- Posted byon August 19, 2014 at 10:30 AM EDT
Today I traveled to the Bakken oil field region to announce the release of the 2014 National Northern Border Counternarcotics Strategy (Strategy), which updates and expands upon the Obama Administration’s first Strategy released in 2012. Like the inaugural Strategy, this document sets forth the Administration’s plan to reduce the illegal trafficking of drugs across the U.S.-Canada border.
There are inherent challenges in curtailing illicit drug trafficking across the Northern border. Among them are the vastness of the border itself, which extends more than 5 thousand miles, as well as the ever-evolving illegal drug production and trafficking trends that confront law enforcement officers. In fact, my visit earlier today was prompted by one such trend: the emergence of drug trafficking and related crime resulting from the development of the Bakken oil fields of northeastern Montana, northwestern North Dakota, and southern Saskatchewan. In recognition of this emerging threat, the 2014 Strategy includes a section dedicated to drug trafficking in the Bakken region and our efforts to address this threat.
Despite the challenges that we face, we are confident that by building upon our strong history and shared commitment with our Canadian partners, we will succeed in reducing cross-border illegal drug trafficking. Through integrated cross-border law enforcement efforts, the United States and Canada will build upon existing relationships, programs, and policies; will seek further opportunities to pursue national security by disrupting transnational criminal organizations; and will improve information sharing, enabling more efficient and effective use of resources to curb the flow of illicit drugs and drug proceeds across the Northern border.
The Strategy provides an overview of current counternarcotics efforts and identifies strategic objectives and specific actions that support the strategic goal to substantially reduce the flow of illicit drugs and drug proceeds along the Northern border. In updating and expanding upon the Administration’s first Strategy, the 2014 Strategy incorporates some significant changes and additions, such as the inclusion of sections addressing drug trafficking in the Bakken oil field region and the emerging threat posed by synthetic drugs; enhancements to the financial investigations section, including the addition of three new action items focusing on partnering with the private sector, targeting virtual currency and electronic payment devices, and targeting trade-based money laundering schemes; the addition of two new action items focused on eliminating public corruption; and significant enhancements to the section detailing our cooperative efforts with our Canadian counterparts.
Michael Botticelli is the Acting Director of National Drug Control Policy.
- Posted byon August 6, 2014 at 5:15 PM EDT
A big surprise awaited the more than 40 teens attending the Community Anti-Drug Coalitions of America’s (CADCA’s) Mid-Year Training Institute in Orlando, Florida, on July 23. As they prepared for a training session – a Mock City Council Meeting – they were unaware that the “mayor” presiding over the meeting would be none other than Michael Botticelli, ONDCP’s Acting Director.
Their participation in the event, part of CADCA’s National Youth Leadership Initiative, gave the teens an opportunity to better understand the inner workings of local policymaking. It also helped them learn first-hand the value of speaking out and having their voices heard on important issues. In this instance, the topic for Council consideration was an ordinance to ban the sale of medical marijuana within the local jurisdiction.
Participating youth represented organizations on both sides of the issue, including the local school system, health care organizations, and the cannabis industry association. Their peers served as City Council representatives and reporters from a local TV station who were summoned to cover the heated debate.
Throughout it all, “Mayor” Botticelli presided with a firm gavel and challenged the youth to support their points of view. In the end, the Council agreed to support the medical marijuana ban, offering many of the facts and figures they learned at CADCA’s Institute. The teens were thrilled by Acting Director Botticelli’s commitment and participation. As for the Acting Director, interacting with the youth was a highlight of his trip to Orlando. “I was impressed by the knowledge, skill, and passion these young people brought to the event,” he said. “It’s clear to me why they are so valuable in the effort to prevent substance use in their communities.”
Helen Hernandez is grants administrator for the Drug-Free Communities program.
- Posted byon August 1, 2014 at 10:50 AM EDT
On July 23, ONDCP Acting Director Michael Botticelli met with hundreds of young people and coalition leaders from around the country at the Community Anti-Drug Coalitions of America’s (CADCA’s) Mid-Year Training Institute in Orlando, Florida. Attendees included young people taking part in a CADCA youth leadership initiative and grantees in ONDCP’s Drug-Free Communities (DFC) Support Program.
It was a busy day for the Acting Director, featuring speeches, roundtable discussions, and even a chance to show off his acting skills.
Speaking at a DFC Town Hall meeting, Acting Director Botticelli shared details of the Administration’s recently released 2014 National Drug Control Strategy. At one point he was joined at the lectern by DFC Administrator Helen Hernandez. Together, they applauded the work of the anti-drug coalitions, whose leaders voiced their appreciation for the Strategy and, particularly, its emphasis on preventing drug use before it begins.
Acting Director Botticelli drew even greater applause with his announcement that ONDCP will increase funding for CADCA’s National Youth Leadership Initiative (NYLI), which equips young leaders with the knowledge and tools they need to get involved and bring about positive change in their communities. Specifically, ONDCP will provide additional funds to support the development of youth leaders representing special populations, such as LGBT youth, African-American and Hispanic youth, and youth from military families.
Earlier in the day, the Acting Director took part in several roundtable discussions with DFC coalitions, exploring such themes as how to address the issue of marijuana legalization and the importance of forging partnerships with ONDCP’s High Intensity Drug Trafficking Areas program.
In what was certainly the liveliest event of the day, the Acting Director got to play the part of “Mayor Botticelli” in a mock Town Council meeting. His task, which he eagerly accepted, was to preside over a make-believe council of young people as it heard opposing arguments and then voted on a proposal to ban the use and sale of “medical” marijuana.
Throughout the day, Acting Director Botticelli met and spoke with local coalition leaders, who shared stories of their success in implementing local solutions to local issues. Grantees were impressed by the time and energy he put into the event and thrilled by the Administration’s show of support for the DFC program and anti-drug coalitions nationwide.
Helen Hernandez is grants administrator for the Drug-Free Communities program.
- Posted byon July 29, 2014 at 4:56 PM EDT
In the United States, millions of Americans are infected with viral hepatitis, a life-threatening disease, with more than two-thirds unaware of their infection.
Though this disease can affect anyone, viral hepatitis impacts certain communities more than others. African Americans, American Indians, Asian American and Pacific Islanders, the baby boomer generation (those born between 1945 and 1965), and people living with HIV are all disproportionately affected by viral hepatitis. Rates are also higher among people who inject drugs.
All forms of viral hepatitis pose serious health threats, but building public awareness can help prevent new cases and more effectively treat this epidemic and related health issues such as HIV and substance use disorders. Thanks to the tireless leadership of researchers and advocates, we are beginning to break the silence surrounding viral hepatitis.
In commemoration of World Hepatitis Day, held annually on July 28, the Office of National Drug Control Policy and Office of National AIDS Policy are honoring national and international efforts to address the “silent epidemic” and achieve the goals of the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis.
In recognition of Leadership in Prevention and Treatment of Viral Hepatitis,
Advancing the Goals of the
Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis
American Association for the Study of Liver Diseases
Barbara Murray, MD
Infectious Disease Society of America
Samuel So, MD
Asian Liver Center, Stanford University School of Medicine
Harm Reduction Coalition
Joan Block, RN, BSN
Hepatitis B Foundation
Michael Ninburg, MPA
Hepatitis Education Project
National Alliance of State & Territorial AIDS Directors
Jules Levin, MS
National AIDS Treatment Advocacy Project
Charles Howell, MD
National Medical Association
Holly Hagan PhD, MPH, RN
New York University College of Nursing
Sanjeev Arora, MD
Project ECHO, University of New Mexico
Daniel O’Connell, MA, MLS
New York State Department of Health, AIDS Institute
World Hepatitis Alliance
Please join us virtually on Wednesday, July 30, from 12:00 PM to 2:30 PM EST, on www.whitehouse.gov/live as we recognize these leaders and provide a forum for domestic and international stakeholders to strengthen their responses to viral hepatitis and associated issues such as HIV and substance use disorders. The program will feature remarks from senior Federal officials, representatives from international and national organizations, and community leaders, including:
- Michael Botticelli, Acting Director, National Drug Control Policy
- Douglas Brooks, Director, White House Office of National AIDS Policy
- Representative Mike Honda (CA-17), Co-Chair, Congressional Hepatitis Caucus
- Ambassador Deborah Birx, U.S. Global AIDS Coordinator
- Dr. Howard Koh, Assistant Secretary for Health
- Dr. Paul Farmer, Partners in Health
- Posted byon July 28, 2014 at 6:40 PM EDT
The New York Times editorial board opined in its Sunday July 27, 2014 edition that the Federal government should legalize marijuana for adults aged 21 years and older. The New York Times editorial board compares Federal marijuana policy to the failure of alcohol prohibition and advocates for legalization based on the harm inflicted on young African American men who become involved in the criminal justice system as a result of marijuana possession charges. We agree that the criminal justice system is in need of reform and that disproportionality exists throughout the system. However, marijuana legalization is not the silver bullet solution to the issue.
In its argument, The New York Times editorial team failed to mention a cascade of public health problems associated with the increased availability of marijuana. While law enforcement will always play an important role in combating violent crime associated with the drug trade, the Obama Administration approaches substance use as a public health issue, not merely a criminal justice problem.
The editorial ignores the science and fails to address public health problems associated with increased marijuana use. Here are the facts:
- Marijuana use affects the developing brain. A recent study in Brain reveals impairment of the development of structures in some regions of the brain following prolonged marijuana use that began in adolescence or young adulthood. Marijuana use is associated with cognitive impairment, including lower IQ among adult chronic users who began using marijuana at an early age.
- Substance use in school age children has a detrimental effect on their academic achievement. Students who received earned D’s or F’s were more likely to be current users of marijuana than those who earned A’s (45% vs. 10%).
- Marijuana is addictive. Estimates from research suggest that about 9 percent of users become addicted to marijuana. This number increases to about 17 percent among those who start young and to 25-50 percent among people who use marijuana daily.
- Drugged driving is a threat to our roadways. Marijuana significantly impairs coordination and reaction time and is the illicit drug most frequently found to be involved in automobile accidents, including fatal ones.
The editors of The New York Times may have valid concerns about disproportionality throughout our criminal justice system. But we as policy makers cannot ignore the basic scientific fact that marijuana is addictive and marijuana use has harmful consequences. Increased consumption leads to higher public health and financial costs for society. Addictive substances like alcohol and tobacco, which are legal and taxed, already result in much higher social costs than the revenue they generate. The cost to society of alcohol alone is estimated to be more than 15 times the revenue gained by its taxation. For this reason, the Obama Administration and the Office of National Drug Control Policy remain committed to drug use prevention, treatment, support for recovery, and innovative criminal justice strategies to break the cycle of drug use and associated crime. This approach is helping improve public health and safety in communities across the United States.
Two recent studies by the nonpartisan RAND Institute suggest that policies making drugs more available would likely not eliminate illicit sales or increase tax revenues to the extent that marijuana legalization advocates predict. The first study examined various methods of measuring marijuana use and found that people under 21 account for a substantial share of marijuana consumption. Under most legalization schemes those under 21 would not be able to purchase marijuana legally; therefore, they would continue to turn to the grey market of illicit or diverted legal marijuana to obtain the drug. The second study examined the likely impact of California’s 2012 initiative to legalize marijuana use and concluded that dramatically lowered prices for marijuana as a result of legalization could mean substantially lower potential tax revenue for the state.
We are also keeping a close eye on the states of Washington and Colorado in conformance with the directive provided by the Attorney General in August 2013.
Any discussion on the issue should be guided by science and evidence, not ideology and wishful thinking. The Obama Administration continues to oppose legalization of marijuana and other illegal drugs because it flies in the face of a public health approach to reducing drug use and its consequences. Our approach is founded on the understanding of addiction as a disease that can be successfully prevented and treated, and from which people can recover. We will continue to focus on genuine drug policy reform – a strategy that rejects extremes, and promotes expanded access to treatment, evidence-based prevention efforts, and alternatives to incarceration.
Note: This post was updated with a correction from Beau Kilmer, an author of the two RAND Corporation studies mentioned above.
 Zalesky A, et al. 2012. Effect of long-term cannabis use on axonal fibre connectivity. Brain: A Journal of Neurology. 135 (7): 2245-2255. Available at http://brain.oxfordjournals.org/content/135/7/2245.full.pdf+html
 Meier et al., “Adolescent-onset cannabis and neuropsychological health.” Proceedings of the National Academy of Sciences.
[August 27, 2012]. Available: http://www.pnas.org/content/early/2012/08/22/1206820109
 Centers for Disease Control and Prevention, Department of Health and Human Services. Alcohol and Other Drug Use and Academic Achievement. 2010. Available at http://www.cdc.gov/healthyyouth/health_and_academics/pdf/alcohol_other_d...
 Anthony, JC; Warner, LA, Kessler, RC. 1994. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology 2:244-268.
 Brady JE, Li G (2014) Trends in Alcohol and Other Drugs Detected in Fatally Injured Drivers in the United States, 199-2010,” American Journal of Epidemiology [Epub ahead of print].
 Ellen E. Bouchery, Henrick J. Harwood, Jeffrey J. Sacks, Carol J. Simon, Robert D. Brewer. Economic Costs of
Excessive Alcohol Consumption in the U.S., 2006. American Journal of Preventive Medicine - November 2011
(Vol. 41, Issue 5, Pages 516-524, DOI: 10.1016/j.amepre.2011.06.045). Available:
http://www.ajpmonline.org/article/S0749-3797(11)00538-1/fulltext xiii Kilmer, Beau, et al., Reducing Drug Trafficking Revenues and Viol
 Kilmer, Beau, et al., Reducing Drug Trafficking Revenues and Violence in Mexico: Would Legalizing Marijuana
in California Help? RAND Corporation. . Available:
 Kilmer, Beau, et al., Altered States? Assessing How Marijuana Legalization in California Could Influence
Marijuana Consumption and Public Budgets. RAND Corporation. . Available:
- Posted byon July 28, 2014 at 1:37 PM EDT
Last week, I was honored to attend a bipartisan forum on women and addiction on Capitol Hill, hosted by Senators Sheldon Whitehouse (D-RI), Amy Klobuchar (D-MN), Rob Portman (R-OH), and Kelly Ayotte (R-NH). The forum focused on the unique challenges women face while suffering from substance use disorders. In my remarks, I mentioned an alarming statistic regarding drug use and pregnancy in young women.
Almost one in five (18.3 percent) pregnant teens aged 15 to 17 reported using an illicit drug in the past month, compared to fewer than 1 in 20 (3.4 percent) pregnant women aged 26 to 44.[i] These statistics are even more alarming in light of data from the Centers for Disease Control and Prevention indicating that the percentage of women succumbing to fatal overdoses involving opioids has risen much more sharply than that for men. From 1999 to 2011, the increase in deaths in women has risen over 400 percent, as compared to 265 percent in men.[ii] These statistics are deplorable, and for this reason, as outlined in our 2014 National Drug Control Strategy, the Obama Administration seeks to decrease drug-induced deaths by 15 percent this year through promoting strong nationwide policies that help improve access to evidence-based treatment, including medication-assisted treatment for opioid use disorders and much more.
This week’s forum also included discussions by other individuals who brought years of experience and education on this topic to the table. Subjects of discussion included lectures on the type of treatment most effective for women, substance use disorders and motherhood, and the role of trauma as a factor contributing to substance use disorders, relapse, and recidivism in women.
I hope to see more of these bi-partisan discussions aimed at reducing – and ultimately eliminating – the stigma associated with those suffering from or in recovery from substance use disorders. Even for people in dire need of substance use disorder treatment, stigma can be an insurmountable barrier to getting help. As a person in recovery myself, I am determined to help people get the treatment they need to live happy, healthy, and productive lives in recovery. The Obama Administration remains committed to reducing drug use and its consequences.
[i] SAMHSA. National Survey on Drug Use and Health, 2011 and 2012. Unpublished special tabulations (September 2013).
- Posted byon July 9, 2014 at 9:50 AM EDT
Today, we will unveil the latest update to President Obama’s plan for reducing drug use and its consequences, the 2014 National Drug Control Strategy. This Strategy, which continues to be shaped by the input of people across the country like you, rejects the notion that we can arrest and incarcerate our way out of the nation’s drug problem. Instead, it builds on decades of research demonstrating that while law enforcement should always remain a vital piece to protecting public safety, addiction is a brain disorder—one that can be prevented and treated, and from which people recover.
Data have shown that in several major U.S. counties, crime and substance use are linked. Most recently, we saw that in five counties, one-third or more of adult male arrestees tested positive for an illicit substance at the time of their arrest. Only one-quarter or fewer of all arrestees had ever participated in any outpatient drug or alcohol treatment and less than 30% had ever participated in any inpatient drug or alcohol treatment. Many of these men will be caught in a painful cycle of arrest, incarceration, substance use disorders, and re-arrest. Our prisons and jails are already overcrowded with people who desperately need compassionate, evidence-based treatment for the disease of addiction--not a jail cell.
The plan we released today calls for reforming our criminal justice system to find alternatives to incarceration – and effective interventions across the entire system to get people the treatment they need.
Here’s the problem: far too often, for people who need it most, the criminal justice system can seem like the only way to get help for a substance use disorder. That’s because until recently, prohibitively high costs and limited access to treatment put it out of reach for millions of people in need.
We know that only about 10 percent of people with a diagnosable substance use disorder actually receives treatment at a specialty facility. While several factors contribute to this abysmal statistic, much of that disparity is owed to a lack of healthcare coverage – and that’s about to change. Through a rule made possible by the Affordable Care Act, we are requiring insurers to treat substance use disorders in the same way they would any other chronic disease. Specifically, this new rule expands coverage of mental health and substance use disorder services to 62 million Americans.
The plan we released today calls on healthcare providers to prevent and treat addictive disorders just like they would treat any other chronic disorder, like diabetes or heart disease. It calls on law enforcement, courts, and doctors to collaborate with each other to treat addiction as a public health issue, not a crime.
We chose to release the 2014 Strategy in Roanoke because, in three important ways, it’s a microcosm of the policies our office has been promoting since 2009:
- Access to treatment, a focus on prevention, and compassion. Roanoke is home to one of the largest behavioral healthcare centers in the region. The center is co-located with a Drug Free Communities coalition, which prevents substance use among at-risk youth, and a program called Project Link, which helps opioid-dependent women and pregnant mothers get treatment and give birth to drug-free babies.
- Alternatives to incarceration. In 2011, the Roanoke Police Department worked with community and faith leaders in the Hurt Park neighborhood to shut down the open-air drug market operating there and drastically reduce violent crime in the area. As part of this intervention, community leaders came together to offer the low-level, non-violent drug offenders involved in the sweep a life-changing alternative: either face prosecution and lengthy sentences, or change your lives with the support of the community. In Roanoke, I met with one of those ex-offenders who is now employed full-time and caring for his family.
- Local solutions for local challenges. In a corner building in downtown Roanoke operates a community action center with roots in President Lyndon Johnson’s landmark anti-poverty legislation. Half a century ago, local leaders established what is now called Total Action for Progress (TAP), which operates 30 programs in the Roanoke Valley region aimed at improving employment opportunities at-risk youth, early childhood development, and re-entry and support services for veterans. I visited TAP to speak with young people and a veteran whose lives have been changed by these programs, and was inspired by their stories of hope.
Like the rest of the country, Roanoke has seen a devastating rise in heroin and prescription painkiller abuse. According to the Centers for Disease Control and Prevention, drug overdose deaths surpass homicides and traffic crashes in the number of injury deaths in America. In 2011, more than 110 Americans, on average, died from overdose every day. Prescription painkillers were involved in over 16,900 deaths that year. Heroin was involved in more than 4,300.
In response to this opioid epidemic, this Strategy updates the President’s 2011 Prescription Drug Abuse Prevention Plan by calling for increased access to naloxone, a lifesaving overdose-reversal medication.
The widespread use of naloxone in the hands of law enforcement, firefighters and emergency medical personnel will save lives. It can also serve as a critical intervention point to get people into treatment and on the path to recovery.
Today, there are millions of Americans in recovery from substance use disorders who are healthy, responsible, and engaged members of their communities. The Strategy outlines steps to help lift the stigma associated with substance use disorders. It also works to reform the laws and regulations that impede recovery from substance use disorders, including those that place obstacles in the way of housing, employment, and obtaining a driver’s license or student loan because of a prior conviction for a drug-related offense.
The National Drug Control Strategy released today is rooted in the belief that illicit drug use is a public health issue, not just a criminal justice problem. As the innovative law enforcement and social support programs in Roanoke prove, this philosophy can reduce illicit drug use while building healthier, safer, more vibrant communities.
Michael Botticelli is the Acting Director of National Drug Control Policy.
 National Center for Health Statistics/CDC, National Vital Statistics Report, Final death data for 2011 (June 2014).
 National Center for Health Statistics/CDC, National Vital Statistics, unpublished special tabulations (June 10, 2014).
- Posted byon June 19, 2014 at 4:02 PM EDT
Today, Acting Director Michael Botticelli hosted Attorney General Eric Holder, Vermont Governor Peter Shumlin, Director of National Institute on Drug Abuse Dr. Nora Volkow, and two panels of experts to address the national epidemic of opioid abuse.
The abuse of opioids, a group of drugs that includes heroin and prescription painkillers, has a devastating impact on public health and safety in this country. According to the Centers for Disease Control and Prevention (CDC), approximately 110 Americans, on average, died from drug poisoning every day in 2011.[i] Prescription drugs were involved in more than half of the 41,300 drug poisoning deaths that year, and opioid pain relievers were involved in nearly 17,000 of these deaths.[ii] There were about 4,400 drug poisoning deaths involving heroin. Drug poisoning deaths even outnumbered deaths from gunshot wounds or motor vehicle crashes.[iii]
Corrections to previously published number of deaths involving heroin: 2009 to 2011 should be 3,279, 3,038, and 4,397 respectively (for 2009 and 2010 to include deaths involving opium and a typo for 2011).
In his remarks, Attorney General Holder underscored the important role that law enforcement professionals play not only in reducing drug-related crime, but preventing overdose. Often, police officers are the first responders at the scene of an overdose, and their decisive action can mean the difference between life and death for an overdose victim.
We join the Attorney General in encouraging first responders to carry the overdose-reversal drug naloxone. When administered quickly and effectively, naloxone immediately restores breathing to a victim in the throes of an opioid overdose. Used in concert with “Good Samaritan” laws, which grant immunity from criminal prosecution to those seeking medical help for someone experiencing an overdose, naloxone can save lives. The map below shows which states currently have laws which increase access to naloxone and encourage witnesses to an overdose to call 911:
Governor Shumlin, who previously dedicated his entire State of the State address to the opioid crisis in Vermont, outlined the steps his administration is taking to prevent and treat substance use disorders.
Dr. Nora Volkow provided an overview of the groundbreaking advances we’ve made over the past several decades in the study of addiction – a progressive disease of the brain that can be prevented, treated and recovered from. Watch her discuss the disease of addiction:
The opioid epidemic has already brought heartbreak to too many families across the country – but we’re not powerless to stop it. You can help – right now – by spreading the word about how to save a life and where to seek treatment.
Missed the summit? Watch videos of the summit here:
Dr. Hillary Kunins
Acting Executive Deputy Commissioner, Division of Mental Hygiene, Assisting Commissioner for the Bureau of Alcohol and Drug Use, New York City Department of Health and Mental Hygiene (DOHMH)
Dr. Traci Green
Assistant Professor of Emergency Medicine and Epidemiology, Brown University
Dr. Josh Sharfstein
Secretary, Maryland Department of Health and Mental Hygiene
Program Director, Operation UNITE
Dr. Michelle Lofwall
Associate Professor, Departments of Psychiatry and Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky College of Medicine
Dr. Ed Bernstein
Professor and Vice Chair for Academic Affairs, Emergency Medicine, Boston University School of Medicine
[i] National Center for Health Statistics/CDC, National Vital Statistics Report, Final death data for each calendar year (June 2014)..
[ii] National Center for Health Statistics/CDC, National Vital Statistics Report, Final death data for each calendar year (June 2014)..
[iii] National Center for Health Statistics/CDC, National Vital Statistics Report, Final death data for each calendar year (June 2014).
- Posted byon June 16, 2014 at 6:40 PM EDT
The abuse of opioids – a group of drugs that includes heroin and prescription painkillers – is devastating public health and safety in communities across the nation. While the Obama Administration has been leading a comprehensive response to the prescription drug problem for more than four years, the recent uptick in heroin use across the country, and the increasing number of overdose deaths, requires a new approach.
Michael Botticelli, Acting Director of National Drug Control Policy, will be joined by Eric Holder, U.S. Attorney General, Peter Shumlin, Governor of Vermont, Nora Volkow, Director of the National Institute on Drug Abuse, and other public health and government leaders to discuss the scope of the epidemic and strengthen collaborations across government to ensure we’re doing everything we can do prevent substance use disorders, reduce overdose deaths and treat those who are struggling with addiction.
Please join us for this important conversation. Here’s how:
Share your story and ask questions on Twitter using #OpioidSummit, and follow @ONDCP for live updates.
Sign up for email updates for the latest news in drug policy.
- Posted byon May 9, 2014 at 2:35 PM EDT
Over the course of my more than 20 years as an emergency physician, I have seen thousands of patients with painful conditions. During that same time, I have witnessed the remarkable evolution of modern pain medication – its potential and its pitfalls. We can now help patients manage both short-term and long-term pain. Yet, while medications – particularly opioids – have helped us heal patients, we have also seen their detrimental effects, chief among them addiction.
Opioids can be very helpful for patients with conditions such as broken bones and kidney stones, and they are also useful after many types of surgery. They may also be used to treat those with chronic pain – people who experience pain carrying out normal, daily functions of life that others take for granted. Used for short periods of time at the proper dosage, opioids are safe medications and excellent choices for a wide variety of acute painful conditions.
While opioids work well for pain control, they have a number of potentially serious side effects: They can hinder or stop breathing, cause constipation, result in drowsiness, and act as central nervous system depressants. That’s why your doctor tells you it is not safe to drive after taking opioids.
Another devastating side effect is addiction. The body develops a tolerance to opioids and, after only a couple of weeks, may require higher doses to control pain. Over time, increasing doses of opioids may be needed to manage the same level of pain. Patients may develop dependence – their bodies will crave it. They will exhibit a strong desire or compulsion to take the drug for reasons beyond simple pain control. At this stage, if they stop taking opioids, they will experience withdrawal. This is how opioid use can lead to addiction and all its inherent problems for the individual and society.
As providers, our responsibility is to carefully manage the side effects of opioid therapy. Dependence, tolerance, and addiction must be discussed with patients, and a careful well-planned strategy is crucial for their extended use of opioids.
That is exactly what we are doing at Fletcher Allen Health Care in Burlington, Vermont. Recently, providers and pain management experts from multiple specialties (Anesthesia, Emergency Medicine, Family Medicine, Internal Medicine, and Surgery) converged to standardize how we care for patients with painful conditions and to develop best practices for our patients.
What did we do? Here is an overview:
- Systems Approach. We built standardized protocols so that patients will get similar treatment in various settings. We believe this standardization will help our patients and providers. There will be clear, defined expectations and goals for treating our patients’ pain.
- New Rules & Tools. We use processes and tools such as pain agreements with patients and surveys to assess how patients are functioning with their pain and to measure their risk for addiction.
- Defining Maximum Daily Dosage. We are one of the first hospitals in the country to define the maximum daily dose of opioids. Research shows that beyond certain doses, patients experience no additional benefit. We know that very high doses of opioids increase the risk of dangerous side effects but offer no additional pain control.
This approach helps ensure that we are more reliable and consistent in our approach to pain in our patients and that our patients will know what to expect from their providers.
Gil Kerlikowske, then-Director of ONDCP, recently visited Fletcher Allen Health Care to discuss our new approach and tools. He lauded our systems-level strategy and our standardized protocols.
I believe that the current dialogue in Vermont and elsewhere on how to better manage opioid abuse will be productive and lead to changes across the country in how these drugs are prescribed and how acute and chronic pain is managed. Fletcher Allen Health Care is on the leading edge of this transition and could be a model for other health systems managing this complex issue. I hope that sharing our practices here is the first step toward being that model.
Stephen M. Leffler, M.D., is the Chief Medical Officer at Fletcher Allen, former Medical Director of the Emergency Department, and has been a practicing physician for 20 years. He grew up in Brandon, Vermont.
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