Just three months after the joint Seattle-King County Opiate Addiction Task Force issued its recommendations for addressing the opiate addiction epidemic in the region, the federal government appears poised to slam the door on many of those proposals, county officials, state legislators, and experts on addiction and mental illness said Wednesday. Speaking at the county’s annual legislative forum on behavioral health at Town Hall, King County Executive Dow Constantine described a grim future if Congressional Republicans repeal the Comprehensive Addiction and Recovery Act, a move Constantine said “would reduce or roll back access to treatment, particularly for people with substance use disorders. And even if there is treatment, it is more likely to be involuntary”–in places like lockdown mental hospitals and jails, Constantine said.

CARA, which President Obama signed into law this year, funds local programs to address heroin and opiate addiction, including traditional inpatient and outpatient treatment, medication disposal, distribution of the overdose-reversal drug naloxone, and medication-assisted treatment for opiate addiction with drugs like buprenorphine.

National Council on Behavioral Health president Linda Rosenberg noted that president-elect Trump and Congressional Republicans want not only to repeal the Affordable Care Act—eliminating mental health coverage for millions of newly insured Americans—but to turn Medicaid, the program that provides health care for the very poorest Americans, into a block grant to states, which would effectively end health care as an entitlement. Without ongoing funding for Medicaid expansion, King County Behavioral Health and Recovery Division Director Jim Vollendroff added, the county could find itself unable to fund drug treatment and other recommendations of the opiate task force recommendations. At the same time, “the county’s overall financial crisis threatens its ability to keep us all safe and healthy,” Vollendroff said.

One of the task force’s recommendations, supervised drug-consumption sites—where drug users could consume heroin, crack, meth, and other illegal substances under medical supervision—could be threatened from another corner of the new administration. Sen. Jeff Sessions, Trump’s nominee for attorney general, has made no secret of his opposition to drug legalization, speaking out strongly against legal weed. (“Good people don’t smoke marijuana,” Sessions once said.) It’s hard to imagine this drug warrior will sit idly by while a liberal city creates a space for people to use illegal drugs with impunity, and county officials say they are waiting on tenterhooks to see whether the new administration will crack down on innovative experiments like safe-consumption spaces.

So although the county distributed a short but ambitious list of federal legislative priorities—including full funding of CARA,  preservation of Medicaid expansion, and federal funding for 30-day treatment stays, rather than the current 15-day limit—it’s pretty clear that any real progress on improving the state’s treatment capacity will have to come from the state. The legislators gathered on stage at Town Hall last night promised to introduce a full slate of bills promoting addiction prevention and education, drug takeback programs, and programs to encourage people to enter the mental health-care field and keep them there. “The need is outstripping the number of workers in the field who can serve this community,” said freshman state Sen. Lisa Wellman, D-41. “We need to work, we need to educate, and we need to make sure this is a good paying job that people want to serve in.”

However, few legislators described how they would actually fund all these programs—Sen. Reuven Carlyle, D-36, talked about directing taxes from recreational marijuana toward treatment instead of the state’s general fund, a perennial Democratic goal—and none talked about safe consumption, the most controversial element of the task force’s recommendations. Sen. Mark Miloscia (R-30), the only Republican on the stage, has been vocal about his opposition to safe consumption sites—yesterday on Twitter, he characterized “decriminalization/legalization of heroin, rather than elimination” as “Death!”—and has proposed legislation that would prevent any local jurisdiction, such as the city or the county, from opening a safe consumption site.

Check out King County’s full list of state and federal legislative priorities here.

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