Addressing the Opioid Crisis at the Local Level

The largest social and economic crisis facing Ohio communities is the devastation brought on by the invasion of opioids and other drugs in the community.  Unfortunately, Ohio is a leader in drug overdose deaths with over 4000 deaths in 2016.  As the chart below from the Center for Disease Control illustrates, Ohio has the second highest ranking for drug overdose in the United States.

A call to action is clear to address this critical crisis facing state’s urban, suburban and rural communities.  Addressing the lack of drug treatment facilities is part of the solution to this challenge.  Communities looking to address this challenge must first build a public-private-partnership (PPP) with their regional health care leaders to focus on the need for new behavioral health and drug treatment centers.

The opioid PPP has four critical partners that include funding sources provided by the federal, state and local government connected with health care professionals among national or local not-for-profit or for-profit health care providers specializing in behavior health and drug treatment centers.  Financing must be connected with the health care professionals essential to the enhanced delivery of these services. It is the health care professionals that need to develop the financing model that involves direct grants and loans but also connects.  Hospitals, local mental health agencies or for-profit treatment centers are likely health care partners.

State funding, often through federal government resources are a prime source of financial support for local drug treatment centers.  Ohio will see an influx of $26 million in federal funding during 2017 to help fight the opioid epidemic through the 21st Century Cures Act. To secure up to $26 million a year for the next two years, Ohio Mental Health Addiction Services Department submitted a grant application through the State Targeted Response to the Opioid Crisis Grants program during February 2017. States and territories are awarded funds through a formula based on unmet need for opioid use disorder treatment and drug poisoning deaths. Ohio was notified of its award on April 24, 2017.  Ohio Mental Health  Addiction Services leadership elected to focus on several core principles in the application, including: medication-assisted treatment; prevention; Screening, Brief Intervention and Referral to Treatment (SBIRT); recovery supports; workforce devel­opment; and addressing secondary trauma among first responders (law enforcement, EMTs, fire personnel, etc.) In January of 2018, the FY 2017 funding was announced through this program for nearly 30 Ohio counties working to address the opioid issue.

Ohio’s biennial budget invested over $180 million to fund a variety of programs targeting addiction, including prevention and workforce development.  State General Revenue Fund (GRF) dollars allocated $2.6 million to prevention services are often distributed to county ADAMHS boards to subsidize the development and provision of community mental health, alcohol, and other drug prevention programs that meet local needs. $20.5 million in state funding is also provided through the Dedicated Purpose Fund (DPF), Statewide Treatment and Prevention Program. The DPF dollars provide subsidies to county boards for treatment, prevention, education, outreach, and early intervention services generated by revenue from driver’s license reinstatement fees and liquor permit renewal fees.

The federal government is a prime funder of opioid treatment centers. The Substance Abuse and Mental Health Services Administration (SAMHSA), under the U.S. Department of Health and Human Services (HHS), is the federal agency responsible for advancing the behavioral health of the country. The single greatest source of prevention funding in Ohio comes from the Substance Abuse Prevention and Treatment Block Grant (SAPT or SABG) awarded by SAMHSA. Over the 2018-2019 biennium, the Ohio Department of Mental Health and Addiction Services is set to receive nearly $132 million from this grant, which will primarily be used to distribute funds to local boards for prevention, treatment, and recovery support services. In FY 2018, Ohio Department of Mental Health and Addiction Services is distributing over $10.7 million for evidence-based and culturally appropriate prevention efforts to county ADAMHS boards on a per capita basis. Aside from the board allocations, ODMHAS directly awards the remaining federal block grant funds to community prevention and treatment programs such as the Urban Minority Alcoholism and Drug Abuse Outreach Programs.

The local taxing authority for each county or multi-county ADAMHS board is permitted to levy property taxes within its jurisdiction to support the board’s operating and programmatic expenses. 74 of Ohio’s 88 counties utilize property tax to fund local alcohol and other drug addiction services.  Tax rates for these levies vary significantly across the state, ranging from 0.50 mills in some counties, to nearly 3.00 mills in others. Unfortunately, many of the rural counties with the largest opioid challenges have the smallest amount of local funding through the property tax.  A recent Center for Community Solutions report found that the 14 counties that do not have ADAMHS levies at all, nine are located along the southern border of the state, where the opioid epidemic has been particularly deadly.

Tackling the opioid crisis at the local level is also tied to substantial public policy issues at the federal and state government to be an engaged lobbyist focused on a continual funding stream necessary to provide the treatment centers needed to address this major crisis