Governor Mary Fallin on How To Solve Oklahoma's Prescription Drug Epidemic
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As communities throughout the country struggle to find solutions for prescription drug misuse and growing opioid-related overdoses, Oklahoma Governor Mary Fallin has been one of the most proactive Republican leaders to address the crisis in her state. Governor Fallin has consistently championed drug courts and alternative sentencing for nonviolent drug offenders, such as "Women in Recovery," a diversion program that provides services and treatment for Tulsa women with alcohol and drug addictions. She has also worked to repeal mandatory minimum sentences for first and second drug offenses and reduce maximum sentences, earning her praise from groups such as Families Against Mandatory Minimums.
In your 2015 State of the State, you pointed out, “Oklahoma ranks at the top of the nation for prescription drug abuse.” Why do you think this is the case, and how can this problem be effectively addressed?
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Oklahoma has had a high rate of prescription drug abuse, and the rate of people in Oklahoma who die from overdoses from prescription pain pills stands at about 12 deaths per 100,000 people. Between the years 2007 and 2013, we know that 3 out of 4 unintentional poisoning deaths happened because of prescription drugs. As governor, I saw that as a problem facing the state, and I wanted to bring more public education attention to the issue. I also wanted to encourage the state legislature, along with our substance abuse and mental health agency, to try to address unintentional poisoning deaths from prescription pain pills.
Frankly, we want to encourage people to come forward that need help with addiction issues. A key part of such encouragement is education programs that raise awareness in the general public. Oklahomans need to see that there not only is a problem, but a solution as well.
Your latest state budgets are highlighted by what you describe as “performance informed budgeting” that focuses on dedicating funds to properly address the real problems of Oklahomans, like prescription drug abuse and the overdose epidemic. Are you breaking ranks with conservatives by dealing with these problems in a manner that focuses on treatment and recovery as opposed to enforcement?
There’s a great movement going on throughout our nation within both political parties, and I am very proud of Republican efforts to work on the substance abuse and addiction issue. I had the opportunity to speak with two of my fellow Republican governors on a panel about the great work being done in Kentucky and Georgia, along with Oklahoma, on how to effectively address prescription drug abuse and recovery efforts, particularly the use of drug courts and mental health courts. We are also working on prescription drug monitoring programs to help stop what we call "doctor shopping" in our various states.
I believe it’s a bipartisan issue that all people are interested in addressing. Addiction is not an issue that strikes one political party or persuasion. Of course, it has no boundaries as it relates to income, race, or socioeconomic standards of living because it can affect everyone. It’s an issue I believe the whole nation needs to be talking about because it can ruin lives, it can keep people out of employment, and it leads to terrible outcomes for people like a fall into criminal behavior and prison.
One of the reasons why I highlighted this problem when presenting my performance informed budgeting was to set goals; specific measurable things that we could accomplish in the state. We needed to be able to determine if the money that we were spending on certain programs actually achieve the outcomes that we want, as opposed to the outcomes that we hope we might get.
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In the 2015 State of the State, you explained how, “Many of our current inmates are first time, non-violent offenders with drug abuse and alcohol problems… It costs the state around $19,000 a year to house an inmate, but only $5,000 a year to send an addict through drug court and on to treatment. In addition to being less expensive, it’s also more effective; the recidivism rate for offenders sent to drug court is just one-fourth of the rate for those sent to prison.”
This would appear to be a very moderate perspective on addiction in the context of the penal system. Are you taking the higher ground to make sure your constituents are well-served?
One of the things that I believe is that a public official should be smart on crime. As I mentioned, a lot of our non-violent offenders in our penal systems have had some kind of conviction related to drug abuse or alcohol abuse. It is very costly to our state. As you pointed out, it is costly from a financial standpoint because it costs our state $19,000 a year to house an inmate. Beyond that cost, while that person is incarcerated, they are not available to the workforce, they are not available to support their family, and they lose time from their lives that could be productive. We know that we can have successful programs with our drug courts and with our treatment programs in our state. We just feel that it’s good public policy for our state.
Every time I speak to a big audience about substance abuse or correction related issues, I always ask the question, “Does anyone in the room not know anyone who has a substance abuse or addiction issue, whether it’s been a colleague or a family member or someone close to them in their community?” Nobody ever raises their hand. In other words, everyone knows someone who’s had some type of substance abuse issue. In response, what I’m trying to address is what is the best way to divert people from going into the system in the first place? How can we get them the help they need for their addiction issues? We need to understand that addiction doesn’t touch just that individual. It touches family members, it touches people’s finances, and it certainly has a negative effect on our expenses as a state. We can address it better by looking at treatment.
Certainly, we will keep those who are violent and are a potential threat to the community in prison. They should be incarcerated. Non-violent offenders who have a true substance abuse or addiction issue, however, need to be given access to treatment and help. This is a smarter way that we can be smarter on crime, helping people and saving money at the same time.
Do you agree with Dr. Nora Volkow, the director of the National Institute on Drug Abuse, that addiction is a brain disease? Does this belief help reduce the stigma of drug addiction?
Yes, I do. The experts that I have talked to, both here in Oklahoma and nationally, have said that addiction is a brain disease that can be overcome in most cases. There are some cases where it’s very, very tough. I know we need to change our public understanding and perception of addiction and mental health issues. We need to focus on how we can help people be healthy and functional in their family lives, in their communities, and certainly in the workplace.
In the 2011 State of the State, you said, “I'm continuing to offer my full support to programs like "Women in Recovery" and other initiatives that address substance abuse, prevent incarceration, and allow more families to stay together. By fighting the hold that substance abuse has on our communities, we can make Oklahoma healthier and safer.”
The Comprehensive Addiction and Recovery Act (CARA) seems to be in line with what you have been recommending for years as well as an example of what you describe as “performance informed budgeting” that saves money by focusing on treating the problem.
Don’t your state policies mirror CARA? If recovery and support is the key, why do you think Republicans on a federal level have resisted the funding to make this law viable?
I can’t speak for Congress because all I can speak for is the state of Oklahoma. We do know that programs like "Women in Recovery" have been a critical piece in helping to solve a very complicated issue that’s plagued our state for over 20 years. I believe our legislators in the state of Oklahoma, as they have become more informed and as we have talked more publicly about addiction and substance abuse, have worked hard to make some strategic policy changes that reflect this awareness.
We do have broader use of drug courts, and we do use more community sentencing, giving our judges and our district attorneys more discretion when it comes to sentencing. We have passed laws to enact prescription drug monitoring bills. We are working on reducing doctor shopping, preventing people that have addiction problems from finding doctors that will prescribe pain medication. We also have cracked down on doctors that overprescribe, running pills mills in their facilities. We have prosecuted those doctors that criminally abuse their position. We have installed prescription drop boxes throughout our state to dispose unused or unneeded pain pills. We have a great prescription drop box program with places like Walgreens. We have awareness programs like "Take As Prescribed" when it comes to medications to avoid misuse and abuse. We have worked locally in our state to help reduce drug abuse through these new initiatives and programs.
I understand that some of these initiatives and programs may mirror what they are trying to do federally with the CARA act, but they are separate from any federal legislation. Hopefully, they will look at what is working on a state level and see that states can be good models for the replication of successful policies that work in practice.
When it came to the shooting of an unarmed Terence Crutcher by a Tulsa police officer that resulted in a manslaughter charge, you tweeted, “Our thoughts and prayers should be with the Terence Crutcher family as they struggle to find answers during this difficult time.”
How much did perceptions of the drug epidemic by police officers contribute to this shooting? Do criminal actions fueled by addiction lead to a greater bias in police officers against minorities?
I can’t speak for what’s in the minds of police officers, but certainly I think our police officers should be trained and they are trained on substance abuse issues, the challenges presented by addicted people, and the challenges of people with mental health issues. If our law enforcement are trained to be able to recognize those problems, then it keeps the officers safe, but it also helps them make good decisions. Such good decisions are needed when they come upon someone who might be high on some type of prescription medication or other substance that could cause them to be a danger not only to themselves, but to the public as well.
On September 13, you announced on Twitter the OK Veterans Pilot Program to “help develop a comprehensive healthcare system for our vets.” Addiction and alcoholism are huge problems for veterans, often contributing to frighteningly high suicide rates. Does your pilot program address this problem?
Absolutely. We know that our veterans should be honored, but we also know that they may need help when they return back from their service. Addictions issues and alcoholism can be a big problem for veterans, along with suicide. We have worked really hard with our veterans’ professionals to address these concerns. In Oklahoma, we even have a Veterans Court so if someone is arrested for substance abuse issues or other non-violent issues, we can help them get the treatment and services that they need. We are making sure that we have a better coordination of care that focuses on what is the true problem with the veteran, and helps them.
You recently signed a Ban the Box executive order that required all state agencies to eliminate questions about felony convictions from employment applications. One in 12 Oklahomans is a convicted felon, with more than 55,000 people currently in prison or under supervision of the Oklahoma Department of Corrections, most for nonviolent offenses.
You said in a statement, “Employment after a felony conviction is always a challenge, but the ability to gain employment is a critical and necessary component in reducing recidivism and for those individuals to lead productive and successful lives. Thus, we should remove unnecessary barriers to employment opportunities for Oklahomans with felony convictions.”
Is this choice also connected with your policies to help drug addicts convicted of non-violent drug related crimes get back on their feet? Do you truly believe in second chances and the miracle of recovery?
I am a believer in helping people get a second chance in their lives if they’re willing to take the steps they need to take to get clean and the help that they need for addiction recovery. One of the things that we can do as a state is to give them the ability to find employment. As we know, one of the biggest barriers to success for people who have had felonies was to check a box on a job application that you’ve been convicted of a felony. We took that off our employment applications for the state of Oklahoma.
When a person is going through the interview process, they won’t be automatically screened out and have their resume thrown in a trashcan before they ever get to interview. If the interviewer later asks them if they’ve ever been convicted of a felony, then they’ll have the opportunity to explain what happened and what’s changed in their life that will now make them a good employee. We believe that helping a person find a job will help them recover quicker and help them become a more productive citizen in our state.
Marijuana legalization is all the rage across the country, both in relation to medical marijuana and recreational use as well. You have said about medical marijuana, “I just don't see that it provides a substantial benefit to the people of Oklahoma.” Given the additional taxes being reaped by other states, have you ever questioned this decision?
No, not in the least. I would never trade off money for the possibility of someone becoming addicted to any type of substance, then later moving on to hardcore heroin or prescription drugs. I do not support legalizing marijuana. Now that being said, I have signed laws into place that allow the use of cannabidiol oil for children that have seizures and for adults that have certain conditions that cannabidiol oil can be helpful. But cannabidiol is different from medical marijuana. As far as just having recreational marijuana or marijuana for medical purposes, I don’t support that.
When signing House Bill 1948 in 2015 that set up the Prescription Drug Monitoring program, you said, “Sadly, prescription drug abuse in Oklahoma is nothing short of an epidemic … There are more fatal overdoses in Oklahoma involving hydrocodone or oxycodone than alcohol and all illegal drugs combined. In 2013, there were more overdose deaths than fatal car accidents. As a state, we need to take a stand and say ‘enough is enough’.”
This is a very open-minded approach to the problem for a traditionally conservative Republican. In contrast, after Ted Cruz discussed his sister’s death due to a prescription opioid overdose in a New Hampshire meeting during primary season, he was asked how he would fix the problem. Despite the legacy of his sister’s death, his reply, following in the footsteps of eventual presidential candidate Donald Trump, was, “I would build a wall.”
Do you think Donald Trump would agree with your 2015 State of the State policy statement on, “a prescription drug monitoring bill that cracks down on the practice of ‘doctor shopping’ and ensures we aren’t prescribing narcotics to addicts” as a proper approach to the drug crisis?
I don’t know because I haven’t talked to him about this particular issue. I can’t comment on the positions of the candidate. I can tell you, however, what’s worked in Oklahoma. The prescription monitoring law in our state has cut down on doctor shopping. It has helped us raise awareness of the dangers of prescription drug abuse in our state, and it has saved lives in Oklahoma. I know it’s made a big impact.
One of the other things I forgot to mention that we have done in our state is we have made naloxone available in our state, both in the hands of first responders and in pharmacies, and that has helped save the lives of people who have overdosed. We established a training program to teach our police and first responders how to use naloxone. We’ve had nearly 1,800 people trained statewide since 2014 and it has saved many lives. Since we have pharmacies carrying naloxone as well, we’ve given access to this lifesaving drug to the people that really need it. This is a step that makes sense for all people and is part of the national movement to address this drug crisis that I mentioned earlier. By stopping overdoses, we save lives—and saving lives is always for the best.