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Q&A

On the Front Lines of the Opioid Crisis

Regina Labelle returned to find her hometown devastated by deindustrialization and opioid abuse. Now she is working to ensure those she grew up with and others have access to effective treatment.

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Regina LaBelle served as the legal counsel for the mayor of Seattle for two terms before being recruited to serve as the Director of the Office of National Drug Control Policy (ONDCP). That role in the ONDCP brought her to rural parts of West Virginia, Kentucky, and other Appalachian states, which at the time were hardest hit by the opioid epidemic. LaBelle was reminded of the rural New England community in which she was raised, which had also not been spared by the opioid epidemic. LaBelle left the Obama administration in January of 2017 but continued to work on policies to address the epidemic. She will continue this work as the head of a new center focused on barriers to treating addiction as a public health issue and funded by Arnold Ventures.

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Arnold Ventures

Why have you spent the past 10 years advocating for better treatment for people with addiction?

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Regina Labelle

I’m a lawyer, and I became a lawyer to be an advocate and to use legal policy tools to right wrongs. There is so much work to be done in the field of addiction. The opioid epidemic really captured me because I grew up on a farm, and it initially affected rural areas the most. There’s such a stigma attached to addiction. Substance use disorders have been treated in such a harsh, punitive way in the past. I felt very pulled to right what I think are historical wrongs about how we treat people with addiction.

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Arnold Ventures

Tell me about a moment that stands out in your memory as an influential point in your career.

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Regina Labelle

In 2010, we [members of ONDCP] were invited by the Kentucky delegation to visit Kentucky. We started at the CDC [Centers for Disease Control and Prevention] in Atlanta, and that was where CDC Director [Tom] Frieden declared the opioid issue an epidemic. Then we went to Kentucky, and it had devastated these small towns. It was really distressing because I grew up in a rural area. I know a lot of communities can be resilient, and you could see at the same time as families were really torn apart and torn up over the issue, you could see these rays of hope. It was just something that made you think, “We’ve got to do something.” And at the Office of National Drug Control Policy, that’s what our job was. Our job was to look out for people who were being so affected by the epidemic. We went back, and we started working on the administration’s plan to address the issue.

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Arnold Ventures

After eight years with ONDCP, you’re transitioning into a new role. How does the Addiction and Public Policy center you’ll be heading at Georgetown University fit into the ongoing efforts to address the opioid epidemic?

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Regina Labelle

The purpose of this is to identify barriers and to find ways to eliminate the barriers that stand in the way of effective treatment for people, or that stand in the way of helping people enter long-term recovery. We’re really interested in looking at the child welfare system, the criminal justice system, and diversion programs like drug courts. It’s looking at all the points of intervention and making sure the points of intervention don’t have barriers to getting people the help they need.

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Arnold Ventures

What types of barriers to treatment exist for people who have been incarcerated?

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Regina Labelle

The majority of correctional institutions don’t provide medications to treat opioid use disorders. People who are on medications must discontinue them and go through withdrawal or “detox.” Detox can be a very painful experience, and research has shown that people who have gone through it once are less likely to want to go on medications again for fear they will be incarcerated again and will have to go through detox.

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Arnold Ventures

Why try to change the existing system instead of creating a new one?

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Regina Labelle

We are in the midst of an opioid epidemic, and there is no sign that it’s abating. Recently released overdose data showed yet another year of increases. This issue is urgent. We know what to do to effectively treat people with opioid use disorders — we need to reach people at numerous intervention points in correctional institutions, the criminal justice system, child welfare — and make sure we’re providing evidence-based solutions. This effort is focused on identifying those intervention points and removing legal, regulatory or policy barriers that stand in the way of what works.

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Arnold Ventures

You plan to include people with a Substance Use Disorder on the center’s advisory panel. Why?

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Regina Labelle

“Nothing about us without us.” I don’t have a Substance Use Disorder. I have members of my family who do, but I can’t speak to what having the disease of addiction is like from first-hand knowledge. I have been to AA meetings, but I don’t go regularly to AA meetings. I don’t know what it’s like growing up with the disease and recognizing when you need to get help. Or not being diagnosed and to be expected to recognize when you need to get help. This is not a scientific, ivory-tower experiment. I am not an academic. This is about changing policy, and changing hearts and minds. The way we’re going to change hearts and minds is by having people who have been through this for themselves devising the policies.