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White House fully engaged in fight against heroin abuse in rural U.S.

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@ONDCP Director @Botticelli44 talks to County News about the opioid abuse epidemic

County News will focus its next Hot Topics special report on how counties are dealing with the plague of opioid abuse that is cascading across the country.

To set the stage, County News interviewed the White House’s top drug policy official, Michael Botticelli, director of National Drug Control Policy. 

Our report on the interview begins a series of Hot Topics articles published over several months about efforts to curtail opioid abuse.

The director of the White House Office of National Drug Control Policy (ONDCP) knows addiction first hand.

Michael Botticelli has successfully been in recovery from alcoholism for 26 years — of which he’s made no secret.

Recently, he sat down with County News to discuss the heroin and prescription opioid crisis sweeping the nation and how the federal government is responding.

Heroin abuse has historically been seen as a big-city problem, but rural America has been hit hard in recent years. Botticelli cited the over-prescribing of prescription pain relievers by physicians as a major factor.

Doctors are prescribing enough prescription medications to “give every adult American a bottle of pain pills,” he said. “That is one of the reasons why we’ve seen … the explosion of the opioid epidemic beyond just our urban communities.”

The link between prescription opioids and heroin is well established. “We know that about four-fifths (80 percent) of newer users to heroin started by misusing prescription pain medications,” he said.

That’s why part of ONDCP’s strategy to stem the problem includes educating physicians.

Widely known as the drug czar, Botticelli dislikes the label’s militaristic, “war on drugs” connotations. He brings a public health background to the job.

“Clearly, we want to make sure that people have access to good prevention and good treatment services,” he said. “One of the refreshing things that I have seen as I travel the country…local law enforcement understand that we can’t arrest and incarcerate our way out of the problem and [they’re] really looking at ways to divert people away from the criminal justice system.”

Last summer, the U.S. Department of Health and Human Services (HHS) announced $100 million in support for community health centers, he said. “We know that many parts of the country, particularly rural parts of the country, might not have access to a substance abuse treatment program, but have a community health center, and that’s a really good opportunity to look at how do we increase access ….”

The Affordable Care Act has helped in that regard, he said. “We know that many people are not able to access treatment because they haven’t had insurance coverage before, and the act mandates that those marketplace plans, Medicaid expansion plan have a dedicated substance abuse treatment benefit to it.”

Botticelli said some of the best ideas for combating the opioid epidemic have come from local communities. In 2010, the Quincy, Mass. police department was the first in the nation to carry naloxone, a drug that can reverse an opioid overdose, he said.

“Since then, we have just seen it explode across the country in terms of other law enforcement and other first responders taking it on, and other bystanders.

 “I think it’s a really good example of how something can happen at the local level and then, through our office, we can amplify it….”

One bright spot in the epidemic, if there is one, Botticelli said, is the availability of prescription drugs such as buprenorphine, which can help users break their dependence on opioids. Buprenorphine is a mild opiate that targets the same areas of the brain as heroin but without the same intense “high” or dangerous side effects.

Weighing treatment outcomes, he said that people with opioid use disorders do far better on medication along with counseling and other recovery supports than those not receiving medication-assisted treatment.

The Obama Administration’s proposed budget for FY17 includes $1 billion in new funding over two years to expand access to treatment for prescription drug abuse and heroin use.

Included in that funding would be $500 million for U.S. Departments of Justice and Health and Human Services, a portion of which would fund targeted enforcement activities — specifically in rural areas — and to improve access to the overdose-reversal drug naloxone.

The vast majority of that money, $920 million, would go to states to expand access to medication-assisted treatment for “opioid use disorders.”

“Part of what we’ve been trying to promote here is a balanced strategy with both public health and law enforcement,” he explained. “I’m happy to say, for the first time in the history of our office, (in) the president’s FY17 budget, we actually have a balanced budget in terms of demand-reduction strategies, those public health approaches, as well as our supply-reduction strategies.”

Botticelli said he’s encouraged by the breadth of support in Congress for addressing the opioid addiction problem. “From an overall perspective this has been a bipartisan issue,” he said, “and there’s been a tremendous amount of interest and leadership across the aisle….”

For any of these efforts to succeed, the conversation about addictive disorders needs to change. Words like addict, junkie and substance abuser can be stigmatizing, he said.

“We have great partners in the broader community who are working with us to change the language of addiction to reflect a nonjudgmental, therapeutic response to people with addictive disorders.

“Part of our work is how do we make sure that we’re working with state and local and county governments, and our stakeholders to make sure that we are implementing good responses? And that we are bringing everybody together to really come to common agreement in terms of the strategies.”

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