What Should We Do About The Opioid Epidemic? (NIFI Issue Advisory)

The National Issues Forum Institute released the six-page Issue Advisory, What Should We Do About The Opioid Epidemic?, published October 2017. The issue advisory presents three options to use during deliberation on how society can address the rising opioid epidemic that has swept the U.S. The issue advisory is available for free download on NIFI’s site here, as well as, a post-forum questionnaire.

From NIFI…

Drug abuse, a problem the United States has faced for decades, has taken a sharp and lethal turn with the rise of opioids—both legal pain- killers, such as oxycodone and fentanyl, and illegal ones like heroin.

More than 64,000 Americans were killed by drug overdoses in 2016, according to the Centers for Disease Control, and at least two-thirds of those deaths were caused by opioids. That is worse than the peak of the HIV epidemic in 1995 and more than the number of US combat deaths in the entire Vietnam War.

In the last year, doctors wrote more than 236 million prescriptions for opioids, or about one for every American adult. But many patients became addicted to the painkillers as their bodies began to tolerate higher and higher doses. Others, if they could no longer get prescriptions, switched to heroin; then came the even deadlier fentanyl.

Now drug abuse is so widespread it is even affecting productivity–employers say they can’t fill positions because too many applicants fail a drug test. The Federal Reserve reports that opioid addiction may be shrinking the number of job applicants because it is keeping otherwise able-bodied people out of the workforce.

The problem exists in almost every community throughout the United States, though it has hit hardest in the Northeast, the Midwest, and Appalachian regions, where joblessness and poverty have hollowed out many small towns and left families in desperate circumstances. In Cincinnati, Ohio, police estimated that police officers and paramedics spent at least 102 hours tending to overdose patients in just one week. Responding to the crisis is straining the budgets of many small towns and counties.

Doctors and nurses now see the epidemic’s effects on the next generation, a wave of babies born addicted to painkillers or heroin. Sara Murray and Rhonda Edmunds, nurses in Huntington, West Virginia, founded Lily’s Place, a facility for addicted babies and their mothers.

“The devil has come to Huntington,” Murray said on CNN. “We have generational addiction and that’s their normal. It was their mother’s normal. It was their grandmother’s normal. And now, it’s their normal.”

What should we do to relieve the opioid epidemic facing our communities? This issue advisory presents three options for deliberation, along with their drawbacks. Each option offers advantages as well as risks. If we increase enforcement, for example, this may result in many more people in prison. If we reduce the number of prescriptions written, we may increase suffering among people with painful illnesses.

Option 1: Focus on Treatment for All
This option says that, given the rising number of deaths from opioids, we are not devoting enough resources to treatment to make real headway in turning around the epidemic. Addiction is primarily a medical and behavioral problem, and those are the best tools for combating the crisis. Treatment should be available on demand for anyone who wants it. At the same time, the pharmaceutical companies that have profited from making and promoting opioid painkillers need to contribute more to the solution

Option 2: Focus on Enforcement
This option says that our highest priority must be keeping our communities safe and preventing people from becoming addicted in the first place. Strong enforcement measures are needed, including crackdowns and harsher sentences for dealers, distributors, and overprescribing doctors. And we should take tougher measures to cut off the supply of drugs at the source. Addiction to opioids and other hard drugs brings with it crime and other dangers, and closing our eyes to these dangers only makes the problem worse. Mandatory drug testing for more workers is needed. In the long run, a tough approach is the most compassionate.

Option 3: Focus on Individual Choice
This option recognizes that society cannot force treatment on people. We should not continue to waste money on a failed “war on drugs” in any form. Only those who wish to be free of addiction end up recovering. We should be clear that crime will not be tolerated, but if people who use drugs are not harming society or behaving dangerously, they should be tolerated and allowed to use safely, even if they are damaging their own lives. Those who do not or cannot make the decision to get well should not be forced, and communities shouldn’t spend their limited resources trying to force treatment on people.

About NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Follow on Twitter: @NIForums

Resource Link: www.nifi.org/en/issue-guide/issue-advisory-what-should-we-do-about-opioid-epidemic

Making Ends Meet: How Should We Spread Prosperity and Improve Opportunity? (NIFI Issue Guide)

The issue guide, Making Ends Meet: How Should We Spread Prosperity and Improve Opportunity?, from National Issues Forums Institute and Kettering Foundation, was published December 2015. NIFI_MakingEndsMeetThis guide will provide the framework for deliberation that will happen in 2016 between January and May. The results from the deliberation will be given to U.S. policy makers and elected officials in May 2016. Below is an excerpt from the guide and a short video about the guide. Download a free copy of the PDF on NIFI’s site here.

From the guide…

For many Americans, the recovery from the 2007  recession, a recovery that officially began in 2009, feels very remote, or nonexistent. Even as the stock market surges and millions of jobs have been created, they see a very different picture.

This issue guide presents three options for deliberation:

Option One: “Create New Opportunities”
We should make it easier for people to start new enterprises that will improve their circumstances. Whether it’s starting a house painting business on the side or opening a restaurant, when individuals start new firms, it helps spur economic growth. More skilled tradespeople are needed, for example, as construction bounces back. Half of all private-sector jobs in the US are at small businesses, and in recent years small businesses have supplied two-thirds of all new jobs.

Option Two: “Strengthen the Safety Net”
We should secure and expand safeguards so that changes in the economy don’t push people into poverty or leave families with children homeless or hungry. In the last decade, millions of people found themselves unemployed or underemployed with few or no benefits, sometimes indefinitely. Fewer people work with one company for decades, employee benefits have shrunk, technology and globalization have eliminated jobs, and more people are employed in freelance work. We need to make sure people will not face catastrophic losses as they adapt to these changes. To do this, we should strengthen the unemployment insurance program, protect workers’ retirement, and make benefits more portable.

Option Three: “Reduce Inequality”
We should shrink the income gap. Today, the richest 10 percent of the country’s population earn more than half of its total income. It is not right that CEOs make hundreds of times more than their employees, even as their companies cut workers’ hours to avoid paying overtime and offering benefits. Some inequality helps drive people to succeed and become wealthier, but if people can’t move into or stay in the middle class, or if the wealthy manipulate the system to their benefit, then we all lose. To reduce the large gaps between the very rich and the rest of society, schools should be funded more equally, we should do more to control college costs, and people who don’t go to college should be able to get decent-paying jobs that allow them to stay in the middle class.

About NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Follow on Twitter: @NIForums

Resource Link: www.nifi.org/en/groups/new-issue-guide-making-ends-meet-how-should-we-spread-prosperity-and-improve-opportunity

Mental Illness in America: How Do We Address a Growing Problem? (NIFI Issue Guide)

The 13-page issue guide from National Issues Forums, Mental Illness in America: How Do We Address a Growing Problem?, was published November 2014. The issue guide gives three options for discussion on how mental illness can better be addressed in the US. Below is an excerpt from the guide and it can be downloaded from NIFI’s site here.NIFI_Mental Illness

From the guide…

Many Americans share a sense that something is wrong when it comes to treatment of mental illness. More and more of us are taking medications for depression and other disorders. Meanwhile, dangerous illnesses are going undetected and untreated. What can be done to keep us safer and healthier?

One in five Americans will have mental health problems in any given year. Unaddressed mental illness hurts individuals and their families and results in lost productivity. In rare cases, it can result in violence.

This issue guide presents a framework that asks: How can we reduce the impact of mental illness in America?

The issue guide presents three options for consideration:

Option One: “Put safety first”

This option holds that more preventive action is necessary to deal with mentally ill individuals who are potentially dangerous to themselves or others. We should identify those who need help and intervene where necessary to prevent them from harming themselves and others. These individuals should be sought out and their needs addressed.

Option Two: “Ensure mental health services are available to all who need them”

This option holds that people should be encouraged to take control over their own mental health and be provided the tools to do so. We should make sure that everyone who wishes can get the needed help.

Option Three: “Let people plot their own course”

This option holds that we should not rely on so many medical approaches. We should reduce our dependence on drugs and allow people the freedom to plot their own course to healthy lives. In many cases, simple changes to lifestyle can improve mental health.

More about the NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Issue Guides are generally available in print or PDF download for a small fee ($2 to $4). All NIFI Issue Guides and associated tools can be accessed at www.nifi.org/en/issue-guides.

Follow on Twitter: @NIForums.

Resource Link: www.nifi.org/en/catalog/product/mental-illness-america-issue-guide-downloadable-pdf

What Should Go on the Internet: Privacy, Freedom and Security Online (NIFI Issue Guide)

The National Issues Forums Institute published the 12-page Issue Guide, What Should Go on the Internet: Privacy, Freedom and Security Online (2013) and is an update to an earlier guide about the Internet. This guide is designed to help facilitate balanced deliberation about what should go on the internet.

From the guide…

NIFI_Internet2013The same Internet that has given us new ways to socialize, learn, and engage in civic life has also given criminals new avenues to steal from us and scam us, often using information gleaned from public government documents now posted online. And because no one’s in charge, there’s no single authority we can call to complain.

When does our personal information become public? What data collection is acceptable? Should there be limits on what we can do online? It’s time to find a way to balance our needs to safeguard privacy, preserve free speech, and ensure security for all our citizens, young and old.

It’s time to answer the question: What should go on the Internet?

This issue guide was prepared for the National Issues Forums Institute (NIFI) in collaboration with the Kettering Foundation, and is an updated version (2013) of a previous guide about the Internet.

This issue guide presents three options for deliberation:

Option One: “Protect Individual Privacy”
Privacy is a fundamental American value. But the Internet has obliterated the line between public and private, forcing Americans to live in a virtual fishbowl. Our top priority must be to safeguard personal information on the Internet.

Option Two: “Promote Freedom of Speech and Commerce”
The Internet is a revolutionary leap forward for democratic societies and free markets. Direct or indirect censorship by concerned citizens, special interests, or government could stifle this great resource.

Option Three: “Secure Us from Online Threats”
The Internet is a Wild West of criminal activity that threatens our personal safety, our economic vitality, and our national security. Our top priority must be protecting our children and ourselves.

More about the NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Issue Guides are generally available in print or PDF download for a small fee ($2 to $4). All NIFI Issue Guides and associated tools can be accessed at www.nifi.org/en/issue-guides.

Follow on Twitter: @NIForums.

Resource Link: www.nifi.org/en/issue-guide/what-should-go-internet-2013

The Future of Work: How Should We Prepare for the New Economy? (NIFI Issue Guide)

The National Issues Forums Institute published the 13-page Issue Guide, The Future of Work: How Should We Prepare for the New Economy?, in February 2015. This guide is designed to help facilitate balanced deliberation about how we should prepare for the future economic reality of work.

From the guide…

NIFI_futureofworkThe nature of the work we do has changed in ways that few Americans a generation ago could have imagined, and it will undoubtedly be dramatically different in yet another generation. These changes will bring both opportunities and difficulties…

The stakes are high. Many Americans share concerns about the nation’s competitive edge, stagnant wages, and a sense that young people today will be worse off than previous generations.

We have choices to make together in shaping the future of work. Business, government, individuals, and communities all play a role in addressing this issue. This guide presents some of the options we might pursue, along with their drawbacks.

This issue guide presents three options for deliberation:

Option One: “Free to Succeed”
Give individuals and businesses the freedom they need to innovate and succeed

Option Two: “An Equal Chance to Succeed”
Make sure all Americans have a chance to succeed in an increasingly competitive environment

Option Three: “Choose the Future We Want”
Strategically choose to support promising industries rather than simply hoping that the changes in work and the economy will be beneficial

More about the NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Issue Guides are generally available in print or PDF download for a small fee ($2 to $4). All NIFI Issue Guides and associated tools can be accessed at www.nifi.org/en/issue-guides.

Follow on Twitter: @NIForums.

Resource Link: www.nifi.org/en/issue-guide/future-work

Medicare and Medicaid (NIFI Issue Guide)

The National Issues Forums Institute published this 16-page Issue Guide, Medicare and Medicaid, in 2015. This guide is to help facilitate deliberation around the health-care choices.

From the guide…

NIFI_medicareNearly everybody will, at some point, get sick and need the help of health-care professionals. Finding the resources to cover these public programs is an ever-increasing challenge at a time when our national debt is at an all-time high. Ultimately, all Americans—policymakers as well as citizens—will have to face painful decisions about reducing the cost. This may mean fewer choices in health care for the tens of millions of people enrolled in these programs. The choices are difficult; the stakes, enormous.

The guide presents three options for deliberation:

Option One: “Do What It Takes to Maintain Our Commitment”
Keeping the programs solvent may mean higher taxes for workers and companies, or raising the age of eligibility for Medicare. It could mean asking Medicaid patients to share the cost of their coverage. We need to do what is necessary to continue the commitment even if that costs everyone more. But, raising taxes to pay for both programs may cost them the broad-based support they now enjoy. Making people wait longer to collect Medicare or forcing the poor to pay part of their health care may cause people to delay getting help, resulting in higher costs later on.

Option Two: “Reduce Health-Care Costs Throughout the System”
It is critical to put Medicare and Medicaid on a better financial footing. We need to pay for fewer lab tests people get and reduce money spent on end-of-life care. The U.S. government should negotiate for lower drug costs as other countries do. But, fewer tests may mean more people will die from undiagnosed illnesses. Less end-of-life intervention may mean that more people will die sooner than they would otherwise need to. And lowering the profits of drug companies will mean less money for research into better drugs that benefit everyone.

Option Three: “Get Serious about Prevention”
One reason Medicare and Medicaid are headed for a crisis is because so many Americans have unhealthy lifestyles that cause them to develop preventable illnesses like diabetes and heart disease. We should stop expecting others to pay for the consequences of our bad choices. Government incentives should reward those who weigh less, eat right, and exercise more. But, an emphasis on prevention and requiring that people adopt healthier lifestyles would invite unfair scrutiny of their behavior and would increase government intrusion into people’s lives.

More about the NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Issue Guides are generally available in print or PDF download for a small fee ($2 to $4). All NIFI Issue Guides and associated tools can be accessed at www.nifi.org/en/issue-guides.

Follow on Twitter: @NIForums.

Resource Link: www.nifi.org/en/issue-guide/medicare-and-medicaid

A New Land: What Kind of Government Should We Have? (NIFI Issue Guide)

The National Issues Forums Institute published the Issue Guide, A New Land: What Kind of Government Should We Have?, in 2015. This guide is to help facilitate deliberation the current and future state of the US union.

From the guide…

It is the spring of 1787. We are now iNIFI_NewLandn a critical period. Our new republic is unstable and the liberty we won just four years ago is threatened. We’ve lost the unity inspired by our fight against Britain. Trade is difficult and our physical safety is uncertain. There are conflicts within and threats from without.

The current state of affairs has sparked conversations in pubs and shops, town squares and farmyards. Everywhere, people are asking the same questions: What should we do? How will we survive? How can our hard-won liberty be sustained? The questions boil down to this: What kind of government should we have?

This historic decisions issue guide presents three options for deliberation:

Option One: “Strengthen the Current Partnership Among Equals”
The Articles of Confederation and Perpetual Union need to be amended. The current one-vote-per-state Confederation Congress assures that we are a union of equal members, but the current central government lacks the power to raise funds or make binding decisions. It needs to have the power to hold states accountable without impinging on their rights. We must figure out a workable balance that gives the central government more power and yet still respects each state’s autonomy.

Option Two: “Create a Strong Central Government”
To maintain our independence, we must ensure our stability. We need a strong central government to protect our liberty. Too much freedom at either the state or the personal level can be destructive. A republican form of federal government, with proportional representation from all of the states, guarantees that individual citizens will still have a say. A stronger central government in a new federal union of the states will also have the authority to safeguard our economic stability and physical security.

Option Three: “Let States Govern Themselves”
Now that we have our liberty, we should dissolve the Confederation and let the states govern themselves as independent republics. Local governance works best. We are too economically, geographically, and culturally diverse to form one nation. Each state has its own traditions of self-governance, some going back a century or more. Each has its own way of determining citizenship. We’ve proven we can successfully unite in the face of a common threat, and we can do it again if need be.

More about the NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Issue Guides are generally available in print or PDF download for a small fee ($2 to $4). All NIFI Issue Guides and associated tools can be accessed at www.nifi.org/en/issue-guides.

Follow on Twitter: @NIForums.

Resource Link: www.nifi.org/en/issue-guide/historic-decisions-new-land

America’s Energy Future: How Can We Take Charge? (NIFI Issue Guide)

The National Issues Forums Institute published the Issue Guide, America’s Energy Future: How Can We Take Charge?, in January 2015. This Issue Guide puts forth three options for deliberation of how America can address its energy consumption and how to deal with it in the future.   

NIFI_USenergyFrom the guide…

Americans depend on easy access to energy. Most of us take it for granted that we will be able to light up a room with the flick of a switch, adjust the temperature of our homes at will, and climb into our cars every morning to go to work, often at distant sites.

We use more energy than any other country. Americans make up only 4.5 percent of the world’s population, yet we consume about 20 percent of the world’s energy production. Collectively, we drive more, heat more, air condition more, and plug in more electronic devices than anyone else. We use 22 percent of the oil consumed in the world each day.

Worldwide energy use is on the upswing as well, and is projected to keep increasing, as rapidly developing countries, such as China, India, and Brazil, become bigger players in the worldwide market for energy supplies, especially oil. And— sooner or later—the world’s available supply of oil will run out.

The Issue Guide presents three options for deliberation:

Option One: “Produce the Energy We Need to Maintain Our Way of Life”
We need to control our own sources of energy so that we do not have to depend on other, possibly unfriendly, countries for our supplies. We have abundant sources of energy in this country and off its shores. We should develop and use them.

Option Two: “Put More Renewables and Clean Energy Sources into the Mix”
Not only is our lavish use of fossil fuels causing untold damage to the environment, but someday we will run out of oil, coal, and natural gas. We need to make the switch to renewable sources of energy, such as wind and sun, as soon as possible.

Option Three: “Find Ways to Use Less Energy”
The most practical way to deal with our current energy problems in not to produce more energy but to use less of it, and to do more with the energy we do use. This will involve both stricter government regulations and changes in our individual lifestyles.

More about the NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Issue Guides are generally available in print or PDF download for a small fee ($2 to $4). All NIFI Issue Guides and associated tools can be accessed at www.nifi.org/en/issue-guides.

Follow on Twitter: @NIForums.

Resource Link: www.nifi.org/en/issue-guide/americas-energy-future

How Can We Reduce Costs and Still Get the Care We Need? (NIFI Issue Guide)

The National Issues Forums Institute published the Issue Guide, How Can We Reduce Costs and Still Get the Care We Need?, in April 2015. This guide is to help facilitate deliberation on the issues around the entire US healthcare system.

NIFI_HealthcareCostsFrom the guide…

Americans have good reason to worry about the high costs of health care. Medical bills are the leading cause of personal bankruptcy. Nationally, health care spending threatens the nation’s long-term solvency. We urgently need to find ways to make our health care system financially sustainable.

Health Care: How Can We Reduce Costs and Still Get the Care we Need? clarifies this difficult challenge and offers three options to address issues through changes in the way hospitals and doctors function, end of life care, unhealthy lifestyles, smoking habits, employee wellness, health insurance, childbirth procedures, the pharmaceutical industry and reforms in Medicare, Medicaid, and the Affordable Care Act. It’s a balanced, open-minded look at the entire healthcare system—one that moves the discussion beyond the current political debate.

The Issue Guide presents three options for deliberation:

Option One: “As a Nation and as Individuals We Need to Live within Our Means”
The problem is we spend more than any other developed country on health care without questioning whether more is always better. Reining in spending is a matter of tightening our belts and sticking to a budget even if it means sacrifice.

Option Two: “Make Health Care More Transparent, Accountable, and Efficient”
The biggest driver of health care spending is the design of the US health care system- or rather the lack of design. The system needs regulation or incentives, or both, to instill financial discipline and end greed and abuse.

Option Three: “Take Responsibility for Lowering Health Care Costs by Focusing on Wellness”
Our own unhealthy behaviors- smoking, excessive drinking, drug abuse, lack of exercise, and more- are driving up health care costs. Collective and individual efforts in improve healthy behaviors are the key to lowering costs.

More about the NIFI Issue Guides
NIFI’s Issue Guides introduce participants to several choices or approaches to consider. Rather than conforming to any single public proposal, each choice reflects widely held concerns and principles. Panels of experts review manuscripts to make sure the choices are presented accurately and fairly. By intention, Issue Guides do not identify individuals or organizations with partisan labels, such as Democratic, Republican, conservative, or liberal. The goal is to present ideas in a fresh way that encourages readers to judge them on their merit.

Issue Guides are generally available in print or PDF download for a small fee ($2 to $4). All NIFI Issue Guides and associated tools can be accessed at www.nifi.org/en/issue-guides.

Follow on Twitter: @NIForums.

Resource Link: www.nifi.org/en/issue-guide/health-care