New Mexico’s been fighting the opioid epidemic for decades, but it wasn’t until last year that the federal government declared it a public health emergency. Congress just pumped up the budget for fighting the epidemic by billions, including $100 million for rural areas. But none of the rural counties in our state were targeted for that money. Now that’s changing.
It’s just a couple of words in the federal budget bill that’s thousands of pages long. But they pointed millions in rural opioid funding to "220 counties identified by the Centers for Disease Control and Prevention as being at-risk."
Dig through the data, and some of those counties have a below-average overdose death rate. No place in New Mexico made the list even though we have some of the highest drug death rates in the nation, and have for decades. There was one commonality: On average, counties on the list are 93 percent white.
Sen. Tom Udall said the list is inadequate, and it shouldn’t be used to channel dollars for treatment and prevention. "Using this list to guide our efforts would completely leave New Mexico and minority communities behind," he said.
After KUNM began covering this story, Sen. Martin Heinrich and Rep. Ben Ray Luján signed onto a letter with Udall urging the inclusion of New Mexico counties, saying they were worried the feds would wind up not directing the funds to the rural places in America that need it most.
"I don’t think there’s any doubt that this is a very serious issue for New Mexico and for the nation as to how we proceed here," Udall said.
The federal agency that distributes this money, the Health Resources and Services Administration, deleted mention of the list from the funding page online. Then, the agency issued a clarifying statement to all congressional offices. "The entire hundred million dollars is now going to be targeted in a different way than what they started out," Udall said.
A spokesperson for the federal agency confirmed with KUNM via email that the 220 counties on the list will not be prioritized for funding, and that applicants do not need to be on the list to be eligible for the money. Udall says he’ll make sure it’s also removed from federal opioid appropriations next month.
Lauren Reichelt is the Health and Human Services director up in Rio Arriba County, which was ground zero for the nation’s epidemic. Last week, she spoke at a podium to the county commission there before commissioners unanimously passed a resolution calling for the feds to change their priorities. "I was fully expecting to see Rio Arriba on the list," she said. "And that caused me to start looking into why we weren’t."
She’s been at this 24 years. Entire generations have been lost. It started with doctors ramping up prescription of opioid pain-killers, she said. With treatment, they’ve made gains there, but decades later, the county is still one of the worst in the U.S. for people dying of overdoses. Looking at a map, Reichelt could tell straight away that the target counties for the treatment funding were mostly white regions.
"The way you get away with that is if nobody’s paying attention," she said.
Rio Arriba is more than 70 percent Hispanic and 20 percent Native American, and Reichelt said she’s extremely happy to hear the money won’t be funneled to only white counties.
Most seem to be in agreement that it was the wrong list to be directing the opioid epidemic response because it diverts funding away from people of color. But where did the list come from? And what was it for?
It comes up in Gretchen Weiss’s work. She’s with the National Association of County and City Health Officials. In 2015, a rural, white county in Indiana saw a sudden and severe outbreak of HIV because of needle sharing. The message afterward was: HIV is not just a big-city disease. "It really helped to raise awareness of the infectious disease consequences of the opioid epidemic," Weiss said.
But the United States does not have a great method of tracking either HIV or people who inject drugs, she said. The CDC used six factors to forecast potential outbreaks in rural areas. And one factor was mostly white populations. "So it is certainly a very important data source, but it does not cover the full breadth of the opioid epidemic," she said.
Money for rural communities, though, is critical, Weiss added. "An infusion of resources at the local level is essential to mounting the required, full-fledged response to the opioid epidemic."
The problem is diverse and complex, gripping people all over the country, Weiss said, and national funding for treatment and harm reduction needs to reach folks on the ground.