When Tom Vilsack was a boy, his mother would sneak into the attic to go on benders. From his bedroom, he could hear the thud of an empty bottle hitting the floor.
Once, he woke up in the middle of the night to see his grandmother and father walking her in circles to keep her awake. She had downed a number of pills, trying to take her own life.
Now 65, Vilsack has had a long career in politics, working his way from small-town mayor to Governor of Iowa and now U.S. Agriculture Secretary, where he’s been tasked by President Obama with fighting the problems of heroin and opioid abuse in rural communities. In a sense, it’s a job he’s been training for since those childhood days.
“It is not hard for me, even at my age, to conjure up the combination of fear, anxiety, worry, concern, anger—all of those emotions that I had as a child when I watched my mom, for a number of years, self-destruct,” Vilsack says. “I may not have every experience that families dealing with this today have, but I’ve had many of them. And I can certainly understand it from the perspective of a child.”
Today, opioids, a class of mind-altering and addictive substances that include Oxycontin and heroin, are the most commonly abused drugs in the U.S. Around 2.4 million Americans are estimated to be dependent on or addicted to opioids. In 2014, 61% of fatal drug overdoses— or more than 24,000 deaths—were related to opioid abuse, according to the Centers for Disease Control and Prevention.
The problem has proven more acute in rural areas, where people are more likely to be unemployed or else to have a job with a higher risk of injuries likely to be treated with prescription painkillers that can lead to an addiction. States like West Virginia, Indiana, and Kentucky are on the front lines of the epidemic.
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Since 2011, Vilsack has been leading the Obama administration’s Rural Council, which was established to address the unique challenges that faced rural communities as America dug itself out of the worst recession in the nation’s history. From confronting economic issues, to minding the specific hardships facing children in poverty—the council has been ticking away at the laundry list of problems facing the country’s more remote communities.
But a 2015 study that showed that there had been a significant increase in the mortality rate of white men between the ages of 45 and 54, particularly in rural communities and even as the mortality rates for other groups fell, gave the president pause. What was even more striking was the fact that the reason behind the shifting mortality rate was an uptick in suicides and deaths due to poisonings and substance abuse. In January, he tapped Vilsack to lead an interagency effort to address the heroin epidemic, as well as high levels of suicide and mental illness in rural areas.
“The president is obviously aware of the opioid issue generally, but the fact that rural males were dying incredibly elevated rate really got his attention,” Vilsack said.
The Obama Administration has signaled it is committed to confronting the issue of heroin and opioid abuse as rates of usage and overdose deaths have ticked up. Since the President released his first National Drug Control Strategy in 2010, the White House offered piecemeal solutions to the problem. The 2016 budget the president signed in December guaranteed a $100 million increase in funding to address the epidemic. The White House has overseen the establishment of prescription drug monitoring programs across the states, hosted national drug take-backs resulting in the collection of 5.5 million pounds of drugs. The CDC is scaling up efforts to distribute drug awareness material across the states.
Though these efforts are underway, and the president recently requested an additional $1 billion worth of funding to fight opioid abuse, neither President Obama nor Secretary Vilsack wanted urban centers to get the bulk of the attention and resources necessary to get a handle on the epidemic.
“We have an opportunity to deal with what has become a consequence of a rural economy that’s been struggling historically quite some time and the impact it has on families and kids,” Vilsack says.
Within rural communities, Vilsack says, on top of the need for expanded access to treatment and better training and communication among physicians and pharmacists, there’s also a need for more manpower. For example, it can take someone facing a mental health crisis up to three years before they make initial contact with a professional. In 55% of all American counties, most of which are rural, there are approximately zero psychologists, psychiatrists or social workers. On top of that, there is a lingering stigma associated with seeking help for a mental or substance abuse problem in rural communities; something that the Secretary understands from experience.
“My mom dealt with drug and alcohol abuse and when I was a kid, I thought it was because she was a weak person,” Vilsack said. “To this day, I feel badly about the fact that I was so judgmental.”
Read More: The Problem With Treating Pain in America
The task that lies ahead for the country when it comes to the heroin epidemic is great—and one that certainly won’t be met before Obama leaves office. Yet the White House is hopeful opioid abuse is an area where Congress and Obama’s successor can help fill in the gaps. The topic has been hot on the trail for the White House, particularly as the race shifted from Iowa to New Hampshire, one of the epicenters of the epidemic in the Northeast.
“There is a genuine desire on the part of Republicans and Democrats who see this not as a partisan issue but as a real serious problem that needs to be addressed,” says Vilsack. “I’m hopeful that between the president’s budget proposal and some ideas and thoughts that members of Congress have that we get through this process in the very near term with a comprehensive commitment with additional resources.”
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