Jim McClelland, who leads Indiana's efforts to fight the opioid epidemic, acknowledges the state has been slow to spend federal funds earmarked for the crisis. But that was to get it right, he said in a recent interview.
“It took longer to roll some of that out than might have been desirable,” he said. “We've got a problem here that took 20 years to develop,” said McClelland, Indiana's executive director for drug prevention, treatment and enforcement. “There's no instant solution to it.”
As The Journal Gazette's Ron Shawgo reported recently, during a one-year period that ended in April, Indiana had spent about a quarter of its $10.9 million allocation for fighting opioid abuse. An Associated Press analysis of the use of funds from the 21st Century Cures Act passed by Congress in 2017 revealed that states such as Indiana that had accepted Medicaid expansion dollars have generally been slower to spend that money. That's because Medicaid funds had already allowed them to “go beyond the basics.”
Indiana, though, had farther to go than most other states. It is among those states with the biggest problems from opioids, and the least effective response systems, as noted in a recent report from IUPUI's Richard M. Fairbanks School of Public Health (also discussed on the facing page). AP reported Indiana's rate of spending Cures Act funds lagged even among those 33 states where Medicaid expansion had occurred. Through April 30, the state spent $2.47 million – 24.9 percent of the money allotted.
In an interview this week, McClelland said Cures Act funds are being distributed much faster now. “When we got into this, we just did not have anywhere near the treatment infrastructure that we needed to respond to a crisis of this magnitude. You don't just flip a switch and make that happen.
“What appeared to be a slow rollout of the Cures Act grant in its first year was largely a result of our desire to take a strategic approach and build a well-thought-out infrastructure that could be sustained,” he said. “Our interest is in spending money wisely rather than just spending money fast.
“We did not lose a dollar by doing that,” McClelland continued. “All of what was unspent the first year carried over to the second year.” In fact, he said, the Cures money is just a portion of the resources the state is marshaling against its worst drug epidemic. The original Cures Act allocated another $10.9 million for this year; the omnibus opioid-fighting bill that became law in October will make the same amount of money available to Indiana each year through 2023. And Indiana will receive additional federal grants of $18.1 million this year and next.
McClelland said the state has used Cures funds to train medical professionals to administer medically assisted treatment with buprenorphine; to create mobile-response teams for rural counties; to distribute the opioid antidote Naloxone; and to launch an anti-stigma campaign called Know the O Facts.
In addition to its support through Cures, the federal government has given Indiana a waiver allowing the state to spend more of its Medicaid funds on a wider range of assistance, including as much as 30 days of residential treatment and some types of recovery-support services – the kind of sustained therapy that can help victims overcome opioid addiction and get back on a path to a normal life. That may mean as much as $80 million a year targeted at the epidemic, McClelland said. Meanwhile, Fort Wayne is one of several sites around the state the legislature has approved for pilot programs to add treatment beds. Locally raised funds will be used to match a $1.5 million state grant.
If that seems like a lot of money, consider the costs in deaths and devastation to families, and the economic cost to Indiana, which the Fairbanks School estimated at $43 billion over the past 15 years. There are a few signs of progress statewide, such as dropping opioid prescription rates and a reduced number of visits to emergency rooms this year, according to McClelland.
“Unfortunately, there are no quick solutions,” he said. But the state is quickly resolving how to best spend the windfalls of opioid-crisis-related funds.
“I don't think,” McClelland said of the slow start to spending the federal dollars, “you'll see this problem, going forward.”