Officials tout Obama administration’s work on substance abuse

By Melissa Patrick
Kentucky Health News

Officials and health advocates touted the Obama administration’s work in addressing substance-use disorders at a forum Nov. 29, and also advocated for the passage of the 21st Century Cures Act to increase funding for prevention and treatment services, which continue to be inadequate.

Michael Botticelli

“We have made some significant progress, no more impactful than expanding health care for millions of Americans,” Michael Botticelli, director of the Office of National Drug Control Policy, said in the opening remarks of the final “Making Health Care Better” series.

Botticelli noted that the Patient Protection and Affordable Care Act not only requires medical plans to cover mental health and substance-use disorders, but also requires them to be covered in the same way other health conditions are covered, called parity.

“The Department of Health and Human Services estimates the ACA expanded mental health and substance-use disorder benefits and parity protection benefits to more than 60 million people,” he said. “Making sure that people have access to treatment for this disease is key to improving the health of our nation.”

Botticelli said funding from the 21st Century Cures Act, pending legislation that includes $1 billion to expand access to treatment and prevention services, as well as further provisions for mental-health and substance-abuse parity, would help each this goal. The bill has passed the House and is expected to be called up for a vote in the Senate soon.

“The administration strongly supports this bill,” he said. “We hope Congress sends it to the President’s desk for his signature so that everyone with an opioid use disorder who wants treatment can get it.”

Progress in public health

The deputy undersecretary for Health for Organizational Excellence at the Veterans Health Administration, Dr. Carolyn Clancy, said 50 to 60 percent of veterans suffer from chronic pain. She said the VA has led the way in finding solutions to the opioid epidemic through opioid prescription reductions, online reporting tools, Naloxone programs and telemedicine programs.

Kana Enomoto, principal deputy administrator for the Substance Abuse and Mental Health Services Administration, said 21 million Americans are affected by a substance-use disorder and one out of every seven people will develop one in their lifetime. But only one in ten people who need treatment, get it, she added.

Enomoto praised the ACA provisions that requires substance-use disorder treatment and parity, but added that medication-assisted treatments, like buprenorphine, are not being utilized enough, though research supports the use of them, along with  the “right psycho-social help.”

Another successful public health initiative is the new opioid prescribing guidelines for chronic pain released earlier this year by the Centers for Disease Control and Prevention. Dr. Deborah Dowell, senior medical adviser at the CDC, said they are working to inform providers of these changes and said many medical schools and nursing programs have already incorporated them into their curriculum.

The panel noted that future challenges include synthetic opioids, like fentanyl, finding non-addictive medications to treat chronic pain and increasing access to affordable treatment.

Local solutions and advocacy

Don Flattery, chairman of the advocacy committee for the Fed Up Coalition, who lost his 26-year-old son to an opioid addiction, reminded advocates to keep a face connected to this issue, noting that discussions about addiction are often too clinical. “It’s absolutely essential to personalize this issue,” he said.

Timothy Rabolt, a recovering addict and recovery advocate for college students, said more colleges need “full-fledged collegiate recovery programs” that include recovery housing, recovery spaces that host group meetings and academic advisers who are trained to help these students.

Baltimore Health Commissioner Leana Wen, who has created a successful Naloxone program, said she was pleased the “tone and the discussion really have changed” over the years and that people are now talking about addiction as a disease and a public-health crisis.

“We have to continue to fight stigma with science,” she said. “And that’s where everyone in this room, all of our advocates, really have to speak up and say that treating addiction as a crime is unscientific. It’s inhumane. It’s unethical.”

Public health and public safety as partners

Cynthia Reilley, director of the Substance Use Prevention and Treatment Initiative at the Pew Charitable Trusts, also pointed out medication-assisted treatments (MATs) are greatly underutilized, but added that they continue to face many access barriers including not enough providers willing to prescribe them, lack of support services for those who are on them and restrictions from insurance policies.

“We know that MAT has been demonstrated to be effective in addressing substance-use disorders. In fact, it is more effective than other intervention in reducing dependence on prescription opioids, heroin and alcohol,” she said.

Daniel Raymond, policy director of the Harm Reduction Coalition, talked about the importance of syringe-exchange programs and Naloxone, said, “Several years ago, harm reduction would not be represented in one of these discussions.”

Sheriff Peter Koutoujian of Massachusetts said, “We can’t incarcerate our way out of addiction.”

Koutoujian, who is also a former prosecutor and legislator, touted the success of the substance-use disorder programs offered to every inmate in his jail who needs it, including access to medication-assisted treatment and a “recovery coach” to support them when they leave.

“You shouldn’t have to come to jail to get that type of treatment or programming, you should be able to get it on the street beforehand,” he said.

Koutoujian said people in addiction programs must have access to a full range of services if we expect long-term recovery, including appropriate housing, mental health care, substance-use disorder supports and strong social network support.

“Until we actually get our leaders to step forward and provide some of those services, we are just going to keep having the same conversation over and over again,” he said.

What’s next?

Tom Vilsack

Agriculture Secretary Tom Vilsack, closing the forum, said the U.S. has responded with “great vigor” to diseases like diabetes and cancer, each of which affects a similar number of people as substance-use disorders, “but here we are with 21 million of our fellow citizens suffering from substance-use disorders and only one in 10 of them have access to treatment.”

He highlighted many of the Obama administration efforts in fighting the opioid epidemic, but placed special emphasis on the role of communities in the fight, especially in rural communities, which often don’t have adequate resources to help those with addictions.

Vilsack said his mother had been an alcoholic and that it took many years before she was able to successfully become sober, but only because she had access to long-term recovery and the support systems within their community, including Alcoholics Anonymous and her sponsors and a supportive family.

“In the past, we have suggested that perhaps if these folks had a little more character, if they had a little more will power, if they had a little more faith — then they would be able to overcome their addiction, just by shear will,” Vilsack said. ” This is a disease and it needs to be understood by everyone that it is a disease.”

Vilsack called on advocates to push for more prevention, to push for more treatment, to create communities of support and to find creative ways to deal with the issues of housing and economic opportunities.

“Use your voice everywhere — at the local level, at the state level, at the federal level, everywhere — use your voice to explain to people who can make a difference in the lives of these 21 million Americans,” he said.

Vilsack ended the event with a passionate call to continue the fight: “I would hope that we are a strong enough, compassionate enough, intelligent enough country to understand the importance of taking this on and taking it head on,” he said. “People, we can change this. We can be the country that we should be, but it’s going to take everybody here and thousands more like you.”

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