Why you should care

Because Ohio is at the center of America’s addiction woes.

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To gauge Robert Sprague’s importance, it helps to know that in addiction-rattled Ohio, the line separating life and death can be as thin as a two-lane road like South Dixie Street. At a treatment center in a Dayton suburb, recovering addicts haggle over payments next to pamphlets that advertise yet another miracle treatment in America’s newest boom industry. It’s impossible to overlook the consequences of relapse here, two doors down from the local funeral home. Family members who pony up the cash to treat relatives do so pragmatically, says Paul Kolodzik, a doctor at North Dayton Addiction and Recovery. “Sadly, the family’s logic is that they’ll try to contribute to their recovery rather than risk having to pay for their funeral.”

This is the reality in Ohio, the nation’s ground zero for overdose deaths, with 3,310 in 2015, according to the most recent data from the Centers for Disease Control and Prevention. Only California, with three times the population, had more.

The man leading the charge for change is Sprague, a 44-year-old Republican state representative — now running for treasurer — with a sharp suit and an even sharper pedigree. The great-grandson of Ralph Cole, who sparred for the Ohio governorship with future U.S. President Warren G. Harding, is perhaps an unlikely champion for the everyman. But Sprague positioned himself as a leader on drug bills and opioid-related task forces long before the spiraling epidemic made national headlines. Politicos believe he could follow his ancestor’s footsteps and pursue the state’s highest post. “He’s a guy that people talk about as a future governor,” says Micah Derry, the Ohio state director for the Koch-backed Americans for Prosperity.

“I don’t want to just give you the talking points,” Sprague insists from his hometown of Findlay, a manufacturing hub that churns out tires and washers and so much patriotism that it once was dubbed “Flag City, USA” by a visiting Woodrow Wilson. For the Thomas Friedman-touting conservative, the opioid issue is also about economics. Hence his championing of bills that promote technical jobs and his support for Donald Trump, aligning with the bombastic candidate’s pledge to improve trade deals. “Here in northwest Ohio, we still make things,” he quips.

Trained as a mechanical engineer at Duke University and the University of North Carolina at Chapel Hill, he touts no medical expertise while tackling the state’s starkest health problem. Instead, he’s “a problem solver,” he says. After college, he was recruited by Ernst & Young for a consulting gig that took him to Fortune 500 boardrooms from Atlanta to Hong Kong to help set strategy and remove organizational roadblocks. “That’s what’s important, in my mind, for public policy,” he says. ”There are a lot of challenges that our state faces.”

What would it take to keep pharmacists from distributing painkillers like Pez dispensers?

A former Findlay auditor and treasurer, Sprague thought he would be “a finance guy” when he was appointed to the state legislature in 2011. But after hearing from a constituent whose daughters’ lives had been decimated by drugs, he emerged as the point man for lawmakers determined to address opioid abuse. He analyzed the problem like a consultant by asking a question: What would it take to keep pharmacists from distributing painkillers like Pez dispensers?

Since filing paperwork with insurers is a chore for doctors, Sprague led legislation to require prior authorization for any chronic pain prescription extending past three months (in March, Gov. John Kasich reduced that limit to seven days). With his help, the state House has expanded access to the anti-overdose drug naloxone and allocated funding for nine new detox centers in its budget passed in May. “That will get help to about 7,500 additional people,” Sprague says. Even Democrats, like Nancy Stephani, chair of the Hancock County Democrats in Sprague’s district, say he’s receptive to smart criticism: “He’s very much a numbers person — he wants the data.”

The sheer enormity of the opioid problem — from heroin to fentanyl, carfentanil and, now, “gray death,” which authorities say can kill with a single dose — has forced creative solutions. Sprague wants to leverage the treasury post to help Ohio lead the nation in using social-impact bonds. The arrangement, explains the father of five, would be as follows: A private company invests, say, a million dollars in a pilot addiction-treatment program. If the program hits a target goal — for example, a 25 percent recovery rate, compared to the state’s dismal average of 5 percent over two years — then Ohio pays the company back, plus interest. It’s a decidedly conservative idea, Sprague argues: the state encouraging local industry to take care of its neighbors, while paying only for solutions that actually work.

In his bid for statewide office, Sprague is likely to earn kudos from conservatives for backing a “heartbeat bill” that would limit abortions (it passed, but was vetoed by Kasich) and a plan to localize Medicaid through health savings accounts, favored by many on the right because it shifts control (and responsibility) from the government to the individual.

Still, Sprague faces a considerable challenge if he’s unable to claim the middle ground of Ohio Republicans like Kasich and U.S. Sen. Rob Portman. “He will appeal to the Tea Party people, but I think a lot will depend on the overall opinion of how Trump is doing,” Stephani says. Sprague’s health reform initiative was criticized by Wendy Patton of Policy Matters Ohio for decreasing Medicaid access while imposing premiums on poor enrollees. And even with his work curtailing opioids, the body count keeps mounting. It’s an onerous test, but also an opportunity, Sprague says: “If Ohio is going to be ground zero for the heroin epidemic in the United States, we need to be ground zero for how we treat heroin addiction.”

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