View from the Hill: One Step Forward, Two Steps Back

Over the last few years, the advocacy community in Washington, D.C that works on substance abuse issues has scored some tremendous victories. In 2008, more than a decade of work came to fruition when the Wellstone/Domenici parity act was passed. In 2010, we celebrated as the Affordable Care Act was passed, inclusive of not only parity, but also of the treatment of substance abuse as an essential health benefit. Millions who were previously discriminated against for no other reason than they had a disease could now access treatment and care for their affliction. By one estimate, close to one-third of the newly covered 32 million Americans under the ACA are in need of substance abuse and addiction services.

Yet in our ongoing fight to convince lawmakers that addiction is a disease, that substance abuse touches all sectors of the population and people from every race, religion, creed and socio-economic strata, we appear to still have fallen short. We know full well that we face an uphill struggle, fighting decades, if not centuries, of stigma and discrimination. Many still view those in need of treatment (but apparently not worthy of it) as poor, lazy, weak and in need of being taught a lesson. While we have our champions in congress, such as Rep. Karen Bass or Rep. John Sullivan, too many members of congress continue to write legislation that advances outdated stereotypes, ignoring science and unbiased evidence in the process.

The economic and political environment in Washington is undoubtedly toxic, and as a result, not much gets done. When nothing is done for long periods of time, larger pieces of legislation become necessary in order to provide stopgap measures that our country’s economy desperately requires. Yet the larger the bill, the easier it is for members of congress to attach smaller policies that can “fly under the radar,” because few politicians will risk voting against such vital legislation over more marginal issues. As is becoming annoyingly customary, the appropriations process this year went long past the required statutory deadline of September 1 (hence the need for so many continuing resolutions). In the end, after five continuing resolutions passed in order to avoid a government shutdown, 9 of the 12 appropriations bills were rolled into one, with close to a trillion dollars of our nation’s budget wrapped up in it. Called a “megabus” (because it was bigger than an “omnibus” bill, which generally holds two or three appropriations packages), it passed in late December and was signed into law.

What did not receive headlines or air time was an amendment to the bill that undid a major victory for our field that was less than two years old. Less than two years ago, advocates celebrated a tremendous victory as a ban on the use of federal funds in needle exchange programs was lifted, a ban that had been in place for more than 20 years (“Eye on the Needle,” Recovery View, September 4, 2009). Tucked deep into the megabus, in three separate places, was legislative language that reinstated the ban. In the Health and Human Services section, the ban was reinstated for programs in the United States. In the State Department/Foreign Operations section, it was reinstated for the funding of syringe exchange programs abroad. Finally, in the Financial Services section, the ban was reinstated in the District of Columbia, despite scientific evidence that syringe exchange programs there improved public health and saved the government money.

“Eight federal studies accomplished by bodies as diverse as CDC and the IOM have repeatedly shown that syringe exchange helps prevent HIV and does not increase drug abuse. New studies show that it also can prevent hepatitis C,” said Bill McColl, political Director at AIDS United. “Local communities have now been disempowered from making the decision to use federal HIV prevention funds on one of the best known means to actually prevent these diseases. The failure to scale up syringe exchange to prevent HIV and viral hepatitis has already cost the U.S. hundreds of millions of dollars and will run into the billions if this policy is not reversed.” McColl went on to add that Congress and the President must stand up to the anti-science rhetoric.

Another large piece of legislation getting much media attention was the bill that would prevent payroll taxes from increasing. Stuffed deep inside this bill was a provision that no one in the national media was talking about. Rep. Jack Kingston (R-GA) wrote into the law a provision that would allow states to force those who apply for unemployment benefits to undergo drug testing. In a press release, Kingston claims he was told by a small business owner in his district that half of all job applicants failed a drug test (an anecdote that is clearly exaggerated and unreliable.) This comes on the heels of Florida forcing such testing on welfare recipients, a law that has been challenged in the courts and could very soon be ruled unconstitutional. Further, in Florida, where it is estimated that 8% of the general population would test positive for illicit drug use, the first round of welfare recipients tested under the new law revealed that approximately 2% of those tested used illicit drugs, a rate four times lower than the general population. This proposal did not become part of the Senate’s version of the legislation, but will almost certainly be reintroduced in the current session of Congress. In anticipation of this, 14 senate democrats issued a letter in direct opposition to the policy. As George Washington said to Thomas Jefferson, “We pour legislation into the senatorial saucer to cool it.”

What such a provision does is advance the notion that those who abuse drugs are the lazy, the unemployed, the lower class or the less fortunate. As we know, nothing could be further from the truth. Addiction touches everybody, from all backgrounds and from all economic classes. The disease of addiction is not kept at bay simply by having a good, stable job. Yet that is exactly the mindset that such a provision advances. “Suspicion-less drug testing is an expensive and ineffective method of identifying people with alcohol and drug problems and getting them the help they need to get well,” said Pat Taylor, Executive Director of Faces and Voices of Recovery. “By singling out particular types of public benefits, drug testing proposals stereotype Americans who are unemployed and/or in need of public assistance during these challenging economic times. When it comes to unemployment insurance, individuals are eligible for benefits because they have been employed – and for a long enough period of time to be eligible. “

Many critics of this policy also cite it as singling out only one specific group of government benefit recipients, and the result is discrimination. “They want to make every one of their constituents urinate in a cup before they can collect unemployment benefits, a program that every American has paid into in case they need it,” said Bill Piper, National Policy Director for the Drug Policy Alliance. “In other words, they not only want people struggling with drug abuse to die, they want to treat every American as a criminal.”

“If the goal of these proposals is to make sure that anyone who gets a public benefit takes a drug test, executives of companies that receive tax credits and other benefits; taxpayers who take the mortgage interest deduction; students with government loans and grants; and other beneficiaries of public benefits should also be tested,” remarked Taylor.

Some find it odd that those who claim to be fiscal conservatives are the ones introducing these policies, since they end up costing states more money in the long run. “In both cases they’re wasting taxpayer dollars on failed policies,” said Piper. Taylor agrees. “These proposed policies are misguided, ineffective and waste precious taxpayer resources.

Despite all our advances and policy victories over the past years, we must be keenly aware of these efforts. They further discriminate against those afflicted with addiction and jeopardize our progress. We must continue to our effort to frame the debate around substance abuse treatment policy, one that is grounded in health, science and an expertise that is brought to the table by professionals, such as substance abuse and recovery counselors.

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