James P. Freeman: State representative a brilliant warrior against the opioid crisis

Massachusetts state Rep. Randy Hunt was casually flippant — but with an intentionally serious undertone — when he imagined the day when constituents would call him complaining that they “can’t find any heroin anymore.”

Given the still-raging opioid crisis in the Commonwealth, that call will take time arriving as four people die every day of overdose here. But Hunt (R.-Sandwich), who sits on the Joint Committee on Mental Health and Substance Abuse and recognized as one of the state’s top thinkers on this crisis, is still hopeful that that day will indeed arrive.

Today, every community in Massachusetts is fighting a two-front war involving illegal street heroin (the contents of which are largely unknown to both dealer and user), and legally prescribed — and highly addictive — medications (oxycodone, hydrocodone and methadone). Both fronts of chemical cousins have collided, forming a complicated battle line which is forcing elected officials to devise new means of productive combat.

Hunt realizes that this also is a public-policy crisis, involving addiction, criminal justice, immigration, a maze of public entities not normally known for successfully collaborating and patience (see Special Commission on Substance Addiction Treatment in the Criminal Justice System). In 2014, he was instrumental in passing ASSIST Act (creating a path for formulating long-term strategies). HisWeb site  is must-reading for those interested in information, not just data on the subject matter. Much of his public service is dedicated to seeking solutions to this man-made epidemic.

Sitting comfortably in his office and appropriately dressed for a typically humid August day, Hunt was stoically reflective on why he has taken such a zealous interest. He said that “the opiate epidemic was going to be one of the biggest problems we would be facing,” after reading the work done by the OxyContin and Heroin Commission, during the 2009-2010 legislative session, just before he was elected to the House of Representatives.

Shortly after joining the legislature, he determined that “very few of my colleagues had any appreciation of the scope of the problem.” Today they do. Awareness, seemingly, is no longer an issue. But action, what kind of action, and specifically, efficacious action, is another matter.

Last year, the governor — who consulted with Hunt about the crisis during the 2014 gubernatorial election — commissioned the Governor’s Opioid Working Group (GOWG). This past March, a landmark bill limiting certain prescriptions on opioids was signed into law. Progress was made for those seeking treatment for addiction, requiring weeks of treatment without pre-authorization, a recognition of the critical need for immediate assistance. Over the course of the last year, more than two-thirds of the 65 recommendations made by GOWG have been implemented. And work continues on prevention, education and early interdiction.

But the statistics are a staggering stampede of defiance.

The year Hunt was elected, in 2010, the Commonwealth reported just 526 opioid-related deaths. Last year, that figure rose to 1,531 deaths and, incredibly, 221 of the 351 towns and cities in the state reported at least one overdose death in 2015. Hunt had hoped that 2015 would have been the “high water mark” for these grim figures but already the deaths for the first half of 2016 are estimated to be higher than those for the first half of 2015. “Policy,” he reasons, “takes time to filter” through the system. And annual appropriations may be short-term fixes for a problem demanding long-term oversight. So he is looking for ways for the state to make commitments in 10-year blocs.

Hunt is as rare as a longhorn in a cranberry bog.

He hails from the dust of El-Paso, Texas, not the dunes of Cape Cod. He is an accountant by profession, not a lawyer or career politician. He is a three-term incumbent Republican in a House controlled 80 percent by Democrats, and yet he is running unopposed in this year’s general election. And his perfect voting record was interrupted this past session only because he served jury duty (having “dropped to 99.11 percent,” as only a CPA could describe it).

Best described as a low-key personality, Hunt nonetheless radiates analytics like a prairie fire, no doubt the burning residue from the exacting science of accountancy; since he applies an outcomes-based approach to solving problems, he is not interested in the vauntingly ambitious or the vaguely ambiguous. Therefore, his method at creating and shifting public policy is markedly different than those of most public officials.

He looks at the supply-demand equation of addiction, where he calls street heroin an “economic rescue,” as it sells far cheaper than pills, when addicts run out of resources and alternatives. But today’s heroin is often laced with an even more powerful additive, fentanyl (that combination was responsible for half of the deaths in 2015). Now, there are legitimate fears that heroin infused with carfentanil, known as an elephant tranquilizer (10,000 times more powerful than morphine), will soon be hitting Massachusetts streets, as it has already in other drug ravaged states.

He wonders if legalizing recreational marijuana is a “gateway behavior” rather than a “gateway drug.” And he is already preparing for the likelihood of the marijuana ballot measure passing this November. If so, does creating a state-chartered bank solve many secondary issues associated with its passage, such as accounting for these new “revenues”?

While Hunt appreciates the emotional and spiritual toll on addicts and their families, he is mindful that solutions will arrive based upon cold metrics — the process of measuring what works, identifying trends that may emerge from using the same tools that yield different results or directions. Accordingly, he is encouraged by the conclusions reached in a recent study of Falmouth High School students, the 2015 Communities That Care Youth Survey. Administered over an eight-year period, it charts a dramatic reduction in drug and alcohol use by students and suggests prevention methods are working.

This simple but powerful indicator gives Hunt hope that someday he will get that phone call about no more heroin.

James P. Freeman is a New England based political writer. This piece first ran in The New Boston Post.