Opioid Crisis: Implementation of the Family First Prevention Services Act

Comments for the Record

United States House of Representatives

Committee on Ways and Means

Human Resources Subcommittee

Hearing on The Opioid Crisis: Implementation of the

Family First Prevention Services Act (FFPSA)

Tuesday, July 24, 2018, 10:00 AM

By Michael G. Bindner

Center for Fiscal Equity

Chairman Smith and Ranking Member Davis, thank you for the opportunity to submit my comments on this topic. This hearing will review the Department of Health and Human Services’ ongoing progress implementing recently enacted legislation to address family substance abuse issues, improve child well-being, support kin caregivers, and strengthen families. I submit these comments as past health research data manager, prevention community leader, and a current recovered abuser and Medicare patient. I will leave the progress report to the Agency witnesses and address the relevant items.

Family Substance Abuse Issues

Substance abuse can occur in families in a variety of ways. One of the parents, but not the other, could be using, either innocently because of bad pain management or intentionally. Another pattern can be both parents using as a couple. When Cannabis is used this way, it is less damaging once the kids are down for the night. That cannot be said of the grip of an opioid addiction, however acquired. Lastly, one or more of the children, usually teens, sometimes even younger children or grown children in the household may be the addict. Prevention and intervention are different in each case.

Accidental addiction can be prevented by better medical treatment. No one needs opioids past their follow-up appointment to an injury or surgery and that appointment should be as soon as possible, with no pain management following.

If addiction is surrendered to or mutual, then adult intervention strategies are necessary, including family services to either monitor the situation or remove the minor children. Likewise, addiction by teens or adult children demands intervention. These drugs are so lethal that waiting for the user to have enough may result in death.

Improve Child Well-being

From our example above, the best thing for children if only one parent is an addict is to get the addict out of the home, with or without treatment. Family services and criminal justice already know how to do that and, except for the shortage of treatment beds and temporary housing, there is already a system in place to help both addicted adults and children, especially if managed by the Drug Court system.

The current penal system could be replaced by mandatory treatment rather than incarceration, with extended stays and funded pre-release programs, but that costs money but is cheaper than jail or prison, unless you own stock in Corrections Corporation of America, who I am sure is paying attention to these proceedings. 

If both parents are addicted, temporary placement is necessary for the children outside the home. However, this should not be an excuse to sell the home, let it lapse into foreclosure or permanently place the children in foster care or adoptive services.

Recovery is more likely if the government and family care agencies do not further aggravate conditions by kidnapping the children.  Instead, families should be fostered as a unit – both children and parents once they are able and are past the point of needing to be with their kids to stay sober – because if that is their excuse, they won’t do so.

Sobriety needs to be pursed for one’s self, but it is still easier when the perception that someone else wants your kids is removed. Of course, if the parents are frequent relapsers, there may not be any way to keep the family together, but that should be the rare case for people who fall into opioid addiction through bad medicine.

Support Kin Caregivers

If one or both parents is an addict, often siblings or parents are called to serve as foster care providers or to help deal with the addict in early recovery.  They don’t have the option that sponsors do to walk away (carry the message, not the mess) and it is a hard role to take, especially if social services proves intrusive in establishing suitable guardianship. 

As important is the provision of financial assistance to guardians. If there were a decent child tax credit that met the cost of living a middle class life style (which would require not punishing the poor for being poor), adequate funding would be no problem because the tax credit would come from the foster caregiver’s job, although the parents who are addicted would fight to keep that money. It is still not an excuse to not pay it. 

Another problem is that guardians become protective of the children and may not want to give them up to family members who may still be at risk. Managing that is the function of local family services agencies.  It is a hard job. The Federal Government needs to provide the money to pay them more.

Strengthen Families

The best way to strengthen families is to help make them less susceptible to addiction by providing all concerned with good quality education and training, including payment to train or get remedial education if the system has failed so far.

While the system loves low wage labor, especially in nursing homes, reinstituting slavery through welfare programs should not be a societal goal.  Eliminating poor people as a permanent source of cheap labor will prevent both drug sales and drug use. Ending the mass incarceration of African American males will strengthen their families as well, saving multiple generations at once. Whether Black Lives Matter or All Lives Matter, shutting down mass incarceration sends the message that this Act and these hearings are about more than public relations.

Prevention may also help prevent teen addiction if it offers a profitable way, such as paying students in danger of dropping out to attend school at enough of a wage, for them to not feel the need to sell drugs or be depressed enough to succumb to their use. This is not a cheap alternative; however it is cheaper than prison (unless you are paid to run the prison). The current regime has not expressed a willingness to spend the necessary resources to do what I suggest, as it is cheaper and more popular with its base to blame the poor for their poverty and addiction. At some point, that will no longer be acceptable. The Opioid Crisis may make that point sooner than later.

Thank you for the opportunity to address the committee.  We are, of course, available for direct testimony or to answer questions by members and staff.