POLITICO, 1/15/18
By Katie Jennings
Gov. Chris Christie’s biggest legacy item — a campaign against opioid abuse that made him a somewhat unlikely anti-addiction champion in national circles — is now in the hands of one of his harshest critics.
Christie made his anti-opioid fight personal, publicly relating the story of a friend who died from an overdose, putting himself in a statewide ad campaign, devoting much of his final year in office to funding programs he created and chairing President Donald Trump’s national opioid commission.
But as the Republican governor leaves office Tuesday, and the overdose death toll continues to rise both in New Jersey and nationally, the fate of his anti-addiction agenda and his public health legacy will be out of his control.
Democratic Gov.-elect Phil Murphy, who will present his first budget to the state Legislature in a little over a month, will have to decide whether to continue the mission of his predecessor, who, in the last year alone, dedicated $200 million in state funds to 25 opioid prevention and treatment programs.
Murphy said during a campaign stop last year that the anti-addiction effort was an opportunity for bipartisan action and also promised to expand access to treatment and fund a public prevention campaign. But he gave no specifics on spending, and more broadly, he has positioned himself as the polar opposite of Christie, promising to undo eight years of “bullying” rhetoric and “failed” policies.
What that means for Christie’s opioid programs is far from clear.
“The opioid crisis still needs lots of money and attention because it’s not under control yet here or any place,” said Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies. “Gov. Christie has set that in motion. All these initiatives and funding that he started, they can’t be one-time. They have to be recurring.”
Christie’s spending in New Jersey is around half the $500 million Congress authorized this year for opioid crisis grants to states.
“Christie isn’t all talk and no money because when it came to his budget, he showed what action is,” said former Democratic Rep. Patrick Kennedy of Rhode Island, a longtime advocate for mental health and addiction treatment who served on the national opioid commission alongside Christie.
Christie is credited with bringing the issue to the forefront, but his success in fighting an epidemic that is only getting worse is hard to measure, particularly as the more potent synthetic opioid, fentanyl, continues to flood the market.
Overdose deaths have increased annually since 2010, the year Christie took office. The number of heroin- and morphine-related deaths in New Jersey tripled from 2010 to 2015, to 961 deaths.
The grim statistics come despite efforts that drew praise from liberals and conservatives alike, including mandatory drug courts, immunity for people who report drug overdoses, increased state spending and the yearlong $42.6 million advertising campaign “ReachNJ,” which prominently featured the governor alongside people recovering from addiction.
“The reality is that he really brought it into everyone’s living room,” said Robert Budsock, president and CEO of Integrity House, one of the largest nonprofit addiction treatment providers in the state. “There’s no longer a need to whisper about it in our communities. Addiction is front and center.”
Integrity House in Newark has been a bipartisan stop for politicians looking to better understand the state’s opioid epidemic for many years — from Christie to former President Barack Obama to Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services.
It’s also the place where then-candidate Murphy declared in January 2017 that fighting addiction might be “the most bipartisan opportunity before us as a state.”
Murphy’s campaign platform called for “battling addiction” in broad strokes by expanding access to treatment facilities and medication-assisted treatment, lowering the cost of the overdose antidote naloxone and funding a public awareness campaign, but he’s offered few specifics about how he plans to proceed.
The governor-elect and his staff have met with many mental health and addiction treatment providers, though a spokesman would not say whether Murphy will continue any of Christie’s programs.
“I hope Murphy picks up where Christie left off,” Budsock said.
Christie’s motives and goals are often praised, but the means he used are subject to the same partisan criticism that is another part of the governor’s legacy.
He spent several months last year trying to squeeze hundreds of millions of dollars from the state’s largest health insurer, Horizon Blue Cross Blue Shield of New Jersey.
When that plan failed, he inserted language into the state budget that unilaterally allowed him to shift funds from any existing programs to go toward a public health crisis. The governor declared the state’s opioid epidemic such a crisis in January 2017.
In recent months, his administration has announced many of the program contracts, including nearly $40 million for an enhanced care management program to provide incentive payments to treatment providers who help low-income patients with severe addiction disorders remain in treatment and find stable housing and employment.
How many people benefit from all this spending won’t be known for months and possibly years, meaning Christie’s ultimate legacy remains an open question.
State Sen. Joe Vitale, who chairs his chamber’s health committee, said the Christie programs are good, in theory, but that there needs to be some analysis to gauge their effectiveness going forward.
“We [need to] do an assessment of whether or not they’re valuable, whether or not they actually work, and if the money is making a difference,” said Vitale, a Middlesex County Democrat.
There is one policy change by the governor that has undeniably increased access to treatment for a particularly vulnerable subset of the state’s population.
Christie was one of a handful of Republican governors who expanded Medicaid under the Affordable Care Act, enabling a half-million New Jersey residents to gain health insurance coverage and expanding access to drug treatment.
In 2013, there were around 6,300 Medicaid recipients with a substance abuse disorder diagnosis. In 2017, more than 40,700 Medicaid recipients in New Jersey were diagnosed with a substance use disorder — a six-fold increase, according to figures provided by the state Department of Human Services.
Christie, though he rarely mentions Obamacare except to trash it, takes credit for the increased number of low-income residents getting treatment and, in his role as chairman of the national commission, has called for even more Medicaid spending.
The commission’s final report included 56 national recommendations, which, if enacted, would require tens of billions, if not hundreds of billions, of dollars in federal funding.
“Most governors tend not to be quite as visible as he has been in this particular policy arena,” said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, which plans to honor Christie in March. “There are political risks.”
In October — and after much delay — Trump declared the opioid epidemic a national public health emergency, based on the commission’s recommendation. That declaration runs out at the end of January, and Trump has yet to propose any new resources or spending. Many key public health and drug posts in the administration have gone unfilled.
Christie may be leaving Trenton, but he doesn’t plan on leaving the issue behind.
He will still have a line to Trump, his longtime friend, and White House special adviser Kellyanne Conway, a New Jersey native who is now leading the opioid agenda.
Christie insists he doesn’t want the role of national drug czar, which remains open, but has repeatedly promised to continue his crusade, saying at a recent vigil that he “will not be able to sleep at night without working on this.”