opinion | 12 Americans die from an overdose every hour. We have the knowledge to stop this.
“Our bill makes it clear that any savings arising from the merger will be reinvested in the system,” says Senator Harkham. “But unions, in particular, are the target of war, and it’s hard to blame them.” Governor Cuomo reduced the Office of Addiction Services and Supports, or OASAS, by about 150 terms during his tenure. Gov. Kathy Hochul has taken steps to address that loss — allocating $402 million in new funding to the agency and appointing a new commissioner to head it. But this welcome development also presents a challenge to the merger movement. “This is the first time in forever that OASAS is getting a boost rather than a cut,” Senator Harkham’s legislative director, Joel Fawcett, told me. “The instinct is going to be to hold onto that, not to risk it in a merger.”
There’s also a matter of history: OASAS was founded in 1992, when alcohol and substance abuse services were spun off from a separate, larger agency and merged into a new entity. Philip Steak, chairman of the Assembly Committee on Alcohol and Drug Abuse, says the whole point of that restructuring was to reform the state’s addiction treatment system by separating it from everything else. “When it was part of a larger agency, substance abuse was neglected,” Steck told me. “People who now want to mix addiction and mental health are forgetting it.”
Mr Steck agrees that the current setup – mental health in one agency, addiction in the other – does not meet the needs of people suffering from both. But he and others say there are faster, more cost-effective ways to fix this than trying to ditch two big agencies at once. For example, his own proposal is only to “infect” more mental health services in the 12 addiction treatment centers that OASAS has already presided over. He said the move would not only lead to more integrated treatment for people who coexist, but would also help increase the workforce, as state facilities tend to pay more than nonprofits. “The idea of a new behavioral health department seems very progressive,” Mr Steck said. “And I’m not saying it should never happen. But it can take 10 years to rebuild a system like this, and we have people suffering right now.”
Those are reasonable concerns, but for Mrs Marquesano and the hundreds of advocates and officials who agree with her, the time for partial reform is too early. “We’ve been begging for 21 years to further integrate and coordinate these systems,” said Paige Pearce, a parent-advocate and chief executive officer of the nonprofit Family Together. “Oppositions keep insisting that merger will not work. But what we have now isn’t really working and hasn’t worked for decades.”
The central government is also ready to accept it. This spring, the Office of National Drug Control Policy unveiled a new, “Whole Government Approach to Beating the Overdose Epidemic.” The National Drug Control Strategy, as it is called, includes billions of new funding for evidence-based treatment initiatives, a renewed commitment to tackling drug traffickers and “to better use data to guide all these efforts.” Includes plan. They are welcome developments, but for the wider effort to succeed, authorities at every level must grapple with a roster of deep flaws in the country’s approach to addiction. Laws have to change: Some of the drug-war-era statutes need to be repealed. Others focusing on similar insurance coverage for behavioral health conditions need to be better implemented. Agencies will have to be reorganized so that the false distinctions between addiction, mental illness and other drugs can be completely eradicated. And funding streams will have to be reworked so that they support, rather than hinder, evidence-based practices.
However, for this to happen, policy makers and advocates must overcome the same apathy and inertia that have thwarted decades of previous reform efforts. And the rest of us will have to face our enduring ambition about what addiction really is and what those suffering from it need and deserve.