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Tobacco settlement architect Mike Moore warns about risks of wasting opioid dollars

There are a lot of tools in the toolbox when it comes to addressing the opioid crisis. But sometimes it seems like state and local governments are grasping at straws when it comes to actually putting them into practice. Do state and local governments know how to effectively put these dollars to use?

You can’t do everything on Exhibit E, so why not figure out the top five things you want to do, or top three, and do them extremely well?

If it were me, I’d make sure I had a prevention and education program that was robust to try to keep people away from abuse. Obviously, fentanyl needs some more education out there and warnings. You still have a bunch of young people dying.

Then, make sure you prevent people from dying — make sure Narcan is available. And then treatment: You’ve got to figure out a way to get treatment to people. Do the things that save the most lives first.

There’s this push and pull over how much of the settlement dollars should be spent on public health and how much should be spent on law enforcement. Some opioid settlement dollars have been already spent on things like new police cruisers, phone-hacking equipment and restraint devices. From where you sit, is that an appropriate use of funds?

I know how stretched out this money’s going to be. That’s why I say it really needs to be prioritized. There’s really not enough money there to solve the opioid epidemic. There’s just not. You can’t buy law enforcement equipment and fund law enforcement to do this or that and not do treatment and prevention and lifesaving things like Narcan.

There’s a whole lot of enforcement. We need, frankly, treatment. Treatment’s what’s missing.

Some states have committed to 100 percent transparency in their opioid spending. Others haven’t made any promises. How hard is it going to be to hold governments accountable?

The problem is there’s no real accountability. There’s not a penalty to pay. You’re not going to go to jail if you don’t spend the settlement dollars the right way. There’s an agreement, and people are supposed to do that, but office holders get elected, they serve, they move on to another place, they get defeated, whatever. People forget their commitment. They think, “That was the last guy that did that.”

That’s why you set up these groups. If you set up a statewide opioid task force or commission, it has a life of its own, and it has some independence, then you have accountability.

Opioid manufacturers and distributors were the target of these lawsuits. But the overwhelming majority of drug overdose deaths involve illicit fentanyl and other synthetic opioids. How does that complicate the response to the overdose crisis compared to something like what we saw with tobacco where there was a legal entity that you could regulate?

It is complicated, and it changes every day. Since fentanyl, now we’ve got tranq and all of these other drugs and chemical compounds that are coming out. You’ve got to stay on top of that. The key is looking at it as substance use disorder. It doesn’t really matter what the substance is. What matters is can you get help to people who need it?

I’ve been in this public life for so many years that people know me and they walk up to me and say, “I don’t know if you know, but I lost my son to opioids, I saw you on TV.” They’ll tell me a story about it. It might be a 17-year-old.

Are there lessons to be learned from tobacco on opioid prevention?

Tobacco is not something that kills you immediately. It kills you over time. But look at the progress we’ve made on that.

That’s been done by public education. We spend probably $100 million a year doing these ads and reaching kids on Instagram and Snapchat. We help them get off of their vaping pens or whatever it might be. But we send messages right to their telephone. If we have the sophistication to do that kind of thing for that, certainly we can do it for opioids and the like. I just think people didn’t focus on the prevention side of this as much.

The drug problem is a demand and supply side problem. Law enforcement works on the supply side and they do a pretty dang good job, always have done a pretty dang good job. Where we have not done a good job is on the demand side. The way to cut down on demand is through a very strong public education campaign, and it works. It sends the right messages to the right people over and over and over through generations. But we’ve never done that on drugs in this country.

We had a “just say no” program — abysmal failure. With tobacco, we came up with all kinds of wild and crazy and unique and interesting ways to attack this. It took some time, but it worked, so it can work here.

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