OPIOID CRISIS DEMANDS PARADIGM SHIFT

Just over a decade ago, ND lawmakers enacted legislation championed by Sen. Larry Robinson of Valley City to establish a state­-funded addiction treatment facility with a primary focus on Methamphetamine. Share House Inc. was subsequently awarded the contract to implement and manage that pilot program, which grew over time in mission and capabilities yet always faced severe financial constraints.

The Robinson Treatment Center has treated as many as 800 people and in recent years put focus on opioid addictions. HPR visited with Sen. Robinson to get a better understanding.

HPR: In your perspective, what’s the state of our ability to respond, intervene and treat folks with addictions and in particular opioid addictions in North Dakota?

Sen. Larry Robinson: In my opinion, we have had a history unfortunately of being reactive and not proactive. We have focused on reacting in terms of building more and more incarceration facilities. As we speak, we have expansions and new jails underway in Burleigh­Morton County, Ward, Mercer, Mountrail, Williams, McHenry and Bottineau County. There’s a planning discussion in Rolette County and, as you know, Stutsman County and Cass County are also discussing the potential of expanding their jail facilities.

We haven’t been able to get a handle on investing in treatment. Statistics will tell us that treatment works. The program at Share House, the Robinson Recovery Center, I believe, has about a 40 percent success rate in treatment. They had a unique model.

They call it the matrix model, it’s a very comprehensive, complex treatment model, but about 40 percent were successful.

That’s not to suggest the other 60 percent were failures. There’s any number of degrees of success in that program. Forty percent compared to the national averages and so on is pretty good.

So, we’ve been reactive. Our approach has been somewhat fragmented. The state has some facilities and treatment programs in place, most notably the Tompkins Rehabilitation Center at the State Hospital in Jamestown. In that facility they have about 75 treatment beds available, great staff, good people, but a tight budget, so they’re driven by the budget. Often we find situations where an individual is making progress but not ready to return home and to go back to work, [yet] they’re relieved from treatment.

In comparison, at the Share House program, often individuals in treatment would be kept there for prolonged periods. The folks there would work with them, find part­time work in the community, and they were not sent home until the conditions were right.

They had a job, they had support back in the home setting. They themselves felt they were ready to go home and the professional staff at Share House felt they were ready to go home. That is one of the reasons why they enjoyed a pretty good success.

So, we have far too much emphasis on incarceration and far too little emphasis on treatment programs in the state. In fact, we’re way behind the eight ball in terms

providing comprehensive treatment across the State of North Dakota.

We need to transfer resources away from incarceration and the prison system and find a way to build treatment programs not only in Fargo but indeed across the State of North Dakota. We’re spending some $215 – $220 million on our prison system. We’ve got about 1,600 incarcerated. We’ve got about 7,000 on parole and probation. And if you stop and think about that in and of itself, 7,000 parole and probation clients across the State of North Dakota, all of them have an assigned caseworker. We’ve got caseworkers in state fleet vehicles crisscrossing the state every day, 365 days a year ­­ it’s an investment beyond words.

And the question is, are we having a positive impact on the big picture? We are seeing continued growth in our corrections department. We cannot build ourselves out of this problem. That we have all of these counties building or expanding their jail facilities, and at the same time we see little if any investment in treatment, tells a powerful story.

HPR: Let’s get to the human aspect of this, the families and the people involved directly and indirectly. How far­reaching is this issue of addiction, first meth and other addictions but now the opioid addiction issue landing on our doorstep with the most serious of consequences? How far reaching is it?

LR: It’s deep. We have an epidemic and I think it’s nothing short of an epidemic across the State of North Dakota. It goes to the inner core of who we are as a people. I always tell folks if it hasn’t knocked at your door I hope and pray that it doesn’t, but sooner or later every one of us will experience in our family and with our loved ones an addiction issue.

These folks aren’t working. They’re on Social Services. We have foster care as a result. They’re not paying child support. They’re not paying taxes. They’re driving up our costs not only in corrections but across the board. We really owe it to them, to families, and to our state to be very proactive and aggressive and tackle this problem head­on.

It’s multi­faceted. It’s not just law enforcement. It’s going to take a complete paradigm shift. We need a lot more education, treatment, enhanced law enforcement, funding for facilities; I think we’re really at a point where the entire system needs to join hands and not point fingers.

We can’t say that this is a corrections problem, this is a human service problem. This is a problem that is impacting every aspect of our society, our schools, our social structure, our enforcement, the health department, and our core families as we’ve seen with the loss of lives. And when we have in many parts of the state babies being born that are addicted, I can’t think of too many things in this world that are worse. It’s a moral responsibility that we have that, whether we like it or not, we’d better face head-on.

HPR: How would you respond to someone who suggests it’s unaffordable?

LR: The cost of investing is only surpassed by the cost of not investing in this program. We are already paying a terrible price. How do you put a price on a life, on a family, on a baby who is born addicted? We are already paying, the price is growing and outpacing our ability to even comprehend, so the greater cost is not addressing this issue.

HPR: What’s your sense of the stigma and shame, and the lack of support for families, or the sense that there’s no place to go, that they don’t dare talk about it, that they’re just kind of in a vacuum?

LR: That’s a serious issue. This issue of addiction and drugs knows no social group, no economic group. It permeates all aspects of our society, regardless of how old you are, men, women, young and old, children, the rich, the poor, all of the above. As a result of that, there’s a greater understanding. That understanding is because of recent developments, not only in Fargo­Moorhead but across the state. People are more supportive of investing in these programs than ever before.

HPR: With the budget tightening at the state level, and lower revenues, and an already constrained financial approach to these issues, how do you predict this will unfold, with the legislature not meeting again until 2017? How can we get there sooner, faster?

LR: Bring all the stakeholders together. It’s timely that we seize the moment. More and more people are realizing this is not going to go away. Budgets are tight in many areas because of this issue. The crime, the incarceration, the social service cost. We can either sit back and hope things will improve ­­ and we know they’re not going to improve or we can creatively dig deep, determine what we are going to sacrifice to address this issue.

You know, if you always do what you’ve always done, you’ll always get what you always got. Clearly, we are not winning this battle right now. We are losing. It’s going to take a major paradigm shift and it’s going to take some courage on the part of all of us to step to the plate, join hands, and meet this head­-on.

Having said that, even with an all-­out effort, we can’t be kidding ourselves. We’re not going to turn this around overnight. Solving this problem will not be an event, it’s going to be a process, and it’s going to be many years in the making. It’s a long­-term complex problem and we had better come together, seek some solutions, and that process needs to happen now.

HPR: How optimistic are you we can get together and get on the same page to put ND ahead of this curve?

LR: We’ve got to have hope, and if ever there was a time when this issue is on everyone’s radar screen, it is now. Unfortunately the revenue picture is extremely challenging but something has got to give and it has to give now. The writing is on the wall. We can no longer ignore this problem. We are paying a hefty price when you start losing lives because of this issue. We have at Share House a model that should be fully funded. We should expand it. We should replicate that effort in western ND. We need to have a paradigm shift and quit building jails and start investing in treatment programs.

That’s the bottom line.

I’m guardedly optimistic that we can make significant improvement this next session, but it’s going to take some work preparing in advance. We need to bring the stakeholders together. We need to be unified and we need to visit with folks who are writing the budget and come up with a plan that will move us down the road in a positive way. And we need to do that as soon as possible.