INDIANAPOLIS -- The mounting financial costs of Indiana's opioid battle may never lead to a clear victory but will prevent some families from paying the ultimate price for drug misuse, officials say.
"The financial cost pales in comparison to the cost to humanity and the cost to lives and families," Gov. Eric Holcomb said. "Unfortunately, we're all getting to know people personally who have struggled or even lost the battle with substance abuse."
On Friday, the governor's office released to CNHI News Indiana a summary of state and federal funding over the past year to fight the opioid crisis in Indiana:
• $5 million in state funds provided last General Assembly session for pilot programs
• About $100 million in state funds directed from state agencies to fight the epidemic
• $10.9 million from a federal 21st Century Cures Act grant. Part goes to Naloxone kits for health departments, and part was earmarked for the expansion of residential detox programs for juveniles leaving detention.
• With approval of the Healthy Indiana Plan (HIP) 2.0 waiver extension, an additional $60 million to $65 million in federal funds to support state efforts
Indiana is among 10 states that have filed a waiver to federal rules that would allow it to continue a state alternative -- HIP 2.0, in Indiana's case -- to the Medicaid program.
Millions needed for crisis
In 2016, 785 of Indiana's 1,518 drug overdose deaths were related to opioids. Six years before, just 283 of 923 overdose deaths in the state were opioid-related, according to the Indiana State Department of Health.
Some state program monies are co-mingled with Medicaid, federal block grants and even Veterans Administration funds. Many state-issued contracts for services use a mix of state and federal funds. Some address addiction treatment and counseling but don't specifically mention opioids.
One estimate of the funding necessary to end the Indiana opioid crisis is $250 million.
"First off, there are a couple hundred thousand addicts, at least, in our state," said State Sen. Jim Merritt, R-Indianapolis, considered one of the Statehouse leaders in tackling the opioid epidemic. "If we were really going to attack this and eradicate it in Indiana, that's when you get into the quarter-billion dollars."
He was among a group of speakers on the first weekend in January discussing the crisis at a forum hosted by the Carmel Interfaith Alliance.
There, Hamilton County Coroner John Chalfin said his office saw 36 opioid-related deaths in 2017. Six others were pending.
Chalfin has noted a rise in opioid deaths in rural areas in the northern end of the county around Sheridan and Cicero. He has talked with a local court and other officials about coordinating programs.
"What we need to do is try and consolidate and get a unified front," Chalfin said. "I see an awful lot of money around the state being dropped on needle exchange programs, so on and so forth. Here's a drop of the money here, here's another one here, and this pilot program and that pilot program."
Under Senate Bill 139, authored by Merritt, county coroners would be required to gather more data if they suspect a person has died from an accidental or intentional overdose of a controlled substance and then report test results to the state health department.
Human costs
Indianapolis mother Justin Phillips' son, Aaron Kent Sims, 20, died of a heroin overdose in 2013. Phillips, who founded the non-profit Overdose Lifeline, often speaks of the stigma felt by families dealing with substance misuse.
"When Aaron acknowledged to me that he was struggling with heroin and he needed help, I didn't go to work and tell my co-workers. ... I kept it to myself," Phillips told Carmel forum participants.
"Because we keep it to ourselves, I believe we don't seek treatment as rapidly and effectively as we would had he been diagnosed with cancer."
The death led to Aaron's Law, which allows Hoosiers to obtain prescriptions for Naloxone, a life-saving drug, if they believe someone is at risk of overdosing.
Overdose Lifeline also reflects some of the complexity in funding for the opioid battle.
The agency has five active contracts with the state totaling more than $520,000, according to the Indiana Department of Administration website. Some of the money is earmarked for teaching parenting and life skills.
Under one contract, the agency received up to $250,000 from federal sources to introduce opioid abuse programs in schools. The contracts run through June and are administered through the Indiana Family and Social Services Administration's Division of Mental Health and Addiction.
Also, Overdose Lifeline received $75,000 to train emergency responders in 44 counties to use Naloxone.
Other contracts for organizations fighting the opioid battle are similarly complex.
The Porter County Substance Abuse Council has a $238,000 contract, running through June 2019, using federal grants through the the Indiana Family and Social Services Administration. The grant is designed to handle two issues: underage drinking among people from 12 to 20 years of age and prescription drug misuse among people 12 to 25.
In mid-December, Holcomb said there might be no clear end to the opioid battle. He looks forward to a time when the trajectory in the number of overdoses begins to decline.
"This fight will never be won," the governor said. "I think we’ll know we’re on the right path when more folks who are struggling with addiction and mental illness are not just seeking recovery and treatment but are on and stay on the road to recovery."