https://www.ajmc.com/focus-of-the-week/some-question-ad-buy-but-christies-battle-against-opioids-leaves-a-mark
Some Question Ad Buy, but Christie's Battle Against Opioids Leaves a Mark

Mary Caffrey

If you watched television in the New York or Philadelphia area during the holidays, the ads were hard to miss: New Jersey Governor Chris Christie, surrounded by families clutching photos of lost loved ones during a candlight vigil, implored those addicted to heroin to seek help, while a phone number and website for the “ReachNJ” hotline appeared onscreen.

It was the kind of “aggressive television and social media outreach” that a Christie-led commission imagined last fall, when it gave President Donald Trump a report with 56 recommendations for fighting the nation’s opioid crisis.

So far, there’s been no opioid media blitz from Trump. At home, meanwhile, Christie’s campaign has brought mixed reviews, even though the numbers show it works.

As Christie leaves office tomorrow, the episode encapsulates his uneven success at repackaging himself as the opioid-fighter-in-chief. In the past year alone, Christie has passed key legislation to compel insurers to cover treatment, directed more than $200 million into programs related to the epidemic, and secured a Medicaid waiver tied to a broader CMS policy change, which will help other states. His attorney general sued the maker of OxyContin, and he took aim at the relationship between prescribers and pharmaceutical companies, among his state's largest and most powerful employers.

And yet, what the nation likely remembers of his 2017 crusade is his scorched-earth battle with an insurance company. It caused him to shut down the state’s beaches on the July Fourth weekend—except for the one at the governor’s residence, where he was famously photographed sunbathing with his family.

One advocate on the front lines of the heroin epidemic believes Christie has done more good than most people realize.

Kevin Meara of Hamilton, New Jersey, plunged into opioid recovery advocacy after the death of his son, KC, in June 2008, and said Christie’s work will have lasting effects. “The main thing is the awareness, and that has a lot to do with the ReachNJ campaign. We’ve been doing this for 10 years, and when we first started you couldn’t get a letter to the editor in the newspaper,” Meara said. “From my vantage point, it’s been very effective.”

Meara believes that work done by the legislature early in 2017, led by Christie and a Democratic state senator, Joseph Vitale, is starting to bear fruit: the key elements of that 30-day legislative blitz capped opioid prescriptions at 5 days and required insurers to fund 6 months of care, including an initial 28 days when inpatient treatment cannot be denied. It will take time, Meara said, for policies to trickle down to the “street level,” where they reach those working to help people with addictions get ongoing care.

As recently as September, Christie unveiled another $200 million in new spending that included funds to address opioid treatment in prisons, among pregnant women and new mothers, and college students; funds went to address holistic mental health services, supportive housing, recovery coaches, naloxone, and substance abuse navigators—staff who help connect people with services.

For Meara, however, a major high point of the Christie era is the change of tone in law enforcement. While attitudes in healthcare and schools can be slow to change—“Can you imagine being told to wait a week if you’d had a heart attack?”—New Jersey law enforcement “is way ahead” in the way it approaches a person with an addiction, Meara said, with more focus on recovery coaches to get people into treatment when they are ready to go. That’s already leading to fewer repeat treatments of naloxone, he said.

Christie has been praised for his expansion of drug courts. The conversion of a shuttered prison into an inmate treatment center is a huge step forward, Meara said, and, coupled with his approach to criminal justice reform, has won the governor praise from some of his harshest critics.

The challenge now is relapse prevention, which will require treatment services that are more customized to identify people with mental health conditions beyond an addiction, Meara said. Some people need to stay in the hospital for medication-assistance treatment, he said.

A final year push. Christie headed into his final year of office bruised from his 2016 presidential effort; spurned by a president for whom he offered early, crucial support; and buffeted by the images of 2 former associates given prison sentences over a 2013 campaign stunt gone awry, in what became known as Bridgegate. Christie vowed to focus on the opioid crisis, which had become his signature issue when people in New Hampshire responded to his story of a successful law school classmate who spiraled to an early death from painkillers and heroin.

New Jersey’s status as a corridor state makes it a hub for trafficking, and the opioid and heroin crisis continues to claim lives at a breakneck pace. In September, the state’s largest media outlet, NJ Advance, mapped out the deaths of 1901 people in New Jersey in 2016, which was more than twice number of New Jerseyans lost in the September 11, 2001, attacks.

Even as Christie leaves office, there’s a bit of unfinished business for his successor, Democrat Phil Murphy. According to several media reports, the $42 million Christie has budgeted for the ReachNJ campaign will run well into 2018, and Murphy will have to decide if the outreach continues. (While Christie's staff told reporters he was not set to appear in ads after he left office, several were seen on the night Murphy was inaugurated. Some ads were made that do not include Christie.)

With Christie’s approval ratings at 13%, some suggested the heavy spending on ReachNJ gave the governor a late image lift. But data released by his office tell another story: the ads work. A wave of ads ran in the spring, then stopped, and a late wave ran in December. Numbers show that calls to the ReachNJ hotline nearly quadrupled from the lull in July to September, when no ads were running (28 calls a day) to December (82 contacts per day). During a particularly busy week in late December, most who made contact said they saw the ads on TV.

Meara said no one should underestimate the value of the bully pulpit. But as he has told the governor, “it can be a double-edged sword.”

“If we’re only ready to treat 1 out of 10 people who need help, what happens if now 2 out of 10 come in?” Meara asked.

Medicaid ruling. After his son died, Meara and his wife, Maryann, worked with a small board to start City of Angels, which works to fill the gap in services for people suffering from addictions and their families. Meara said that today, people with commercial insurance can typically get placed in treatment in a day—the assessment process in now done over the phone. For people who are uninsured or have Medicaid, it’s always been harder. And Meara, who met with the Obama and Trump administrations on this issue, credits Christie with fighting to change the policy.

Like several other states, New Jersey had petitioned CMS in early 2017 for a 1115 Medicaid waiver that would allow federal funds to be used for those seeking substance abuse treatment in facilities with more than 16 beds. On November 1, 2017, New Jersey and Utah were not only granted approval for their demonstration projects, but CMS also issued a letter that went farther than a 2015 directive in encouraging states to apply for demonstrations to bypass the decades-old rule and expand the availability of treatment space.

“CMS’ approval of New Jersey’s Medicaid Demonstration will remove a decades-old federal barrier so that thousands more New Jerseyans with the disease of addiction will have access to treatment and recovery,” Christie said in the statement.
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