Remarks by ONDCP Director Michael Botticelli, Atlanta, GA

Remarks by ONDCP Director Michael Botticelli

“We Don’t Have Time to Wait”

Atlanta, GA

April 7, 2015

Thank you, Thank you for the opportunity to be here today, and thank you, Chairman Rogers, for that kind introduction.  Your leadership on prescription drug abuse issues has been, and continues to be, essential to our continued progress.

I have a few more people to acknowledge, but I will save that to later in my remarks.

First I want to say this:

The title of my talk today is “We do not have time to wait.”

Let me repeat that. “We do not have time to wait!”

To illustrate:

In 1999, there was one overdose death on average every 30 minutes.

In 2013, there was one overdose death on average every 12 minutes.

This means that every day we waited in 2013, 120 people died each day on average, 72 people a day more than in 2000. 

If this clock face doesn’t convince you that we don’t have time to wait, maybe a few of these faces will.

I just came this morning as I have done many times since I started my work at ONDCP from a meeting with parents who had lost children to overdose.

While I wish that I had the time to talk about all of the lost children, husbands, wives and beloved friends that have been affected by this crisis, I want to talk about one of them today.

This is a picture of Taylor Smith from Holly Springs Georgia. Taylor’s mother, Tanya Smith, is in the audience today and is responsible for ensuring that law enforcement in her town carry naloxone -- the antidote for opioid overdose.

This is from a letter she sent our office.

“Attached is a photograph of my daughter, Taylor Smith.  Taylor was a freshman, junior varsity and varsity squad basketball and football cheerleader at Creekview High School; known for her quick wit and infectious squeaky laugh; she was an avid animal rescuer, and quickly came to the defense of those she felt were treated unfairly. 

She was 20 years old when she overdosed in the company of friends, who subsequently dumped her body in the yard of an abandoned trailer to avoid arrest for drug possession”

Thank you Tanya for sharing your family’s story with us. Your experience is a tragic reminder to us all that we must act now to reform the systems that were too late for your child and the countless others affected with this epidemic.

Your courage shows we can and indeed we must make a difference even in the midst of overwhelming sorrow.

Now I am going to turn back the clock and discuss where were when we started and what we have accomplished.

We are truly indebted to the epidemiologists at the Centers for Disease Control who noted the escalation in overdoses that had been occurring prior to the start of this Administration and identified them as injury prevention issue.

At the start of this administration America was in the midst of a growing epidemic.

In 2010, drug poisoning deaths surpassed the historically most lethal cause of preventable injury – traffic crashes – and rates continued to escalate.

To address the crisis the Administration released its  Prescription Drug Abuse Prevention Plan in 2011.

Since then, along with our stakeholders and our Federal partners we have made substantial progress towards accomplishing many of the goals established under each of the Plan’s four pillars – education, monitoring, drug disposal, and enforcement. I would like to touch just briefly on some of our progress on each pillar.

The majority of prescribers do not receive any training in medical school on identification or treatment of substance use disorders.  We have therefore developed continuing education training programs that teach prescribers skills such as how to start a conversation with patients about substance use; managing pain appropriately; and treating patients using opioids more safely. 

Today most federal prescribers in the Department of Health and Human Services and Department of Justice’s Bureau of Prison have taken this training. FDA has trained thousands of prescribers through voluntary training program on extended release long acting opioids and many prescribers in the Department of Defense have been exposed to training the Military’s own “Do No Harm Training”. 

Prescription drug monitoring programs, PDMPs are another part of our plan to address prescription drug overdose deaths.  When the administration started there were 30 states with prescription such electronic databases.

Today all but one state – the state of Missouri – has a database that allows prescribers to check on drug-drug interactions as well as to alert them to early signs of dependence on opioids. Last week in Missouri the state Senate joined the House in passing a a bill authorizing a state PDMP. Now eachhouse has taken the other’s up for consideration. We are cautiously optimistic that this means 2015 will be the year we can finally say we have a nationwide PDMP infrastructure. [i]

The third element of our plan is disposal.  Since the majority of individuals who begin misusing prescription drugs get them from family and friends, we must make it easy to dispose of leftover drugs.

The Drug Enforcement Administration (DEA) published the final regulations on controlled substance disposal in September 2014. Now ONDCP and our Federal partners and stakeholders are beginning to inform the public about the regulations and looking at ways to stimulate local disposal programs in partnership with pharmacies and law enforcement.

Finally, work on enforcement and strengthening existing laws is ongoing at the Federal, state, and local levels.  Those engaged in fraud across the drug-control supply chain are being investigated and prosecuted.

Despite this important progress, I am reminded every day as I do this work how far we need to go to make things better for people living with a history of substance use problems. Every day I ask myself, “What will I do today to make a difference in the lives of people affected by this epidemic?”

As Congressman Rogers mentioned, I was confirmed by the US Senate earlier this year and am the first person to hold this position – previously referred to as the “drug czar” – who is in recovery.  I talk publicly about my story because I believe to make a difference and get people the care they need when they need it, those of us who have lost loved ones and those of us in in recovery from substance use disorders must speak up, to defy the stereotypes and strike down the stigma that keeps too many people from seeking help.  

Selecting a person in recovery to lead our National Drug Control Reform Effort shines a light on the fact that people can succeed with the right treatment and support. People can overcome what research has shown to be chronic brain disease.

The words we use to describe those of us with substance use disorders help to reinforce stereotypes and feed stigma that can prevent people with substance use problems from accessing care and succeeding in recovery.

Pick up any newspaper or watch any TV news program and I’m sure you’ll hear and see these words:

Junkie

Addict

Abuser.

These are the words we use to describe people with substance use disorders.

And our public policies – and societal norms - reflect these attitudes.

• When we suspend a child, maybe a middle schooler, from school because he brings a drug to school.  When the last thing that child needs is to be isolated from support systems – we lose an opportunity to intervene;
• When we don’t intervene to get people the treatment they need because our health care system doesn’t want “those people” in their waiting rooms;
• When a public official can stop PDMP legislation because another overdose just means one less junkie --- 

We do this because our society believes it’s okay to deny people with the disease of addiction the care and respect we accord to other Americans with respect to treating their medical conditions.  

Because “those people” are us.  They are you.  They are our family.  They are our friends.  They are our neighbors. 

When asked by my staff what unique contribution I wanted to bring during the Administration’s remaining two years, I replied without hesitation that we should use our policy levers at the federal level to reduce stigma and help more people get the care they need to live productive lives.

I – along with millions of others who are in recovery – are living proof that substance use disorders are diseases, treatment can work, and recovery is possible. 

To achieve this, we must expand access to both naloxone and treatment especially Medication Assisted Treatment (MAT) so we can keep people alive over the short and long term respectively.  MAT, when combined with other supports has been shown to be THE best course of treatment for opioid use disorders.

That is why the 2016 President’s Budget Request includes millions of dollars in additional funding for treatment and overdose prevention efforts.

We must do all within our power to integrate care for substance use disorders with mainstream medicine and promote models we’ve seen in states like West Virginia that uses Telemedicine or Vermont that uses a Hub and Spoke model that increase access to care, especially in rural communities.  

The prescription drug overdose epidemic has given us an understanding that substance use disorders should be addressed as a public health issue.  And healthcare must play a role in prevention, early identification and treatment, reducing the consequences of use and improving the health of people with substance use problems. 

Along with not having time to wait, we cannot afford to wait. We need identification and care, actual integration with mainstream medicine, to happen now because it’s less expensive to treat a prescription opioid use disorder than to prosecute and incarcerate someone because of their substance use disorder.

It is less expensive to treat a person with a prescription opioid use disorder than to provide medication for HIV or Hepatitis C. Risks of such infections increase dramatically once someone transitions to injection drug use. 

Providers and the medical system must awaken to the reality that when substance use disorders are identified early and treated, the burden on their practices and the healthcare system overall is reduced. 

Recent data shows we are seeing overdose from prescription opioids leveling off in this country but a dramatic 39% increase in heroin overdose from 2012 to 2013. [ii],[iii]

It is easy to think that once users have progressed to using heroin or injecting that law enforcement should simply take over.

That this is no longer a health care issue.

Law enforcement and other first responders have an important role to play but the medical establishment must remain engaged in treating heroin users as well as prescription opioid users. Every day heroin overdose victims appear in the emergency rooms. Models are needed to move these individuals into the drug treatment system.

We cannot expect attitudes to improve if we fail to intervene in the medical system where the problem can be cared for at the highest levels of care by those who can provide the most effective treatments.

Right now we are waiting to treat most people until they present of their own accord or are referred by the criminal justice system. Just like with other medical conditions, people should not have to diagnose themselves.

We know that only about 4% of people move from misusing prescription opioids to heroin use over a five year period.[iv] This means in most cases we have time where we could identify and treat a prescription opioid user and prevent him or her from ever starting heroin use.

This also means that we must redouble our efforts to address people who are using prescription opioids non-medically especially since we know this is a major risk factor for heroin use.[v] 

It is incumbent on our medical system to find these folks and move them to appropriate care before heroin use starts and in fact before any injection begins. 

Failure to act has dire medical consequences even prior to heroin use.

Two weeks ago the Indiana governor declared the HIV outbreak in southeastern Indiana a public health emergency. Many of these infected individuals there began by injecting prescription drugs. This illustrates the strong link between injection drug use and infectious disease.

ONDCP has been represented at the National Prescription Drug Abuse Summit since its inception, and I know firsthand what an incredible group of national leaders the organizers have brought together from all levels of government, public health and safety, associations and business, and communities across the country. 

I want to acknowledge a few people who, like Taylor’s Mom aren’t waiting.

Project UNITE is an incredible asset to Kentucky – and to the nation.  I want to particularly thank Karen Kelly for her energy and commitment.  You have made a difference.

I would also like to thank Secretary Burwell for all of her efforts to address the opioid epidemic.

Also it was NIH supported scientists who made many of the discoveries I will be talking about today, like the importance of recognizing chronic substance use disorders as a brain disease. Thank you Dr. Collins and please give kudos to Dr. Volkow who will be speaking later in the conference for supporting the research that has led to this understanding.

In the future, through their work on the President’s Brain Initiative which NIH is funding along with partners from the research community, we will better understand how complex decisions are made like the decision to use drugs. So thank you, Francis, for your tireless support of this important work. 

FDA has been an invaluable contributor to our Federal efforts and I want to say to Acting Administrator Ostroff (Os-Trough) that I am happy to begin our work together. 

This year we’ve seen so many governors come out and support legislation and other efforts in their state. Governor Fallin and I had an opportunity to talk last night after her keynote.

As a former State Public Health Department person working on the substance use issue, I know firsthand that having leadership and buy-in from Governors is essential to leverage and coordinate state resources to succeed at solving the prescription opioid crisis.

In the final minutes here I would like to read a message from the President of the United States.

“I send greetings to all those attending the National Rx Drug Abuse Summit.

Prescription drug misuse and abuse is a major health issue in our country and can lead to substance use disorders and devastating consequences.  In America, someone dies from a drug overdose every 12 minutes – and a large contributor to these deaths is prescription painkillers.  This is an epidemic claiming the lives of too many men, women, and young people, and we must continue our work to reduce prescription drug abuse, expand treatment, and decrease the number of deaths that result from overdose.

By raising awareness and educating parents, young people, patients, and prescribers about the dangers of prescription drug abuse, we can reduce the drug overdose death rate and the number of people affected by substance use disorders.  When events like the National Rx Drug Abuse Summit bring together individuals from a wide range of professional fields along with those who know the pain of losing a loved one to overdose, we can build partnerships to reduce prescription drug abuse and the tragedies that result from it.

As you gather in a spirit of collaboration to share solutions to combat prescription drug abuse, I wish you the best for a productive event.”

I read this because it’s important that you know that American leaders at the highest levels are engaged to address this issue.

You all play critically important roles in finding solutions to our Nation’s drug problem and it starts with leveraging the prevention and the medical system for
          • earlier identification
          • ensuring linkage to treatment for those identified,
          • engaging people in treatment
          • and ensuring access to naloxone and overdose education. 

Let’s tackle these issues together so we can help all Americans live safer and healthier lives.

“We don’t have time to wait.” 

Thank you for your time today. I look forward to your questions.