A plenary session on policy issues at the April 14-17 American Society of Addiction Medicine (ASAM) Medical-Scientific Conference did not offer a rosy assessment of federal funding, but the physicians in the audience did get a sense of the federal government’s enthusiasm about several developments in which doctors will be at the forefront.
David K. Mineta, M.S.W., deputy director of demand reduction at the Office of National Drug Control Policy (ONDCP), reinforced through his April 16 comments the notion that MDs will be the focal point for the changes expected to come to addiction treatment as a result of federal health reform.
Remarking on the announcement just days earlier of the first-ever accreditation of post-graduate addiction medicine residencies by the American Board of Addiction Medicine (ABAM), Mineta said, “When we saw the news on the 10 new [accredited] sites, confetti came from our ceilings.”
Mineta, a former director of California treatment and prevention programs who added that his own personal physician is an ASAM member, also made several mentions of the national Screening, Brief Intervention and Referral to Treatment (SBIRT) initiative, an effort that some experts consider central to attacking largely unaddressed substance use problems in the population.
As part of a response to a question from the audience about how ONDCP is supporting efforts articulated in the National Drug Control Strategy, Mineta said, “We’d like to see the mainstreaming of SBIRT across primary care practices.”
Mineta was not so sanguine about the federal budget picture, amid the difficult political struggles on Capitol Hill that nearly had led to a government shutdown a week earlier. He said that looking at the current fiscal year and the next two, “It’s difficult to look at any new monies for initiatives.”
As a result, he said physicians need to show leadership at the local level in identifying best-practice strategies that can be effective even in an atmosphere of short dollars. Building new infrastructure for treatment constitutes a tall order right now, he indicated, and that comes as troubling news for an addiction specialist community that believes it does not have nearly enough doctors to meet treatment needs that will be identified through implementation of the Affordable Care Act.
After Mineta completed his remarks and left the morning plenary session at the Washington, D.C. conference, ASAM policy leaders addressed the audience of physicians on the specialist shortage and other topics. Some of the comments reflect the dilemmas that occur in a fiscally challenging environment. One speaker remarked that Washington has indicated a desire to build substance use service capacity through federally qualified health centers (FQHCs). But in recent weeks community health facilities became a prominent target in spending cuts advanced in Congress.