CHICAGO — Health care has come a long way in the past year in attempting to address the plague of prescription painkiller and heroin abuse that’s killing dozens of Americans every day. But it’s stuck in neutral, however, without Congress providing needed funding to move into the next phase of quashing the nation’s opioid epidemic.
That was the main message I gathered from Michael Botticelli, director of the White House Office of National Drug Control Policy, who spoke here in Chicago Thursday as part of the American Osteopathic Association’s annual meeting. Botticelli, a political appointee who admits he won’t be in office much longer, didn’t mince words in questioning Congress’ motives, and urging DOs to voice their concerns to elected officials.
He called failure to include the $1.1 billion in needed dollars “deplorable,” and wondered if there is any other medical condition where just 12 percent of people who need treatment actually get it.
“Only Congress appropriates money, and quite honestly, Congress has not stepped forward in a meaningful, robust way on this epidemic,” he said. “We have been scraping money together and looking at how do we cobble together funds to be able to support, particularly, access to treatment, in this United States.”
“We’re very pleased that Congress passed CARA,” Botticelli added later, referring to the Comprehensive Addiction and Recovery Act, which was signed into law by President Obama on Friday. “It’s a sign that they are paying attention to this issue, but when you don’t appropriate a single dollar to any of the authorized grant programs, I question the commitment of some members of Congress to really focus on this epidemic, and I think that’s where your voice can be crucial.”
Despite the funding roadblock, Botticelli, himself a recovering addict, did note some of the progress made in addressing this epidemic. For one, earlier this month, a new rule allows clinicians to prescribe more of buprenorphine, a drug that treats opioid addiction. Before, prescribers could only give this medication-assisted treatment to about 100 patients, but now that threshold leaps to 275. Plus, the feds are working to remove pain-related questions from patient satisfaction surveys, so as not to inadvertently encourage doctors to prescribe opioids, a complaint that’s been voiced by several trade groups, including the American Hospital Association.
The opioid epidemic has been a key concern for the AHA, which supports several provisions in CARA. The association recently joined with the Centers for Disease Control and Prevention to develop a one-page resource to help hospitals foster more effective and fact-based conversations between patients and physicians about opioids, and has a growing number of AHA opioid abuse resources available.
For far too long, Botticelli believes, America has been overly focused on the enforcement side of the drug problem. “We can’t arrest our way out of this crisis,” as the cliché goes. But in recent years, that’s shifted more toward the treatment side. For the first time in the roughly 27 year history of the Office of National Drug Control Policy, the organization’s budget provides equal funding for both public health strategies and efforts to reduce the drug supply.
“It’s really important for us. There is no one simple, silver bullet response to this and we have to make sure that we’re moving in the same direction on both the supply side and making sure we are working on prevention and treatment issues,” Botticelli said.
What’s also important, Botticelli said, is making sure that we don’t swing the pendulum too far in the other direction in curbing opioid prescriptions. There are plenty of legitimate pain patients out there who need these drugs to live a normal life. But opioids should no longer be the default first choice for pain management, and other treatments must be utilized, including osteopathic manipulative treatment, he said.
The White House believes that much of the 78 deaths occurring every day from opioid use are preventable. But doing so will require treating the whole person, and providing them with access to evidence-based solutions in their own communities, “not two hours and three buses away.” Naloxone, the overdose reversal drug, is also a key part of this fight, Botticelli notes, but there are challenges in getting it into the hands of those who need it most. One Kansas City anesthesiologist in the audience asked why, 30 years ago, the price of one dose was less than $5, when today it’s up over $1,000.
Botticelli said the White House will keep pushing for further funds to disperse the drug, though he declined to address the pricing issue.
“I won’t talk about the reprehensible practices of manufacturers who, in the middle of an epidemic with unprecedented demand, decided to increase the price of naloxone. I won’t talk about that,” he said, to laughs. “But I think we’ve seen tremendous progress at both the federal and state level to look at how we can make sure we’re getting naloxone into the hands of anyone who is in a position to reverse an overdose. Despite some of the pricing challenges, we will continue to look at how we can use federal grants and resources to support naloxone.”
Despite all the widespread publicity this epidemic has received, still, some elected officials are basing their decisions on fear and stigma, as if addicts are in their current state based solely on their choices. Such stigma often perpetuates poor public policy and laws that hinder the spread of naloxone and other treatments. He urged doctors of osteopathic medicine and the rest of the field to spread the word of addiction as a disease that must be treated like any other chronic condition.
“One of the bright spots that have come out of this epidemic has been this movement of recovery in the United States,” he said. “We have young people in recovery chapters all across the country. We have people who are standing up and talking very proudly about their own recovery, because we have to give people hope on the other side of this.”