Fighting Back Against the Opioid Crisis

David: If the opioid crisis has taught us anything, it’s that addiction doesn’t discriminate. What are the next steps we can take at the state, federal, and personal level to turn this tide? I’m David Condos and we’ll discuss this with Chris Christie on this episode of Recovery Unscripted.

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David: On a February night in 2016, Americans tuned in to watch a key debate in the contest for the Republican presidential nomination. The critical New Hampshire primary was just three days away and the seven remaining candidates were all jockeying for ways to stand out in a crowded field. While most viewers were probably already familiar with Chris Christie is the 55th Governor of New Jersey, his performance that night served as a prototypical crash course on the brash style of rhetorical combat he’d become known for no matter what you thought of his platforms or his motives. As you watched him call out other candidates on that stage, one thing was clear, this guy is not afraid to start a fight.

Beyond the passing campaign, adversary or debate opponent, Christie has spent much of his two decades in public service locking horns with a foe that presents an even more uphill battle than seeking the country’s highest office, seeking to change our country’s response to addiction. This isn’t just an issue that he piggybacked on to get some votes. When I talked with him about the ongoing institutional failures that have fueled the opioid crisis and the ways he’s personally seen addiction ruin lives, I got a sense that he really does care about this in a way that’s increasingly rare among the national political class.

It was no surprise to learn that his personal crusade against the ravages of addiction dates back to a time before the spotlight found.

Chris: What struck me all the way back in 1995, I was a county official, 31 years old, the youngest county official on the team and I got assigned the Human Services portfolio. One of the folks who asked me to come and visit them was a guy named Fr. Joe Hannon, who ran a small inpatient adolescent drug treatment facility in our county called Day top Village. When I went there they were housing this in one building on the property of a group of nuns who had donated the property to them. The roof leak, the plumbing leak, it was just in a disastrous condition. I went took a tour around this place and I got to tell you, I wasn’t all that impressed. At the end of it Fr. Joe walked me outside and he said to me, “I’m so glad you came today, Chris and I know that you’re going to be really involved with us.” I was young, I looked at him and brushed, and I said, “Father, really, after all this, why do you think I’d be involved with you?” He grabbed my arm and he looked at me and he said,”Because Chris, this is where God makes miracles happen on earth.” From that moment on I was hooked, hooked by the idea that people’s lives can really change, that their own efforts play a role in that, that getting the right treatment plays a role in that, that also God plays a role in that as well.

Because I’ve always believed that every life is an individual gift from God and that no matter what condition we find that life we have an obligation as human beings to try to help those folks. I think the people we see suffering right now through the opioid crisis in this country are some of the most at risk people we have and we need to protect those lives also. That’s what initially got me involved are a number of other things that happened during the course of my career that made that beginning even more acute but that was where it started with Fr. Joe Hannon in data village.

David: Yes. Then, of course, you served as governor in New Jersey from 2010 to2018 which was really a time period when this epidemic was snowballing all across the country. What did you see during that time that gave you an idea of how this crisis started and then some of the failures that really caused it to become so bad nationwide?

Chris: Well, we put an emphasis right from the beginning even before the opioid crisis was a story nationally, because of this background that I talked to you about. We put an emphasis on increasing money for drug treatment availability for folks who couldn’t otherwise afford it. What that I thought required me to do was to travel around the state to the drug treatment facilities that I was helping to fund and get to know the people who ran them, get to know the people who were going there and getting treatment and how it was going. Back as early as 2010 and 2011 what I was hearing when I went to these facilities were that the overwhelming majority of people in the facilities were heroin addicts.

I couldn’t understand why that overall majority were heroin addicts and people started to teach me that they started almost all of them, started on prescription medication, started on opioids. That after their prescriptions ran out and they couldn’t get them through a doctor any longer they were too expensive to buy in the blackmarket and heroin was much cheaper. You had folks who started off doing what they thought they were supposed to be doing, which was taking a prescription drug at the direction of a doctor who sometimes literally within months were on the street buying injectable heroin and became what we would call back when I was growing up in the 70s in the 80s junkies.

It was extraordinary for me to see and I knew that the problem was growing. I didn’t realize how exponentially it was growing at that point but that became pretty clear tome. The second part was that I had a personal experience with a good friend of mine, one of my best friends from law school, great looking guy, better grades than all of us, married a beautiful woman doctor, three beautiful daughters, a partner in a law firm and also an avid athlete, he was a runner. During one of his runs, he hurt his back. He wasn’t paying attention. He was dealing with his iPhone and he stepped into a pothole and wrenched his back and he was in the midst of getting ready for trial.

He went to a doctor, he said, “Listen, I can’t take some time off here to be treated,I’m going to trial, just give me something to deal with the pain and he started Percocet. When his journey ended he had lost his job, lost his driver’s license, lost his license to practice law, been divorced by his wife, barred by the court from seeing his children. He had gone through almost all of his savings, all of his liquid savings and through almost all of his retirement savings. Ultimately, we got a call on a Sunday morning that he had been found in a motel room in West Orange, New Jersey, dead at 52 years old, with an empty bottle of Percocet and an empty quarter vodka.

This was not somebody who was a casual friend, this was someone I grew up with. We grew up together, we became lawyers together, we got married together, we raised families together. By every definition of success in this country, you would have deemed this guy success and none of it mattered. Because once he got hooked on this stuff, he had the type of personality who even through aggressive treatment couldn’t be helped and no matter how hard we tried to help him, we couldn’t. That’s when I understood acutely that this is a disease. It’s a disease like heart disease, like diabetes, like cancer, that needs to be treated and the people who have this disease don’t need to be ostracized. They don’t need to be judged, they need to be helped. We tried to help my friend and we couldn’t. When I sat at that funeral that day as the governor of New Jersey, I thought to myself, I’ve done some stuff but I haven’t done nearly enough. It was at that moment that I decided to double and triple my efforts inside the state to try to change what was going on. I think that happens when you have someone who is that close to you, who you lose despite all your best efforts in the best efforts of your friends and his family.

David: It really shatters that junkie stereotype in the 70s and 80s.

Chris: It totally, totally shattered. I think one of the biggest problems we have in this challenge is to convince people to eliminate the stigma. It reminds me very much of the AIDS crisis in the 80s. In the beginning of the AIDS crisis, we had folks who called it the gay plague. It was a sense that these folks were getting what they deserved for what was considered at that time to be deviant behavior. They were wrong about that but despite that, that stigma kept pharmaceutical companies away from trying to find treatments. It got the government to ignore it to a great extent. It wasn’t until people started marching in the streets and I remember those marches in state capitals, in big cities, in Washington. Where they’re demanding that the Reagan administration do something through National Institutes of Health and otherwise to try to find a treatment, that too many people were dying. Well, just to keep it in perspective, 72,000 people died of drug overdose in 2017 in the UnitedStates. Not only is that more than the folks who died at the hands of gun violence and automobile accidents combined in America but it’s also more than ever died in any single year from the AIDS crisis, yet we have no marching in the streets. Why is that?I think it’s because parents, spouses, children, are shamed. They think it reflects upon them if they were a better son or daughter, a better husband or wife, a better mother or father, that their loved one wouldn’t have this problem. We need to stop people thinking that way because when they do, then the government will respond even more and private industry to what we need and there’s lots of ways they can help to fix this.

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David: In the face of staggering statistics, cultural stigmas and political gridlock it can seem overwhelming to think about actually turning back this wave of opioid use that swept over America. It’s a huge challenge with a whole bunch of correlated challenges wrapped up inside of it, ranging from how our criminal justice system treats those with addiction, to how our society views pain itself. If this current crisis got it start in the doctor’s office, maybe that’s one good place to begin finding meaningful, large scale solutions.

Chris: We pass the most strict law on opioid prescribing in America and New Jersey in March of 2017 at my initiative. No more than five days worth of opioids in your initial prescription and if you want a renewal of that prescription, you have to go back and see the doctor, the doctor has to see you to renew it, you can’t just do it over the phone. What’s happened? Opioid prescribing in New Jersey in one year has gone down 28% with that amount to 4 million fewer pills were prescribed in New Jersey in one year because of this. Think about what that means, 4 million in just one state because of these restrictions.

It’s one of the things that we’ve said should be instituted across the country. The President gave me this great opportunity to be chairman of the commission and along with Governor Baker and Governor Cooper and former congressman Patrick Kennedy who was himself in recovery. We traveled the country, we visited veterans hospitals, we visited other treatment facilities. We had pharmaceutical companies come in and testified before us. What resulted from that was a report that gave the President 65 recommendations of things that could be done to change this situation and help the problem.

One of the first things you need to know is that it’s a disease and we don’t have nearly enough treatment beds in this country to deal with the people who need treatment. We recommend the changes to Medicaid to make treatment more available to the poor, to the chronic poor and also significant changes the way insurance companies deal with covering this for those who do have insurance. Because insurance companies generally in our experience were looking for ways not to pay rather than to pay. Changes in the way the FDA is reviewing drugs that are non-opioid painkillers.

We brought together a team of all the CEOs of the major pharmaceutical companies and the National Institutes of Health have now offered them a challenge grant to match whatever they would spend to try to develop more non-opioid pain killers.Emphasizing to Medicaid and Medicare that they need to approve payment for non-opioid drugs because remember, there are still people who are in chronic pain and we need to deal with that. We just can’t say no opioids and the green powder

David: We need to give them alternatives.

Chris: We have to give them alternatives. More intervention in terms of stopping Fentanyl which is the next generation of opioid, synthetic opioid mostly coming from China, that are mean country and killing people and alarming rates are so much stronger than the natural opioids. Increasing the budgets to the Postal Service at to customs up protection of border patrol to try to develop new detection devices to stop this flow from coming into our country. We needed to do that as well and I think we also wanted to look at providing treatment to those who are already in the criminal justice system.

In New Jersey, for instance, one of the things– two things we did one, people are no longer jailed for first-time nonviolent drug offenses as long as they’re not dealers. Instead, they’re sent to treatment, mandatory treatment. The other thing that we did was because of some of the criminal justice reforms we passed in New Jersey, we were actually closing state prisons, something that you don’t hear of happening in the country all that often. One of the state prisons we’re going to close my idea was let’s turn it into a treatment facility. and it’s now turned into the first ever in the country, state prison treatment facility.

Where in the last year of your sentence, if you present with a drug addiction or alcohol addiction problem, you’re sent from whatever prison you’re in to this facility, which is run by a private firm at contract with the state that provides state of the art treatments to these folks including medication-assisted treatment, which we think needs to be much more broadly available to folks. All those things are now available to someone before they walk out the prison door because believe me if they walk out still addicted, they’re going to be back in there pretty soon.

David: Right? We’ve mentioned kind of the pharmaceutical companies role in this a couple of times. What kind of responsibility do you think they bear as far as like finding a solution and being a part of what makes us better?

Chris: Well, there’s not a one size fits all on this, right? Many of the major pharmaceutical companies weren’t involved in marketing or developing opioids.There’s two different levels of responsibility first for the opioid producers. I think we are seeing them be sued all over the country and I think the reason for that is that they put their profits ahead of people’s health. We sued Purdue Pharma in New Jersey while I was governor and that lawsuit is continuing and I think they need to beheld responsible for the cost. They made a huge profit and they didn’t care whether or not they were addicting people in the process and they need to pay a price for that and I think they will.

The other part of it is the other pharma companies kind of sat back and said, “Not our problem, we don’t market opioids, we don’t use R&D money to develop new opioids, it’s not our problem, it’s the other people’s problem.” What we’ve convinced them now for the President’s Commission is it is their problem. It’s their problem, because they have a civic responsibility to develop two different types of new treatments. One would be non-opioid painkillers as we mentioned before and two we mention medication-assisted treatment. Right now, there’s only three drugs on the market that are FDA approved, that can be used for medication-assisted treatment but we need more options.

There are ways to do this and to do it in a way that can be we would hope, at some point permanent, to be able to get an inoculation and to be able to have it be blocking those sensors in the brain that send the signals to crave opioids. Pharma companies, I think have an obligation to do that and by the way, as I suggested to them, it’ll be profitable to– there’s a lot of people, unfortunately, who are addicted in this country and a lot more to come. The other thing from the commission that has happened is we urged every educational institution in the country from our public K-12 schools to our universities to have no lock zone on their campus that’s Narcan.

A drug that’s used to reverse overdose deaths, two squirts into their nose of Narcan for most of them can bring them out of the overdose and bring them back to life. The maker of Narcan Avid pharmaceutical has said they’re going to make this available at a reduced price to every educational institution in the country. That’s going to save thousands probably 10s of that thousands of lives.

David: Christie didn’t want to give up on this cause just because his role in government ended in 2018, not with so much work left to be done. He decided to get involved even more directly with some of the treatment providers who are meeting this need as the new executive chairman of Beach House Recovery Center. After having a front row seat with the opioid commission to view not just the full depth of the drug crisis but also the deception and fraud within the treatment industry. It’s not surprising that he chose to make his next move in a state that had more than its share of rehab con artists.

Chris: Florida, as you know, has a mixed record in the area of treatment and there’s been a lot of facilities that have turned out to be not folks who are really helping people but just looking to make a profit. Beach House is one of those places where they’re putting helping people first. Families are desperate. They’re desperate and they’re scared and they don’t know what to do. Going to a place like Beach House Recovery Center helps to give them the tools to understand what they need to do to help their loved one who is suffering from this disease.

David: What do you hope that those on the front lines working in addiction treatment take away from your presentation here at the conference?

Chris: That leaders across the country are finally getting it. That they, who are on the front lines of treatment, have understood it for quite some time, but either had been ignored or just not heard, but that, through the efforts that I’ve tried to make as governor and as chairman of the commission, that this is now a front-burner issue in this country because of the deaths of so many people tragically. Families are beginning to speak out and that they’re the ones on the front lines of treatment who are going to save lives. They’re the ones who are going to defeat stigma. They’re the ones who are going to bring the new cutting edge technology to a broader group of folks to be able to stop the disease in its tracks.

We have a lot of work to do. I assume, in 2018, deaths will continue to go up, but I’m hoping that in 2019, we’ll begin to see a leveling off of that because of the efforts that Congress and the president are making now, because of the efforts of private treatment providers and folks who really care about this issue and state governments across the country. I can tell you, there’s not a governor that I spoke to, Republican or Democrat, all 50 states, who isn’t affected by this problem. They see it. They’re going to the funerals. When you’re a governor, you almost certainly will wind up at a number of funerals a year of constituents who died from an overdose.

You have to sit there and look at those families, those moms and dads and husbands and wives and sons, and daughters who have no choice now but to deal with the tragedy of having lost a loved one to this disease. I hope that the folks on the frontline realize how indispensable their work is and how there are families all across the country that they’ve helped, who have their loved ones back and who can never amply say thank you. Hopefully, the lives of those people who they saved live will be able to be testimony to the goodness of the work they’ve done. I hope that that inspires them. I’m sure their work inspires them and I hope that they know that there are leaders across the country who now notice and want to make a difference.

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David: Chris Christie is a former US attorney, governor, presidential candidate and chairman of the White House Commission on Combating Drug Addiction. To read the final report of recommendations that this commission delivered to the president, just click the link in this episode’s description. As always, this podcast is powered by Foundations Recovery Network and is produced, written and edited by me, David Condos. If you could take a second to share this episode or leave us a review on your podcast app, I’d really appreciate it. Thank you for listening and I hope to see you right back here for the next episode of Recovery Unscripted.