides the best account of the history of heroin and the American opiate epidemic that I’ve come across. We talked for 80 minutes, and parts of that interview will be released on other professional sites. Mr. Quinones and I discussed Governor Christie and the rhetoric of politicians, and he echoed my policy professors’ views:

Frank Greenagel: It is election season, and I’ve been very critical of my own state governor, Governor Christie. He got a lot of press a month ago by giving an impassioned speech about his mother’s tobacco use and his law school buddy’s drug problem. Conservatives liked it and Democrats liked it and he was praised on MSNBC. I’ve heard the speech before, but when push comes to shove, he doesn’t fund anything. He still criminalizes marijuana; I’m for the decriminalization of it. He criminalizes marijuana, he hasn’t funded treatment bills, he resisted naloxone expansion, he resisted the Good Samaritan law. There’s point after point after point, so his rhetoric soars high above his actual policies. What happened after his speech is that politicians on both sides of the aisle have been tripping over themselves in announcing that they have a friend who is an addict. Or my family member is an alcoholic. I’d like you to speak to that. I know you like what Governor Kasich did in Ohio. Is there anyone else or anyone that has any kind of policies that said anything that seems to get it or is it all just a kind of campaign bravado, like I’ve seen from Governor Christie?

Sam Quinones: Regardless of what follow-throughs he did or did not do, the mere fact that people are beginning to talk about it is really important and remarkable. I don’t know his record in New Jersey in funding programs or passing laws. I did think it was interesting to listen to him to say that because those words spoken 15 years before would have disqualified him from the Republican nomination. His campaign would have halted right then. Now, you can see these Republicans now are, again, as you say, tripping over themselves trying to tell the most gripping story of addiction in their family, which I think is a huge step forward. I really do. I think it’s very important. I don’t know that I see anyone who has understood the issue well enough. Nor do I even think Barack Obama does. I watched him at the Charleston, West Virginia town hall meeting that he held and it seemed to me that it was an issue that was far off for him. He did not feel comfortable with it, didn’t know how to pronounce naloxone and this kind of thing. That’s understandable. He’s got ISIS. He’s got a million other things that are important, but it seems to me that it’s still in the phase where people are approaching this, or not entirely comfortable with this topic yet.

About a week after Governor Christie’s New Hampshire talk, Ben Carson responded to a question about addiction by not answering and instead chose to talk about political correctness. I pilloried him for it in an article, and took that as an opportunity to write about past Presidential families and their problems with addictions (Adams, Roosevelt, Ford). Unlike Mr. Christie, Dr. Carson said all the wrong things.

Yesterday, Carly Fiorina penned a piece for Time magazine. She wrote about her step-daughter, who died from addiction at the age of 34. She also wrote about what the government should do for those with mental health problems and addiction disorders, and how we need to reform the criminal justice system:

We must invest more in mental health and in the treatment of drug addiction. We shouldn’t be criminalizing addiction. If you’re criminalizing drug abuse, you’re not treating it. In New Hampshire alone, 85% of state prisoners have a substance abuse problem. These men and women need help. We need to reform the criminal justice system and make sure we’re putting the right people in prison. The federal prison population has nearly doubled in the last 20 years—and nearly half of the inmates in federal prison are in there for non-violent drug offenses.It’s important to keep violent criminals out of our communities—but it’s also true that prison is not always the right answer. Drug offenders who go into treatment—rather than through the normal criminal justice system—are about 25% less likely to be re-arrested in the two years after leaving the program.

I’m thrilled that she made these points. This is an astonishing change from 30 years ago and the disastrous policies of President Reagan, when prevention programs were based on “Just Say No” and funding for treatment programs were cut and the prison populations exploded due to draconian sentences for drug possessions. Now multiple Republican candidates are talking about the importance of drug treatment and sensible criminal justice reform, including the son of Ronald Reagan’s VP.

Today on The Medium, Jeb Bush wrote about his daughter’s addiction and recovery:

As a father, I have felt the heartbreak of drug abuse. My daughter Noelle suffered from addiction, and like many parents facing similar situations, her mom and I struggled to help. I have so many friends and know so many families who have faced this terrible challenge. Addiction crosses all barriers, all lines, all races and all incomes. It creates real hardship and heartbreak in families. And, it places substantial demands on government at every level. I never expected to see my precious daughter in jail. It wasn’t easy, and it became very public when I was Governor of Florida, making things even more difficult for Noelle. She went through hell, so did her mom, and so did I.

It’s very debilitating when you have a loved one who is struggling, and you can’t control it. You have to love them, but you also have to make it clear you cannot enable the behavior that gets them in trouble. Showing a lot of courage, Noelle graduated from drug court. Drug courts use a restorative solution model involving multi-disciplinary coordination, including the judiciary, the prosecution, mental health specialists, social services and treatment professionals. I was the proud dad that saw Noelle finish that. She’s drug-free now.

The New York Times reported on his post today and also wrote that Governor Bush would be appearing at a drug policy forum in New Hampshire later this afternoon and would talk about his plans to address mental health and addiction problems:

Mr. Bush’s plan to deal with the issue has four main components: preventing drug abuse and addiction, strengthening the criminal justice system, securing the southern border with Mexico to stop the flow of illegal drugs, and improving treatment and recovery programs.

Neither Mr. Bush, Ms. Fiorina, nor Mr. Christie have released detailed policy plans yet, but the fact that they are all talking about these issues is substantial forward progress.