WASHINGTON -- Hillary Clinton's policy advisers held discussions last week with experts working to address substance abuse in Iowa and New Hampshire, as the campaign formulates solutions to the growing epidemic in the country.
"Nobody has the option anymore to talk about addiction in the abstract, as if it happens to somebody else," said Tym Rourk, chair of the New Hampshire Governor's Commission on Alcohol and Other Drug Abuse Prevention, who was part of the conversation.
"What we're dealing with right now is something where you can't walk into a room in the state of New Hampshire and not have somebody sitting there who -- either directly, or in their family or in their social circles -- knows somebody who has been impacted by this issue," he added.
Clinton's focus on the issue largely came about that way. Since she launched her presidential campaign in mid-April, she has been having small roundtable discussions in the early primary states. In Iowa and New Hampshire, voters repeatedly brought up the issue of substance abuse -- even though it wasn't explicitly on the agenda -- reflecting the importance of the issue at the local level.
"I am convinced that the mental health issues -- because I consider substance abuse part of mental health issues -- is going to be a big part of my campaign because increasingly it’s a big issue that people raise with me," Clinton said on April 20 at a stop in Keene, New Hampshire.
Her campaign is now looking into policy solutions. Last week, senior policy advisers Ann O’Leary and Maya Harris hosted Google Hangouts with stakeholders in Iowa and New Hampshire, respectively. Participants included treatment and recovery service providers, law enforcement, people in recovery, health care policy experts and people whose lives have been touched by overdoses in some way.
Those who participated in the meeting said it was more of a "listening and understanding call" for the campaign, which plans to announce policy proposals around substance abuse in the coming months. They added that they were pleased Clinton was taking notice of the issue, even though it isn't normally a hot topic in campaigns or in Washington.
Access to prevention and treatment before criminalization, a nationwide shortage of treatment capacity, funding for programs, increased service for rural areas and increased access to mental health services were all areas that participants said needed an increased focus.
People in the meetings stressed the need for medically assisted treatments, such as medications methadone and buprenorphine, to be a piece of the policy solution. Although these treatments are viewed by the medical community as essential components of an opioid addict’s recovery, they are inaccessible to the vast majority in need. As a Huffington Post investigation found, some treatment centers and drug courts continue to insist that addicts refuse these medications.
State Rep. Marti Anderson (D) was one of the four Iowans to participate on the call with O'Leary. She has spent her career dealing with crime victims and currently has a good Samaritan bill before the legislature that would offer limited immunity from prosecution to people who summon help for a person suffering from an overdose.
"I wish we put as much money into drug treatment as we do into prisons. Now I know that it's not the same people all the time, but I think that if we invested in drug treatment, we wouldn't have as many prisons," she said. "And in addition to that, I think we need to look at criminal codes and quit putting people into prison for being addicted."
Anderson said she also believes there should be greater access to naloxone, a drug that can revive a heroin victim from an overdose, which is included in her bill and was discussed on the call.
All the New Hampshire participants who spoke with The Huffington Post stressed the inadequate access to treatment in the state and their fight to secure funding to help ensure that access.
"Approximately one in 10 people in New Hampshire has a diagnosable substance abuse disorder. Yet New Hampshire is second-to-last when it comes to someone in need of treatment being able to access it," said Linda Paquette Saunders, who runs the nonprofit New Futures, which works to prevent and reduce alcohol and other drug problems in the state. Her group has found that alcohol and drug misuse have a $1.84 billion effect on the state economy.
New Hampshire is one of a handful of states that sells, and profits off of, alcohol. The 2000 law creating this system said that 5 percent of the gross profits should go to a dedicated fund for prevention, treatment and recovery support, but that fund has only once received the full amount of money it is owed.
There's also currently a debate over New Hampshire's version of Medicaid expansion under the Affordable Care Act, which includes a substance abuse benefit. It will expire at the end of 2016 unless the legislature reauthorizes it -- not a done deal given that it's wrapped up in the politics of health care reform.
Advocates are also fighting to convince the legislature to give the standard Medicaid population -- those in the program before the expansion -- a comparable substance abuse benefit.
"I think the general consensus at the end was that they understand that there's some incredible work going on around finding solutions, and really the concern is funding problems," said Abigail Shockley, executive director of the New Hampshire Alcohol and Other Drug Service Providers Association.
"This is a public health issue, not just somebody is an addict," added another participant, Cheryle Pacapelli, executive director of HOPE for New Hampshire Recovery. "They're struggling with a disease. If someone had cancer and we told them they had to wait six weeks to get treatment, nobody would stand for that."
Rourke didn't hesitate when asked what he needs to fight the epidemic, naming "on-demand treatment" without the worry that an insurer won't cover it, long-term recovery support that treats addiction like the chronic illness that it is and an "adequately resourced public health and prevention system."
A Clinton campaign aide said the former secretary of state believes it's important to begin with "adequately funding substance abuse treatment programs -- not cutting them, as Republicans have done in many states -- and making sure insurance companies take care of addiction in the same way they approach physical health."
"There is a hidden epidemic," said Clinton at her April event in Keene. "We know the drug use problem, whether it’s pills or meth or heroin, is not as visible as 30 years ago when there were all kinds of gangs and violence. This is a quiet epidemic and it is striking in small towns and rural areas as much as any big city. I think a lot of people are thinking, well, that’s somebody else’s problem, that’s not my problem. And indeed, it is all of our problem and we don’t have enough resources, so that if somebody decides that they wanted to get help, where do you send them to?"
Clinton will be holding her first campaign rally on June 13, where top officials say she will lay out detailed policy proposals that will become the operating manual for the campaign.
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