He was preaching to a choir of opioid treatment program (OTP) leaders who use methadone and the other federally approved medications to treat opioid dependence, but the director of the Office of National Drug Control Policy (ONDCP) left no doubt about his embrace of a central role for medication-assisted treatment (MAT) in combating the opioid crisis.
“Medication-assisted treatment along with behavioral treatments must be the standard of care,” Michael P. Botticelli told the audience at the April 1 closing plenary session of the American Association for the Treatment of Opioid Dependence (AATOD) conference in Atlanta.
Sharing the podium for the closing session with Substance Abuse and Mental Health Services Administration (SAMHSA) administrator Pamela Hyde, Botticelli cited examples of federal initiatives to expand MAT's reach, and reiterated themes that had resonated throughout the March 28-April 1 meeting of OTP executives and staff. He mentioned ongoing efforts to strengthen federal contractual language to ensure that justice systems incorporate medication treatments and not require offenders to cease their use if already on a medication regimen. The justice system's historical distaste for MAT has been seen as a significant impediment to combating today's opioid dependence problem.
Botticelli also emphasized data that continue to demonstrate a shift from prescription opioid misuse to heroin use as governments clamp down on sources of prescription opioids, although he added that he was disturbed about the sometimes-heard notion that anti-drug leaders' efforts have “caused the heroin problem.” Around four of every five recent initiates to heroin in the age group up to age 49 have said they engaged in non-medical prescription drug use before they tried heroin.
At an earlier AATOD plenary session, the executive director of the much-relied on Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System said the recent reports he has received indicate that investigators have all but ceased working in the prescription drug arena and are focusing on heroin.
The phenomenon of what AATOD president Mark Parrino referred to more broadly as “swinging epidemics” highlights why leaders continue to call for more widespread access to treatment in order to give individuals a way out of cycling from drug to drug.
Botticelli also spent some time discussing wider use of overdose prevention strategies, adding that when he served as state substance abuse director in Massachusetts he saw the community of Quincy reverse scores of overdoses because local parents convinced police to get trained in use of naloxone. Botticelli said the federal Bureau of Prisons is launching an effort to expand access to naloxone for individuals leaving custody. He said he has found it noteworthy that there has been a “relatively minor pushback” around use of the harm reduction strategy.
Botticelli's appointment and confirmation as ONDCP director have been lauded in the field in large part because of his longtime involvement in overseeing treatment systems and because of his more than 25 years in recovery. "We are a vast untapped political resource," Botticelli told the AATOD audience in reference to the community of recovering individuals.
Hyde outlined several spending and administrative initiatives affecting OTPs, including last month's release of revised federal guidelines for the programs that include updated information in areas such as treatment of pregnant women and management of comorbid conditions. She said that the proposed federal budget for fiscal 2016 calls for more than doubling the current $12 million for MAT for opioid dependence, as well as a new $12 million overdose prevention initiative that would fund efforts in up to 10 states in the first year.
Hyde also highlighted priority areas in the Department of Health and Human Services' (HHS's) newly announced plan to combat opioid addiction, citing as one example the effort to urge states to adopt guidelines to address over-prescribing of opioid medications and to lift barriers to MAT in state Medicaid systems.