What Ohio’s governor candidates plan to do about the opioid crisis

As drug overdoses continue to kill thousands of people in Ohio — 4,854 last year — each of the candidates for governor has an action plan to address the addiction crisis.

But those on the front lines in the Miami Valley say none of the plans directly address housing for those in recovery — including funding for sober living homes – and without those programs, they say, many people in recovery will relapse.

“There’s no mention of sober housing,” said Jan Lepore-Jentleson, executive director of East End Community Services in Dayton, which often deals with residents needing in-patient treatment. “We need safe, supportive places for people to go before they can access treatment, and after they complete treatment.”

Because the opioid crisis has played such a big role in the governor’s race, the Dayton Daily News asked local treatment providers, recovery support organizations, people in recovery, and faith-based groups to weigh in on the proposals put forth by Ohio’s four candidates for governor.

Overall, they were encouraged by some of the proposals but expressed concern about funding, particularly if Ohio’s Medicaid expansion goes away. And a recent report by a non-partisan research group says Ohio needs a better system for tracking the effectiveness of its treatment programs.

Mike DeWine, the Republican candidate, has a 12-point plan that calls for greatly expanding the number of drug courts where treatment can be ordered in lieu of incarceration. His plan also includes incentives for business owners to hire people in recovery, and he wants to implement what he calls age-appropriate K-12 prevention education.

Richard Cordray, the Democrat, wants to use funds from drug company lawsuits to help expand treatment and prevention services. He vows to protect the Medicaid expansion, and promote more non-opioid pain management through Medicaid coverage.

The two third-party candidates — Libertarian Party of Ohio nominee Travis Irvine and Green Party candidate Constance Gadell-Newton — both say legalizing marijuana will go a long way toward combatting the opioid crisis, but differ on their other proposals.

Irvine wants to roll back Medicaid expansion over a four-year period while implementing what he called free market-based health care reforms.

Gadell-Newton says she supports a universal health care plan that includes more controls on opioid prescribing.

Those surveyed on the plans said they support increased education and prevention efforts — both in schools and for adults.

“I definitely think early education in schools would be great,” said Shawn Trapp, who is in recovery and serves as program director for Good Shepherd Ministries sober living homes in Dayton.

Trapp said he’d also like to see more schools hire peer supporters to work with students struggling with drug use.

Lepore-Jentleson said both Cordray and DeWine have good ideas in their plans. She singled out DeWine’s plans to expand drug courts and programs to encourage the hiring of people in recovery. She likes Cordray’s focus on prevention and said she supports increasing local government funding for treatment and prevention and improving foster care and adoptive services.

Medicaid expansion

Several of those who work with addicts expressed concern over the fate of Medicaid expansion. Although Cordray and DeWine both say they would keep the expansion, DeWine wants to add a work requirement.

“Today, there are 143,000 jobs available on OhioMeansJobs waiting to be filled,” DeWine said, responding to a question in the Dayton Daily News Voter Guide. “We will focus on connecting people who are part of the expansion population and who are able to work with job training programs and job opportunities that are available.”

But some in the treatment community argue a work requirement isn’t needed.

Ohio Medicaid’s annual report released in August said most of the 700,000 Ohioans enrolled in the Medicaid expansion are already working or would be exempt from proposed work requirements due to disability, age, being in school or drug treatment.

The report says 58 percent of the expansion population earned income in the previous year and 44 percent currently meet the work requirement. Only 5 percent of enrollees – about 36,000 individuals – would need to seek work to remain enrolled in Medicaid.

Medicaid expansion, which was pushed by outgoing Republican Gov. John Kasich, raised the eligibility guidelines so those earning up to 138 percent of the federal poverty level can get health care under the program.

“The majority of those with substance use disorders do not have health insurance,” said Jewell DeFrates, Salvation Army recovery program coordinator in Middletown. “It would be so detrimental to the state of Ohio if Medicaid services were to be cut at this time.”

Trapp wants to preserve the Medicaid expansion, but he says Medicaid should focus more money on long-term treatment.

“I think we need to keep Medicaid (expansion) and figure a way to extend the stay of clients going to treatment 60 to 90 days, rather than 30 to 45 days,” he said. “Long-term treatment saved my life.”

Issue 1

One of the key divisions between DeWine and Cordray is over Issue 1, the proposed constitutional amendment that would lessen penalties for some drug possession offenses. DeWine opposes the measure while Cordray supports it.

The two candidates have sparred over the issue in each of the three debates held over the past several weeks. DeWine says it will make the state’s drug laws too lenient and invite dealers to come to Ohio, while Cordray says the amendment will lead to fewer people incarcerated for minor drug crimes.

Lepore-Jentlesen said incarceration is not an answer to Ohio’s drug problem.

“Drug addiction is a disease of the brain that requires treatment, not imprisonment and condemnation,” she said. “The opposition’s position that drug dealers, rapists, murderers, etc. will be released onto our streets is a ridiculous scare tactic, and irresponsible.”

Ohio Supreme Court Chief Justice Maureen O’Connor, a Republican who favors some criminal justice reforms, wrote in a recent opinion piece that Issue 1 is unconscionable and catastrophic and would hamper drug courts in Ohio.

“If Issue 1 passes, Ohio might have some of the most lenient drug crime laws in the nation,” she warned.

Better tracking system sought

In its Addiction Evidence Project scorecard, released in April, the Health Policy Institute of Ohio said the state’s drug policies lack “adequate long-term supports for ongoing recovery.”

Addiction is a chronic, relapsing disease that requires “ongoing chronic disease management,” the nonpartisan research group said in the report. It recommended a more coordinated approach to prevention efforts and a better tracking system for gauging the effectiveness of existing treatment programs.

Lepore-Jentleson called throwing more money at treatment meaningless unless there is better monitoring of the treatment centers.

Some of these programs have “terrible track records,” she said. “They are milking the system and not improving the lives of half the people who need their help, because the state isn’t tracking their efficacy.”

Multi-faceted approach

The addiction experts the newspaper interviewed said the candidates should focus their anti-drug efforts over a broad front that includes prevention, treatment and long-term recovery.

Lori Erion, founder of Families of Addicts, said she wants to see more support for families dealing with addiction issues, including access to therapy for children who have addicted parents.

A DeWine campaign spokesman pointed to the Ohio START pilot program the attorney general spearheaded that ensures families who have been separated due to addiction issues get intensive support and mental health treatment and are reunified quickly. As governor, DeWine said he would like to expand this program to all 88 counties.

In a statement, Cordray said his administration will expand access and funding to long-term recovery services.

“If we’re going to break the cycle of addiction that too many Ohioans face, we need to fully fund those services, and also make sure that individuals get the necessary follow up care they need to get clean, and stay clean,” he said.

Others noted the need to continue supporting harm reduction techniques — including needle exchanges, making the opioid anecdote drug Narcan more widely available, and exploring the use of fentanyl testing strips and safe injection sites.

The number of accidental overdose deaths in Ohio has more than tripled since 2007, climbing from 1,351 to last year’s total of 4,854.

Casey Steckling, founder of Dayton Recovers and a person in long-term recovery, said keeping people alive so they can eventually lead a more productive life will save the state money in the long run.

“Saving someone’s life will ultimately reduce the dependence of future generations on entitlement and other expensive programs,” he said.

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