Since President Obama took office in 2009, his Administration has been working to reduce substance use and to help people live healthier lives. Over the last eight years, with the help of parents, law enforcement, public health officials, local leaders, and others in communities across the country, the Obama Administration has sought to pursue a balanced approach to drug policy, one that includes both public health and public safety efforts. In 2016, we saw several major steps forward for drug policy in the U.S., from significant new funding to address the opioid epidemic to disrupting heroin trafficking, improving prescriber education, and changing how our health care system treats substance use disorder.
In February, President Obama called on Congress to provide $1 billion in new funding to address the opioid epidemic, primarily by increasing access to treatment. In March, the President led a panel discussion at the National Rx Drug Abuse Summit in Atlanta on how to turn the tide on this epidemic. Throughout the year, he and National Drug Control Policy Director Michael Botticelli joined with parents and loved ones of people lost to or suffering from addiction, law enforcement officials, public health professionals, local leaders, and others to highlight the importance of better access to treatment.
Congress acted on the President’s request, and on December 13, President Obama signed the 21st Century Cures Act into law, which authorized $1 billion for states to address the epidemic locally. With this law’s enactment, our country will now spend similar amounts on drug-related law enforcement and substance use prevention, treatment, and recovery for the first time in history. Read more about the 21st Century Cures Act here and watch the signing ceremony here.
“This is an epidemic that can touch anybody -- blue collar, white collar, college students, retirees, kids, moms, dads…all too often, [people] feel as if they’re fighting this fight alone instead of having the community gather around them and give them the resources and the access and the support that they need. So today, I could not be prouder that this legislation takes up the charge I laid out in my budget to provide $1 billion in funding so that Americans who want treatment can get started on the path to recovery and don’t have to drive six hours to do it. It is the right thing to do, and families are ready for the support.” – President Obama, December 13, 2016
In 2015, an average of 144 people died every day from drug overdoses. Yet only 1 in 9 people who need treatment for this disease are getting it. Making sure people have access to potentially lifesaving mental health and substance use treatment is key to improving the health of our nation and helping people with these diseases live healthier, more productive lives.
The Mental Health Parity and Addiction Equity Act of 2008 eliminates certain restrictions on mental health and substance use disorder insurance coverage for plans that offer these benefits to make sure these diseases get the same level of care as other diseases like cancer, diabetes, and heart disease. Parity protections prevent plans from imposing annual visit limits, lifetime benefit caps, or higher copays for substance use disorders when they do not also exist for physical health benefits. The processes health plans use to manage care, such as preauthorization and medical necessity requirements, must also be comparable between mental health and substance use care and physical health care.
This year, President Obama convened a task force to work across government and with stakeholders to ensure that Americans are benefiting from these important mental health and substance use disorder parity protections. In October, the Parity Task Force released its report, which moves the ball forward in implementing parity and increasing the availability of mental health and substance use coverage for those who need it – including producing new guidance on parity and opioid use disorder treatment. Read more about the Parity Task Force’s report here.
This summer, ONDCP directed more than $100 million in grants to communities across the country aimed at preventing drug use and disrupting drug trafficking operations. Specifically, ONDCP provided $85.9 million to the 698 Drug-Free Communities coalitions that are working to prevent youth substance use including prescription drug misuse, marijuana, tobacco, and alcohol, and $230 million to the High Intensity Drug Trafficking Areas (HIDTA) program to help Federal, state, and local authorities address emerging drug threats by coordinating drug enforcement operations, supporting prevention efforts, and improving public health and safety
In August, an additional $17 million was awarded to the HIDTAs, with $5.6 million of this funding aimed at supporting thirteen innovative projects nationwide to disrupt the trafficking of prescription opioids, fentanyl, and heroin, as well as to help train medical providers in safe prescribing practices and increase the use of the overdose reversal drug naloxone. The funding also supports an expansion of the HIDTA Heroin Response Strategy to the Atlanta/Carolinas, Michigan, and Ohio HIDTAs.
In 2016, the Federal government took steps to reduce the supply of illicit opioids moving into and throughout the U.S. to reduce the number of heroin-involved deaths and disrupt the heroin and illicit fentanyl supply chains.
ONDCP’s High Intensity Drug Trafficking Areas (HIDTA) program is funding an unprecedented network of public health and law enforcement partnerships to address the heroin threat across 20 states. In addition, ONDCP, in collaboration with the National Security Council, created the National Heroin Coordination Group and tasked it to develop the Heroin Availability Reduction Plan to coordinate strategies and partnerships at the Federal, state, local, and tribal levels to reduce the availability of heroin and illicit fentanyl in the U.S.
This fall, ONDCP and the Department of State hosted the first North American Drug Dialogue to better coordinate supply reduction and public health responses to heroin and illicit fentanyl across the three countries and to chart a path forward for increased cooperation.
In September, the Administration announced enhanced measures in conjunction with the Chinese government to combat the supply of fentanyl and its analogues to the United States. The majority of fentanyl and its analogues brought to the U.S. by drug traffickers originates in China. China committed to targeting U.S.-bound exports of substances that are controlled in the United States but not in China. Additionally, the U.S. and China agreed to increase the exchange of law enforcement and scientific information with a view towards coordinated actions to control substances and chemicals of concern. The Administration will continue to work with China bilaterally and multilaterally to tighten international scheduling and improve capacity to monitor and analyze illicit synthetic drugs.
Many physicians do not receive adequate training on pain management or substance use disorders in medical school – on average, medical schools spend fewer than 11 hours on prescriber education. This contributes to the overprescribing of opioids and to the opioid epidemic. To address this issue, in March the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain to help prescribers safely and responsibly prescribe opioid pain medications. Hundreds of medical, nursing, and pharmacy schools pledged to incorporate this guideline into their curricula so their students will be better able to address the needs of pain patients while understanding the risks of opioid prescribing. Read about the CDC Guideline here.
The Administration has also encouraged states to set up prescription drug monitoring programs so prescribers can see what other prescriptions a patient has received. Today, 49 states have a program in place.
In October, Grammy Award-winning artist Macklemore visited the White House to premiere a new MTV documentary and participate in a panel discussion on substance use disorder. The film, Prescription for Change: Ending America’s Opioid Crisis, features stories of people in recovery from opioid use disorder and a conversation with President Obama about the Administration’s efforts to expand access to substance use treatment services. The screening was held in conjunction with the first-ever South by South Lawn (SXSL) festival of ideas, art, and action, hosted by the White House.
Immediately following the screening a panel discussion was held that focused on ways to end the epidemic. Treatment and recovery experts, as well as people in recovery from a substance use disorder, including Macklemore, participated. Watch the discussion here.
This was Macklemore’s second visit to the White House in 2016 – in May, he joined President Obama for the President’s Weekly Address, which was a conversation about addiction. Watch that conversation here.
In April, ONDCP Director Michael Botticelli spoke on behalf of the United States at the UN’s Special Session on the World Drug Problem, the first such meeting in nearly 20 years. His statement highlighted the progress the U.S. is making in addressing drug use as a public health problem. In his remarks, he called on the countries of the world to reform their drug policies to focus more on treatment for people with substance use disorders, and to invest in the health of their citizens by working to disrupt drug trafficking organizations and supporting research to improve drug prevention and treatment outcomes for all sectors of society.
“The United States firmly believes that investing in policies and programs to help our citizens is the solution. For people with substance use disorders, we need to provide access to proven paths to recovery, such as medication-assisted treatment for opioid use disorders, a serious problem in the United States.
“And we must address the needs of underserved populations in every country such as women and children; indigenous populations; lesbian, gay, bisexual, and transgender people; rural populations; and incarcerated individuals. Drug policies must address the unique needs of all sectors of society.” – Director Michael Botticelli
Throughout the year, the Administration worked with states, chain drug stores, the medical field, and law enforcement to expand access to naloxone, the opioid overdose-reversal medication. Today, it’s easier to access naloxone in almost every state than it was when President Obama took office. The Administration has also encouraged states to adopt Good Samaritan protections for people who call for help when they witness an overdose – another important tool to prevent overdose deaths.
In addition, the Administration held two more national Prescription Drug Take-Back Days in 2016 to get unused and unwanted prescription medications out of medicine cabinets before they could be misused. While most people who misuse opioid medications don’t move on to use heroin, 4 out of 5 new, recent heroin users started with prescription opioids before using heroin. Throughout the 12 Take-Back Day events during the Obama Administration, the Drug Enforcement Administration (DEA) has collected more than 7.1 million pounds of unused and unwanted prescription drugs. To find a drug disposal site near you, click here.
ONDCP engages with emergency departments, health care professionals, and law enforcement officials to share strategies for helping patients transition from overdose to treatment.
ONDCP held webinars in August and December on helping individuals who have suffered an overdose access treatment. The webinars reviewed steps that hospitals and communities can take to increase the number of overdose survivors who access treatment and better identify patients with opioid use disorder in order to link them to specialty care.
The webinars highlighted innovative approaches for addressing opioid overdose and opioid use disorders in hospital emergency departments and other hospital-related settings, and outlined the Administration’s response to the opioid epidemic. Click here to view the August webinar and here to view the December webinar.
White House hosts final "Making Health Care Better Series" on substance use disorder
On November 30, the White House hosted the final “Making Health Care Better Series” on substance use disorder, bringing together leaders from diverse fields to discuss advancements in recovery, prevention, research, and access to treatment, as well as the road ahead.
To coincide with this event, the White House released a report highlighting the significant progress that has been made over the past eight years in the substance use disorder field. The report included an overview of the Obama Administration’s balanced public health and public safety approach to drug policy, and its efforts to expand resources and protections for people with substance use disorders.
ONDCP engages with courts, law enforcement, and correctional facilities to expand access to evidence-based treatment for people with opioid use disorder who are involved in the criminal justice system.
The Administration has made criminal justice reform a priority. This year alone, ONDCP has worked to engage drug treatment courts, law enforcement officers, and correctional institutions on ways to divert non-violent drug offenders to treatment instead of incarceration and to encourage evidence-based treatment within correctional facilities to help people achieve and sustain recovery before and after their release.
To coincide with National Reentry Week in April, ONDCP hosted a webinar on Medication-Assisted Treatment Programs for Justice-Involved Populations. Watch the webinar here. In May, ONDCP partnered with the National Association of Drug Court Professionals (NADCP) to host a webinar on Medication-Assisted Treatment in Drug Courts. Watch the webinar here.
Deploying the Pay for Success model to address the opioid epidemic in communities
Government leaders at all levels have the responsibility to ensure taxpayer dollars are spent wisely – that they get results for the American people. This is particularly important for public health and public safety issues, such as the ongoing opioid epidemic. An Administration priority called Pay for Success (PFS) can help communities that are stretched thin respond to the epidemic.
The PFS model allows government to only pay for success, such as a decrease in the rate of opioid overdoses in a county. Meanwhile, private investors – banks, charitable foundations, or even individuals – can provide any needed upfront funds for an organization to deliver services. In this way, government does not have to fund services upfront – a helpful advantage particularly in times of tight budgets.
Communities all across the country have used Pay for Success as a way of ensuring better value for taxpayers while expanding services where there is unmet need. The Obama Administration has provided support to communities as they have developed Pay for Success programs and even helped pay for outcomes. In December, ONDCP released a Resource Guide to help states, cities, counties, and their partners learn about PFS as another tool in their toolbox. Read the Resource Guide here.
In November, U.S. Surgeon General Vivek Murthy released his landmark report on addiction. The Surgeon General’s Report on Alcohol, Drugs, and Health is the first-ever Surgeon General’s report on addiction and marks a turning point in our Nation’s understanding of substance misuse and our response.
In particular, the report reinforces the public health strategies this Administration has employed to address the opioid overdose epidemic, and it paves the way for future efforts to change how we talk about substance use disorders, how we prevent drug use before it begins, and the treatment and recovery support services we offer to those with these disorders. Read the full report here.
“Our Nation is facing an opioid overdose epidemic that’s unlike any public health crisis we’ve seen. Everywhere I go, I hear the heartbreaking stories of families and communities who are fighting this disease, as well as the stigma associated with it. To change this, we must treat substance use disorder not as a moral failing, but as a disease that people can and do recover from. I want to thank the Surgeon General for the work he’s done on this issue and on this historic report.” – Director Michael Botticelli