White House undermines own efforts to fight opioid addiction

http://www.modernhealthcare.com/article/20170520/MAGAZINE/170519844

As with so much else, the Trump administration has stumbled in its initial efforts to combat opioid addiction. Given the magnitude of the crisis, healthcare professionals have an obligation to speak out against ill-considered policies.

The more than 30,000 people who die each year from opioid overdoses—nearly two-thirds of which involve prescription drugs—are everywhere. They live in inner cities, rural communities and the suburbs.

Citizens of all political persuasions have cried out for a comprehensive approach to this scourge. Not only must the healthcare system reckon with its misguided approach to treating pain, policymakers must address the reality that the worst of the addiction crisis is being felt in communities experiencing economic decline, poverty, violence and despair.

Instead of unity in the face of those daunting challenges, recent statements by top Trump administration officials either ignored them or went against what public health officials recommend. They also were at odds with the sympathetic statements made by the president.

In late March, Trump unveiled a new Commission on Combating Drug Addiction and the Opioid Crisis. He tapped New Jersey Gov. Chris Christie to head the group. “We want to help those who have become so badly addicted,” Trump said during a listening session on opioid addiction. “The president and I both agree that addiction is a disease, and it’s a disease that can be treated,” Christie added.

In a welcome move toward bipartisanship, the president named North Carolina Gov. Roy Cooper and former Rep. Patrick Kennedy of Rhode Island, both Democrats, to the panel. Kennedy, the son of the late Sen. Edward Kennedy, repeatedly wrestled with substance abuse issues before leaving Congress to become an advocate for a more scientific approach to treatment.

He rounded out the panel with Massachusetts Gov. Charles Baker, a Republican, and Bertha Madras, a Harvard Medical School professor.

Yet before its deliberations even began, several high-ranking administration officials announced policy shifts that, if implemented, would completely undermine the commission’s work. The administration’s 2018 budget draft included plans to cut the Office of National Drug Control Policy, whose head is informally known as the “drug czar,” to just $24 million from $388 million, a 95% cut.

HHS Secretary Dr. Tom Price, during a listening tour stop in West Virginia, revealed his bias against medically assisted treatment, or MAT, with drugs such as buprenorphine and methadone. HHS expanded access to MAT last year, and most clinical practice guidelines have endorsed the approach. “If we’re just substituting one opioid for another, we’re not moving the dial much,” Price told the Charleston Gazette-Mail. He touted faith-based approaches to counseling and support, according to the newspaper.

More than 700 clinicians and public health officials immediately condemned his statement for stigmatizing addiction. “Medically assisted treatments meet the highest standard of clinical evidence for safety and efficacy,” they wrote.

Dr. Price sought to limit the damage. In a commentary posted on the CMS website, he touted community-based solutions such as finding ex-addicts jobs. “The first obstacle is finding an employer willing to hire someone with a criminal record.” He also called for helping people get access to recovery services, “including medication-assisted treatment.”

Of course, the first part of that equation won’t be made easier by Attorney General Jeff Sessions’ plan, still under review, to take the nation back to the days of mandatory minimum sentences for people convicted of low-level drug possession charges. That’s exactly the opposite of what medical professionals recommend. “Stop criminalizing substance use problems,” the clinicians’ letter said.

Downsize the agency fighting traffickers? Treat addicts like criminals? Stigmatize those seeking medical treatment? This isn’t the help that the “badly addicted” need.

Filed under: General Problems