Michael Botticelli Discusses Addiction and Rehabilitation in America
Advocacy Michael Botticelli, the director of the White House Office of National Drug Control Policy, is the first official who also happens to be in substance-abuse recovery.
In an exclusive one-on-one, Michael Botticelli shares his wealth of knowledge on heroin and opioid abuse and answers how we're responding to addiction in America at every level.
Discuss the origins of this epidemic, and how it has evolved from prescription pain medication to heroin addiction.
Since the late 1990s, we've seen a greater emphasis on pain management in health care. Prescription opioid pain medications became an overused tool and as a result the rates of overdose and opioid use disorders increased.
We know that the majority of people who misuse prescription drugs obtain them from family or friends. And while most people who misuse opioid pain medications don’t move on to use heroin, 4 out of 5 new, recent heroin users started with prescription opioids before turning to heroin. As a result, opioid-involved overdose deaths tripled between 1999 and 2014.
This is a serious crisis touching every corner of the country, both in terms of the number of lives lost and the impact on our public health and law enforcement resources.
Why is it so important to ensure easy access to naloxone?
Because overdose deaths are increasing and we must save lives—naloxone can reverse an overdose. In 2014, more than 28,000 people died from drug overdoses that involved opioids. If they all had access to naloxone, and their lives were saved and they were referred to treatment, we’d be talking about recovery success stories instead of overdose deaths.
“There are great recovery stories to tell and we need to tell them, because there’s life after addiction.”
So our work becomes making sure that naloxone is widely available. First responders in many communities across the country are now carrying naloxone and are saving lives nearly every day. Pharmacies in many states are now making naloxone more available via a pharmacist, and health care providers are also co-prescribing naloxone with opioids to help patients at risk of overdose.
In this epidemic, we often focus on the stories of overdoses and deaths, and that needs to change. There are great recovery stories to tell and we need to tell them, because there’s life after addiction. But for many people with an opioid use disorder, they’ll never get there unless they can access naloxone.
What is the role of law enforcement in this issue?
Law enforcement, along with other members of local communities, are on the front lines of this issue. They see the human toll of the opioid epidemic every day. Law enforcement also recognizes that we will never arrest and incarcerate our way out of this epidemic. Certainly, police must hold drug dealers accountable, however, they are also actively seeking alternatives to incarcerating low-level offenders with substance use disorders.
Public safety officials are creating partnerships with the public health community to find ways to reduce this epidemic. One way they are doing this is by administering naloxone, since they are often the first on the scene of an overdose. And some police departments have begun programs to connect people with substance use disorders to treatment.
In addition, law enforcement at the state, local and federal levels work diligently to disrupt drug trafficking networks and to prevent diversion of prescription drugs. The vast majority of prescription drugs that are misused come from family or friends, often in the home medicine cabinet. To curb the number of prescription drugs that can be misused, the Drug Enforcement Administration (DEA) holds regular Take-Back Days at which members of the community can drop off unwanted prescription drugs.
The DEA just held just held its 11th National Prescription Drug Take-Back Day, and I was pleased to participate in an event in Minneapolis on April 30. At this location, the DEA collected more than 5,000 pounds of unneeded prescription drugs. And similar state- and local-level efforts occur around the country and are organized by local police departments. Law enforcement is an invaluable part of efforts to move our country from crisis to recovery.
What is your stance on medication-assisted treatment?
Medication-assisted treatment, when used as part of a comprehensive approach that includes other behavioral support services, is a proven, evidence-based method to help treat people with opioid use disorders and help them sustain long-term recovery.
As with any other disease, people with substance use disorders should have access to the full spectrum of services because everyone is different—the treatment that works for one person may not work for the next.
How should the U.S. approach the implementation of syringe exchange programs?
In December, the President signed the Federal Budget into law, this budget includes a provision to revise a longstanding ban on using federal funds to support syringe service programs. Areas across the country, including rural areas, are at risk for hepatitis C and HIV outbreaks due to intravenous drug use.
We saw this last year in Scott County, Indiana. Syringe service programs provide comprehensive services, to include clean syringes but also treatment for infectious diseases such as hepatitis C and HIV and for substance use disorders. Syringe service programs can improve public health because they reduce both the spread of infections and the associated health care costs of viral diseases contracted through sharing syringes.
“As with any other disease, people with substance use disorders should have access to the full spectrum of services because everyone is different...”
What are some recent actions President Obama has taken to engender change and awareness surrounding this topic?
President Obama has made ending this epidemic a priority for his Administration. Federal resources have been increased to address this epidemic—for example, the bipartisan FY 2016 appropriations included more than $100 million in new funding. And in February, the President announced his FY 2017 budget request, which calls for an additional $1.1 billion to, among other things, expand access to treatment, including in underserved areas.
In addition, the Obama Administration has been focusing on lifting up local, community-based efforts on prevention, treatment and recovery, working to end the stigma attached to people with substance use disorders, and making naloxone, the lifesaving opioid overdose reversal drug, more available.
The President also has made several announcements that bring together private and public sector leaders to address this epidemic. He proposed doubling the number of patients doctors can treat with buprenorphine, a medication that is proven to help people with opioid use disorders. He’s working to make sure prescribers have the training and education they need to safely and responsibly prescribe opioid pain medications and getting commitments from hundreds of medical, osteopathic, nursing and pharmacological schools to incorporate his new “CDC Guideline for Prescribing Opioids for Chronic Pain” into their curricula.
What are some steps those living with addiction can take to achieve long-term recovery?
First, recognize that you have a disease, and that this isn’t something to be ashamed of. Contact the treatment locator at 1-800-662-HELP (4357). There are millions of people across this country in recovery, including me. Get a support network. Life after addiction is possible.