On January 5, 2016, the Addiction Policy Forum hosted the “New Hampshire Forum on Addiction and the Heroin Epidemic” at Southern New Hampshire University in Hooksett, NH. The event provided a well-publicized opportunity for presidential candidates and other state and local policymakers – as well as experts and practitioners from across the addiction stakeholder community – to discuss the ongoing epidemic in a crucial early-voting state where the topic is the top public policy issue. The analysis below looks at where the Governor of Ohio and Republican presidential candidate John Kasich stands on addiction and policy.
When Governor John Kasich agreed to speak at a forum on addiction in New Hampshire, he had no idea that he would also be reuniting with an old friend. When Kasich spotted Jessica Nickel, Executive Director of Addiction Policy Forum, amongst the small group that greeted him just minutes before he was set to speak, he did a proper double-take. The two had not seen each other for many years, when they had last worked together on some of the very same issues that Kasich was there to address.
At the age of 19, Jessica Nickel gave a speech about the impact of addiction on families that struck Kasich, who was a congressman at the time. He sought out her expertise on the issue and inquired about her story. Ms. Nickel grew up with two parents who struggled with heroin addiction. When their family became homeless, she was placed in foster care. Years later, she faced Kasich over a lunch tray at Princeton University and in sharing her story, became a chapter in Kasich’s book Courage is Contagious, “about ordinary people who do extraordinary things.” Nickel went straight from Princeton to Capitol Hill and over the years, they lost touch.
Once on stage, Governor Kasich interrupted Nickel during her formal introduction: “Look, the story is -- this is a miracle. You believe in miracles? I’m gonna tell you one...” he said, and proceeded to tell the audience her story. As Kasich looked from Nickel to the audience and back again, it was clear that their work together had a huge impact on how he approaches the issues surrounding addiction today. “We need to think in this world today about saving one life at a time,” he said.
Kasich traced the beginning of his real work on the issue to a moment six years ago when a group of women came to speak with him, each of them holding pictures of their children who died from a drug overdose. Before this transformative meeting, Kasich said he hadn’t fully realized the scope of the problem. He encouraged those in the audience who have lived this and who know best what this country needs to “squeak the wheel.”
Kasich emphasized the progress that Ohio has made in addressing the issue and said that despite the fact that the state is far ahead of most others in its efforts, there remains much work to be done. Today, Ohio loses 20 people each week to opiate overdoses. In 2011, Kasich began implementing a game plan that incorporates methods he described as effective and scalable: “It’s protocols. It’s busting the dealers. It’s having money for rehab. It’s making sure you free up resources at the local level. All of these things should be done at once.” Again and again Kasich argued that the issue cannot be addressed bit by bit, but instead demands a comprehensive plan, the scope and rigor of which must top the complexity and strength of the epidemic itself.
Kasich said that licensed prescribers of medication need to have training and follow rules. Ohio has a “tough pharmacy board so if a doctor is out of line, we know it” but currently, participation in specific protocols is voluntary for prescribers.
Kasich expressed his enduring commitment to “stopping the flow of drugs and putting drug dealers in prison,” but noted the importance of diverting low level nonviolent felons who struggle with substance use disorders from being incarcerated. Kasich said these people need treatment, not time: “We’ve got to convince the judges that these nonviolent felons -- you don’t want to put em in prison, but there is a sense that ‘well, if I don’t put them in prison than I’m viewed as ‘soft on crime’’and this is a big issue, right? In a world where human beings are too worried about their own future instead of worrying about the person they may put away.”
According to the Ohio Department of Rehabilitation and Correction (DRC), 80 percent of people who are incarcerated in Ohio need to be treated for a substance use disorder. Kasich said his decision to expand Medicaid in Ohio freed up resources on the community level, “so that when people get out of prison they have a place to go.” While noting that the ultimate hope is that these people “never make it to prison in the first place,” the expansion meant that many individuals coming out of prison now have access to treatment and safe recovery housing, which dramatically increases one’s chance at long-term recovery, lowers recidivism rates and cultivates safer communities. “Our recidivism rate -- when we treat people in the prisons and then release them into the communities -- is less than 20%,” he said. This number acts as a striking comparison to a national average of 40-44%. Kasich also “banned the box” in Ohio: state agencies no longer require job seekers to disclose whether or not they have a prior criminal conviction.
The thru-line in Kasich’s comment was a decided call to action from the ground up and everywhere in between. At one point Kasich talked about cooperating with the Democratic Mayor of Cleveland in order to create an effective treatment policy: “You can’t have wars between the parties on this issue,” he said. “It’s too important. I know this is a Republican primary, but too bad!”
Gov. Kasich emphasized mentorship in schools and early education as a vital force in combating the epidemic. He referred to “Start Talking” as “the greatest program,” currently at work in Ohio. “Start Talking” is multi-faceted effort that was launched by Gov. Kasich and his wife, Karen, which is “aimed at preventing drug abuse among Ohio’s most vulnerable citizens--our children.” The program is designed to support the important role that teachers and mentors can play in how adolescents consider drug use: "If you get mentors in the schools telling kids about their potential, about what education is about, the fact that they're loved, about the fact that they've got great potential-- that changes everything," he said.
One such program is “Five Minutes for Life,” wherein highway patrol representatives visit school sports teams and talk to student athletes for a mere 5 minutes about making responsible choices concerning drugs. Students are then recruited as ambassadors and given resources to communicate key points of an anti-drug message to their peers via social media. Gov. Kasich expressed frustration over the fact that many schools are unwilling or unable to participate in such programs, noting that schools in the US today are busier than they have ever been. He said that it is high time that schools across the nation, including higher education, need to commit to implementing such programs: “We really have to ramp it up.”
In response to a question concerning the defunding of two national anti-drug programs for adolescents, Kasich said, "we don't need to give a school teacher money or training to tell kids, 'Don't get on drugs,'" he said. "If someone can convince me that we need money, I'm willing to listen, but I haven't figured it out yet." While noting that the problems associated with addiction are complicated and demand intensive resources, Kasich also emphasized the vital (and free) tool of conversation within communities as a means of bringing the issue to the table and giving students space to talk about it.
In response to a question concerning whether or not first responders should be armed with and trained to use the overdose reversal drug Naloxone, Kasich noted that the drug is used in Ohio but failed to say whether or not he would recommended it as a national imperative, “I need to understand it more -- but whatever is needed.” Throughout his speech, Kasich was insistent that there is not one state in this country with time to spare: “It doesn’t mean we can’t have priorities at the federal levels, but folks, we keep waiting for Godot to come into the room. There is no Godot. It’s on us...This is a curse upon America that has to be destroyed and we’ll never beat it all, but we can make tremendous gains if we are really focused.”
Gov. Kasich joined many of his fellow speakers when he identified addiction as a disease rather than a moral failing, and echoed others when trying to communicate its undiscerning impact: “This disease knows no bounds, knows no income, knows no neighborhood, it’s everywhere.” His cutting reminder that the disease of addiction is not new prompted a true moment of quiet from the audience: “I wonder how African Americans must have felt when drugs were awash in their community and nobody watched. Now it’s in our communities, and all of a sudden we’ve got forums -- and God bless us, but think about the struggles that other people had.” At one point Kasich spoke directly to those present who had struggled with disease of addiction: “You cannot give up, because there's a purpose to your life, do you understand that? Everybody in this room has a God-given potential to do something to change this world. I have no clue how hard it must be, but if you can climb out of it, people will learn from you.” Kasich spoke about his religious faith to help those suffering from addiction as well as their family members: “I don’t mean to offend anyone, but I believe strongly in this.”
Nearing the end of his speech, Kasich gestured again to the spot where Ms. Nickel stood: “You look at Jessica and you have to believe in miracles. And just because a miracle happens to her, doesn’t mean all the miracles are used up. There’s always…” Kasich paused and became choked up before continuing “...there’s always room for one more.”