In the Effort to Address Drug Overdose ‘Public Health Crisis’ States are Part of the Solution

Michael Botticelli serves as the director of the Office of National Drug Control Policy at the White House. In long-term recovery from a substance use disorder for more than 26 years, Botticelli has worked to confront the stigma associated with substance use disorders, which can prevent individuals from seeking treatment. He believes making a variety of treatment options available is key to addressing the opioid epidemic and saving lives.

1. More Americans die every year from drug overdoses than in car crashes. 
What are some of the factors that have helped fuel the crisis?

“The primary contributing factor to the rise in drug overdose deaths since 1999 is the increase in prescribing of prescription opioid pain medications; opioids are powerful drugs that carry a risk of addiction. As a result, opioid-involved overdose deaths tripled in 15 years. In 2014 alone, this epidemic claimed 28,000 lives across the U.S. It’s a real crisis, and we’re working to expand treatment so that everyone who needs it can access it.”

2. Fentanyl, a synthetic opioid, seems to be taking on a leading role in the epidemic. 
Why is it so dangerous?

“Fentanyl is much more potent than heroin, so we’ve seen a surge in overdose deaths involving fentanyl in recent years. It’s also sometimes mixed with heroin, so people may not realize they are using fentanyl. The Obama administration has been working closely with the international community to disrupt and dismantle criminal organizations trafficking heroin, reduce poppy cultivation, and enhance efforts at the border to decrease the flow of heroin. We’ve also focused on making sure that anyone in a position to witness an overdose is equipped with naloxone to help reverse overdoses and give people a chance to enter treatment and, eventually, long-term recovery.”

3. You’ve hosted community forums across the country on the opioid epidemic 
in recent months. What have you learned from the communities you’ve visited?

“First, we have a treatment gap that’s preventing us from saving lives. It’s estimated that only 12 percent of people who need treatment are actually getting it. … Too many (family members of those lost to overdoses) shared similar stories about long waits for treatment or a lack of good treatment options in their communities. … It’s critical that people can access treatment, including medication-assisted treatment, which is unavailable in many places. And we need more treatment providers, especially in underserved areas. The president’s $1.1-billion budget request would help expand access to treatment in areas that need it.”

4. In October 2015, President Obama announced a number of new public and 
private-sector efforts to address the epidemic, such as health care prescriber 
training. How does the administration hope to help stem the tide of overdoses
with these efforts?

“Ensuring prescribers and patients understand the risks involved with prescription opioid pain medications will go a long way toward ending this crisis. In March, the CDC released its new Guideline for Prescribing Opioids for Chronic Pain so prescribers can safely treat their patients’ pain, while also recognizing the risks of opioid prescribing. The Obama administration has also trained more than 75 percent of federal prescribers in safe and responsible prescribing practices. It’s a start, but we need every prescriber of opioids to get the training they need. This will go a long way toward preventing future opioid use disorders—and deaths.”

5. What role are state prescription drug monitoring programs and other state 
initiatives playing in larger efforts to prevent and respond to substance abuse?

“The opioid epidemic affects the whole country, but it’s often state and local governments that are closest to the problem. … While 49 states and the District of Columbia have prescription drug monitoring programs, too few prescribers check these systems before prescribing. States can enhance these prescription drug monitoring systems, allow syringe service programs, expand access to the opioid overdose-reversal drug naloxone, pass Good Samaritan laws that encourage people to call 911 or seek other medical aid without the fear of arrest when witnessing an overdose, and make treatment more widely available. They can also require prescriber education so the prescribers in their states are trained to safely and responsibly prescribe opioid pain medications.”

6. How are state and federal programs expanding access to treatment for addiction?

“There’s a huge treatment gap right now all across the country. … As I’ve traveled the country, I’ve heard heartbreaking stories from parents unable to access treatment for their children, some of these children have died as a result. This is unacceptable to the president, it’s unacceptable to me. We need Congress to pass the president’s budget request that includes $1.1 billion to expand treatment so we can help people reach recovery and regain control of their lives.” 

7. What are some of the evidence-based treatment options that have promise 
to help reduce overdoses?

“People need to have access to every form of treatment because there’s no single path to recovery and what works for one person may not work for another. Medication-assisted treatment is the standard of care for opioid use disorder, but it’s unavailable in many places, partly because of the stigma surrounding addiction and treatment. Yet it’s generally accepted by the public that medication is a useful tool—if not the primary tool—to quit smoking. People with substance use disorders should have the same access to medication.”

8. For many years, drug addiction has been approached as a criminal issue, but leaders are increasingly referring to addiction as a public health issue. Why is this so critical?

“In 2014 alone, drug overdoses killed more than 47,000 people. This is a real public health crisis, and we recognize that we can’t incarcerate our way out of this problem. It’s past time for our country to both reform the criminal justice system and to make sure that people with substance use disorders get the treatment they need. We need to be diverting more people to treatment, including through drug courts. President Obama often says ‘America is a nation of second chances.’ Our country celebrates people who take the steps to overcome adversity. Our policies should reflect this.”

9. How has your personal success story of long-term substance use recovery informed your efforts to help communities across the nation?

“I hope that my story of recovery inspires people with substance use disorders—and their loved ones—to see that recovery is possible, and that you can have a life after substance use. But my story is not unique—there are millions of Americans in recovery across the country. We didn’t all take the same path to recovery, and that’s why it’s so important that people can access every form of treatment.”

10. What role does the medical community play in combating prescription drug abuse?

“The medical community has a huge role to play in preventing, identifying and treating substance use disorders. Prescribers can prevent the misuse of prescription opioid pain medications by following the CDC’s Guideline on Prescribing for Chronic Pain, suggesting alternative treatments to manage their patients’ pain and checking their state prescription drug monitoring program. They can intervene if they think a patient is at risk for overdose or developing an opioid use disorder by co-prescribing naloxone and referring the patient to substance use treatment. They have a tremendous role to play in our efforts to move our country from crisis to recovery.”