ONDCP Blog

  • Community Policing and Drug Overdose: Where You Live Doesn't Have to Determine Whether You Survive an Overdose

    The odds of surviving a drug overdose, much like the odds of surviving a heart attack, depend on how quickly the victim receives treatment. But access to naloxone—which can reverse heroin and prescription drug overdoses--varies greatly across the country, even though all drug poisoning deaths have surpassed traffic crashes as the most lethal cause of preventable injury. Because police are often the first on the scene of an overdose, the Obama Administration has strongly encouraged local law enforcement agencies to train and equip their personnel with naloxone.

    Yesterday, the President traveled to Camden, New Jersey, a city that’s taken steps to create economic opportunity, help police do their jobs more safely, and reduce crime in the process. Yet another area where the Camden County Police Department is taking the right steps is with its creation of an overdose prevention program.  This program has reversed 68 overdoses since it started a year ago. Across New Jersey, law enforcement officers have used naloxone to respond to overdoses 888 times since 2014.

    By engaging with law enforcement in naloxone administration, we are truly pursuing a 21st century approach to drug policy and community policing--one that combines public health with public safety.

    Recently I met Corporal Nicholas Tackett, a police officer from Anne Arundel County in Maryland. Corporal Tackett has witnessed about 50 drug-related overdoses in his law enforcement career.

    He knows the signs of overdose, the looks on their faces. Now, with naloxone, he has a tool that enables him to save lives. Corporal Tackett brought me to the locations where his use of naloxone reversed the life-threatening overdoses of two people. Naloxone works, and it is an incredibly important tool.

    In October 2014, the Department of Justice released a Naloxone Toolkit for law enforcement. This toolkit is an online clearinghouse of more than 80 resources, such as sample policies and training materials designed to support law enforcement agencies in establishing a naloxone program. 

    In the past year, we have witnessed an exponential expansion in the number of police departments that are training and equipping their police officers with naloxone.  They now number in the hundreds and they are saving lives.

    The Police Department in Quincy, Massachusetts, has partnered with the State health department to train and equip police officers to resuscitate overdose victims using naloxone. The Department reports that since October 2010, officers in Quincy have administered naloxone in more than 382 overdose events, resulting in 360 successful overdose reversals.

    The Vermont Department of Health has been distributing Overdose Rescue Kits with naloxone to State police as well as to individuals through community-based partners. To date, naloxone has been deployed 146 times across the State.

    There is also collaboration taking place in rural and suburban communities. In Illinois, the Lake County State’s Attorney has partnered with various county agencies, including the Lake County Health Department; drug courts; police and fire departments; health, advocacy and prevention organizations; and local pharmacies to develop and implement an opioid overdose prevention plan.  As of February 2015, the Lake County Health Department had trained 828 police officers and 200 sheriff’s deputies to carry and administer naloxone, and more departments have requested this training.

    To build on these efforts, the President’s FY 2016 Budget directs the Department of Health and Human Services to permit the use of block grant funds for naloxone purchases. It also provides funding specifically for law enforcement to purchase naloxone.

    Where you live shouldn’t determine whether or not you survive an overdose. So our goal is to get naloxone in every community where overdose deaths are prevalent. Combined with evidence-based prevention programs and access to effective treatment, this approach will save the lives of many Americans.

    Michael Botticelli is Director of National Drug Control Policy. 

      

  • Honoring Courage and Saluting Sacrifice During National Police Week

    This week, Director Michael Botticelli joins thousands of law enforcement officers from across the country, President Obama, Attorney General Loretta Lynch, Secretary Jeh Johnson and other distinguished officials in Washington, D.C. to honor the lives of officers who have gave the ultimate sacrifice. 

    As part of National Police Week, Director Botticelli read the names of three fallen officers at the 27th Annual Candlelight Vigil at the National Law Enforcement Officers Memorial. Today, he will join President Obama at the 34th Annual National Peace Officers’ Memorial Service on the West Front Lawn of the United States Capitol.

    Law enforcement officers have a profound sense of duty to serve and protect their communities.  Every day, they place their lives on the line knowing they could be exposed to harm at any moment.  ONDCP honors all the brave men and women who have died to protect the safety of others. 

    During Police Week, we also particularly recognize officers on High Intensity Drug Trafficking Area (HIDTA) Task Forces who, despite the risks, remained steadfast and gave their lives in the line of duty, including Ogden Police Officer Jared D. Francom, Los Angeles Sheriff's Department Deputy Sheriff Jerry Ortiz, Glendora Police Detective Louis Pompei , FBI Special Agent Paul M. Sorce and Maryland State Police Corporal Edward M. Toatley.

    We owe all those who we have lost, and the men and women keeping us safe today, our deepest gratitude for protecting our families, homes and communities. 

  • The Indianapolis Star: "Work to prevent opiate drug abuse"

    Since Gov. Mike Pence issued a public health disaster emergency order in response to the state's HIV outbreak, public and private leaders have marshalled a remarkable effort to identify cases, provide care and support to those who have tested positive for HIV, and prevent new infections. This evidence-based approach is critical to effectively contain the outbreak.
     
    Last fiscal year, the federal government invested more than $23.2 million to support HIV, sexually transmitted disease and viral hepatitis prevention, treatment and response activities in Indiana. Federal-state partnerships like this are essential to achieving an AIDS-free generation.
     

  • We Don’t Have Time to Wait

    This is a picture of Taylor Smith from Holly Springs, Georgia, with her sister, Gabrielle.

    Taylor Smith photo

    Taylor Smith (right) with her sister, Gabrielle Smith.

    Taylor died of an overdose.

    Her mother, Tanya Smith, writes: 

    "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.”

    Taylor might still be alive if her friends had known that Georgia, along with 21 other states and the District of Columbia, has legal protections in place that shield people possessing drugs from criminal liability if they’re helping someone having an overdose. 

    Her mother Tanya has channeled her grief into action, pushing to make sure that law enforcement officers in her town now carry naloxone — the antidote for opioid overdose. 

  • Recovery Story: Patrick Kelley, Photographer to the Commandant of the Coast Guard

    When Coast Guard Petty Officer Patrick Kelley met Director Michael Botticelli last November on a flight to Panama for an Interdiction Committee meeting, they instantly bonded over their similar past: Both men are in long-term recovery from alcohol use disorders. For Kelley, Botticelli’s journey from alcoholic to 26-years-sober Director of National Drug Control Policy was inspiring – so much so that he decided to share his own recovery story with the Office of National Drug Policy.

    Two years ago, Kelley was in a dark place. His marriage was failing, and he found himself routinely drinking to excess, alone. He was hesitant to admit his alcohol problem to his Coast Guard colleagues because he worried that admitting he had an alcohol use disorder would damage his reputation or force him out of his job.

    After his decade-long struggle with alcohol culminated in one awful night, Kelley finally opened up about his substance use disorder and sought help within the Coast Guard community. He was amazed by the response: His friends and peers rallied around him and helped him into treatment. His biggest fear had been getting kicked out of the Coast Guard, but the opposite happened. He found that the Coast Guard has a compassionate, evidence-based response to service members in need of treatment for substance use disorders.

    In November 2014, the U.S. Coast Guard Headquarters established a 12-step support group that helps ensure that service men and women struggling with substance use disorders don’t have to feel isolated when seeking treatment.

    Director Botticelli sat down in March with Rear Admiral Maura Dollymore, the Coast Guard’s Director of Health, Safety and Work-Life, and other senior staff for a Coast Guard Prevention and Treatment roundtable discussion. At the meeting, Coast Guard leadership talked about the newly formed support group that helps service members like Kelley through treatment, and Director Botticelli offered his support for the Coast Guard’s prevention and treatment initiatives.

    Watch Patrick Kelley’s story, and share it with someone you know: 

  • ‘Reality TV’: House of Cards Highlights the Importance of Prescriber Education

    Spoiler alert: This post discusses  House of Cards Season 3.

    Although House of Cards is known mostly for its political drama and manipulative characters, season three’s story line about character Doug Stamper has highlighted the importance of prescriber education and the realities of relapse during recovery.

    After Doug’s six-month hospitalization to rehabilitate his leg, his doctor prescribes medication to address his anxiety and depression. She tells Doug she cannot prescribe him painkillers because of his history with alcohol use disorder. Yet after he falls and breaks his arm in the shower, an emergency room doctor prescribes Percocet, a mix of oxycodone and acetaminophen. Although Doug had been in recovery and attending Alcoholics Anonymous meetings for 14 years, the prescription triggers a relapse.  Initially regulating the amount of alcohol he drinks with a syringe, Doug eventually begins drinking uncontrollably until he meets with President Frank Underwood while intoxicated and asks for help. With the help of his brother, Doug is able to get sober again and become the President’s Chief of Staff.

    In recent years, the number of filled opioid prescriptions has increased dramatically. Although opioid pain relievers are among the most powerful medications available and can effectively relieve suffering for many patients, they also present grave potential for misuse.

    The first and most crucial step for the prevention of opioid misuse is to educate drug prescribers and dispensers. Practitioners, nurses, and pharmacists have a role to play in reducing prescription drug misuse. Unfortunately, prescribers receive little training in the risks associated with dispensing opioid pain relievers, especially for persons in recovery.

    The physician who treated Doug’s leg was familiar with her patient’s medical history. She knew an opioid prescription would be detrimental to his journey in long-term recovery. Meanwhile, the emergency-room doctor, who met with Doug only briefly, prescribed a highly addictive painkiller without first asking if Doug had any history of substance use or disorder. As we learn from House of Cards, it is essential that prescribers receive training regarding the substance use history of patients to prevent triggering a relapse for those in recovery.

    It is important to note, however, that Doug’s relapse was not out of the ordinary. A substance use disorder is a chronic disease, which means that for many in recovery, relapse is not only possible, but likely. Relapse rates for substance use disorders are between 40 and 60 percent—similar to those for other chronic medical conditions, such as diabetes, hypertension, and asthma. Just like these other conditions, substance use disorders do not discriminate: Anyone can possess the risk factors or fall into the cycle of misuse. Relapse is never a sign of failure for any patient; rather, it is a speed bump on the road to recovery. It is essential that prescribers receive training to aid in the recovery process and make this journey as smooth as possible.

    Doug Stamper is a fictional character in a dramatized television show, but his story of recovery and relapse is far from fictional. House of Cards illustrates how imperative it is for prescribers to know their patients’ histories before prescribing opioids. Doug’s story serves as a reminder to the friends and families of persons in long-term recovery that relapse of a substance-use disorder is as much a reality as it would be for any chronic medical condition, but that with their love and support, recovery is completely attainable.

  • Commission on Narcotic Drugs Endorses Alternatives to Incarceration for Substance Use Disorders

    Earlier this month, the United Nations Commission on Narcotics Drugs (CND) approved a resolution that called for justice and health agencies to work together to provide a range of alternatives to incarceration for those affected by a substance use disorder. The CND, held in Vienna, Austria, is the largest annual governmental meeting on drug issues with 53 member states. The White House Office of National Drug Control Policy initially proposed the resolution.

    “A global consensus is emerging that no nation can solve its drug problem by simply arresting and incarcerating those affected by a substance use disorder,” said Director of National Drug Control Policy Michael Botticelli, who represented the United States at the CND. “The United States is strongly committed to advancing strategies that bring justice and health agencies together on innovative solutions for drug-involved individuals wherever they are in the world.”

    The United States introduced the resolution, which emphasizes that too many individuals with substance use disorders around the world are serving extended prison sentences, but not receiving evidence-based treatment or other needed health services. Increasing the use of alternatives to incarceration and the provision of treatment for these individuals, whether in the community or in prison, supports sustained recovery from substance use disorders, promotes fairness, and reduces prison overcrowding.

    The resolution encourages all countries to utilize a range of alternatives to incarceration and other criminal justice reforms that also promote treatment for substance use disorders.  The health-related interventions referenced in the resolution include screening for substance use disorders, access to treatment, including medication-assisted treatment, counselling services and other behavioral health services, overdose prevention and treatment, recovery support services, treatment for HIV, hepatitis, and other infectious diseases and mental health disorders. The alternatives to incarceration and other reforms listed include reduced or suspended sentences, diversion programs before or during trial, home detention, community service, fines, victim restitution, random drug testing, and GPS tracking.

    Effective combinations of supervision and drug treatment, which are a subject of ongoing research in the United States, can result in more effective crime reduction, better health outcomes and lower prison costs. These alternatives can also allow incarcerated individuals with substance use disorders to return to their families and communities, while concurrently receiving treatment and helping to break the cycle of drug use, arrest, incarceration, relapse and re-arrest.

    The resolution, specifically called for the following:

    • Greater collaboration between health and justice agencies on alternatives to incarceration;
    • Establishment of mechanisms to “break down the silos” between health and justice agencies so they can work together better to provide health services for those under criminal justice supervision;
    • Training for justice officials on the effectiveness and importance of evidence-based treatment for substance use disorders;
    • Recommendation that governments review their drug sentencing practices to ensure that they allow for alternatives to incarceration for those affected by a substance use disorder; 
    • Collection and sharing of best practices and research on collaborations between justice and health agencies on alternatives to incarceration for those with a substance use disorder;

    The full title of the resolution is: Supporting the Collaboration of Public Health and Justice Authorities in Providing Alternatives to Conviction or Punishment for Drug-Related Offenses of a Minor Nature. The following countries co-sponsored the resolution: Australia, Ecuador, El Salvador,  European Union, Germany, Greece, Guatemala,  Israel, Lithuania, Mexico, Namibia, and Uruguay.

  • Celebrating Five Years of the Affordable Care Act

    Nora Zarabia faced a difficult – and all too common -- question when her 20-year-old son, Alex, was diagnosed with a substance use disorder. How was she going to pay for the help he needed

    Fortunately for Alex, Nora’s health insurance – thanks to the Affordable Care Act (ACA) – allowed him the opportunity to receive addiction treatment and care under her policy until age 26. After that, he can obtain insurance on his own that will cover his treatment needs. The ACA requires insurers to cover mental health and substance use disorder treatment at the same level they’d cover any other medical treatment. Without the care he received, Alex may not have entered recovery and gotten back on track at school, building the life he and his mom had hoped for.

    As we celebrate the fifth anniversary of the Affordable Care Act becoming law, we celebrate that millions more people have health insurance than before. And that’s not all there is to celebrate. The ACA establishes the biggest expansion of mental health and substance use disorder coverage in a generation. It requires insurers to provide mental health and substance use disorder benefits at parity with coverage for any other medical condition, like diabetes or heart diseases. In total, this expansion creates new opportunities for substance use disorder and mental health care for more than 60 million Americans.[i]

    Research highlights an increase in utilization of inpatient care for mental health and substance use disorder services among young adults between 2010 and 2012, according to the Health Care Cost Institute.[i]

    The Affordable Care Act offers a profound change for those who suffer from substance use disorders – one that has proven time and time again to save lives. Millions of Americans, like Nora and Alex, have had a burden lifted by having options and access to quality care.

    The Obama Administration is committed to restoring a balance to U.S. drug-control efforts by focusing on public health to reduce drug use and its consequences. By decreasing the number of uninsured Americans and cutting costs, the Affordable Care Act plays a crucial role in connecting Americans to the resources they need.

    We’ve made great progress: after five years of the Affordable Care Act, 16 million people have gained health coverage.

    That’s something to cheer about. So on this anniversary, let’s celebrate opportunity and progress – for our loved ones, for our communities, and for our nation.


    [i] Health Care Cost Institute, Issue Brief No. 8: Selected Health Care Trends for Young Adults (ages 19-25): 2007-2012. September 2014. Available online at http://www.healthcostinstitute.org/files/IB8_YA_09242014.pdf.


    [i]  U.S. Department of Health & Human Services, ASPE Issue Brief: Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans. February 2013. Available online at http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm

     

  • The Work Before Us: A Message from Michael Botticelli

    Many great movements to change public perception and policy around a public health issue have been fueled by people with a disease speaking out publicly.  What is seen as someone else's problem—someone else’s disease – takes on a new dimension when people speak up about it.  

    Such was the case when Betty Ford revealed her breast cancer diagnosis and her substance use disorder. Such was the case when Magic Johnson revealed that he was HIV positive, spurring action to stem the AIDS epidemic.

    Yet, despite the fact that nearly every family and community in America is affected by a substance use disorder, those fighting to overcome this disease are too often hidden in the shadows of shame and denial.  It is whispered about. It is met with derision and scorn. 

    According to the National Survey on Drug Use and Health, only 1 in 9 people with a diagnosable substance use disorder gets treatment.  Compare this to the treatment rate for diabetes, for which 72% of people with the disease receive care.

    When treatment is provided for substance use disorders, it too often comes at the most acute stages of the disease when effective treatment is far more challenging and costly than in the early stages. Because substance use disorders have historically gone unidentified for far too long, and timely access to treatment has been far too difficult to come by, a person is expected to hit “rock bottom” before seeking help for a substance use disorder.

    Standard medical care does not allow a diabetic to enter kidney failure before offering insulin.  Yet untreated substance use disorders routinely proceed unchecked until they have reached such levels of emergency.  In addition to the unnecessary suffering for patients and their families, our current approach costs the United States hundreds of billions a year in increased health care costs, crime and lost productivity-- over $223 billion related to alcohol and $193 billion related to illicit drugs.

    Decades of scientific research have proven that substance use disorders are a health issue:  chronic medical conditions with genetic, biological and environmental risk factors.  Effective substance use disorders requires a comprehensive, public health approach involving evidence-based prevention, early intervention, treatment and recovery support services.  The National Drug Control Strategy, the Obama Administration’s template for drug policy, outlines more than 100 action items across federal government to prevent drug use and its consequences.

    Earlier this month, President Obama in his 2016 Budget requested historic levels of funding --including $133 million in new funds-- to address the opioid misuse epidemic in the U.S. Using a public health framework as its foundation, our strategy also acknowledges the vital role that federal state and local law enforcement play in reducing the availability of drugs—another risk factor for drug use.  It underscores the vital importance of primary prevention in stopping drug use before it ever begins by funding prevention efforts across the country. It sets forth an agenda aimed at stripping away the systemic challenges that have accumulated like plaque over the decades: over-criminalization, lack of integration with mainstream medical care, insurance coverage and the legal barriers that make it difficult for people once involved with the criminal justice system to rebuild their lives.

    The implementation of the Affordable Care Act will dramatically increase coverage for treatment and ensures that services are comparable to other chronic conditions for more than 60 million Americans. This is the biggest expansion of substance use disorder treatment in a generation, and it will transform millions of lives.

    All of these advancements, however, are not enough unless we fundamentally change the way we think about people with addiction.  There are millions of people in recovery in the United States leading meaningful, productive lives full of joy and love and laughter – and I am one of them.

    Tonight, the United States Senate voted to confirm my nomination as Director of National Drug Control Policy. This is an honor I never dreamed of 26 years ago, when my substance use disorder had become so acute that I was handcuffed to a hospital bed. I accept this challenge with the humility and tenacity of someone in long term recovery.

    I am open about my recovery not to be self-congratulatory, I am open about my recovery to change public policy. I have dedicated my life to treating drug use as a public health issue, and that’s how I approach this new role, as well.  I hope that many more of the millions of Americans in recovery like me will also choose to “come out” and to fight to be treated like anyone else with a chronic disease. By putting faces and voices to the disease of addiction and the promise of recovery, we can lift the curtain of conventional wisdom that continues to keep too many of us hidden and without access to lifesaving treatment.

    It is time to make a simple, yet courageous decision to be counted, to be seen and to be heard.

    Share your story with us today. 

    Michael Botticelli serves as Acting Director of National Drug Control Policy. Today, the U.S. Senate voted to confirm him as Director of National Drug Control Policy. 

  • Historic Requests for Treatment and Prevention in President Obama’s 2016 Budget

    Today, President Obama released a budget that shows what we can do if we invest in America’s future. The Budget outlines a strategy to strengthen the middle class and provide opportunity to anyone willing to work for it. Too often, however, in too many towns across America, substance use disorders dim students’ potential and diminish hard-working Americans’ opportunities.

    In response to America’s drug problem, the 2016 Budget reflects the Administration’s ongoing commitment to reducing drug use and its consequences through a balanced approach rooted in science.

    The President’s 2016 Budget, submitted to Congress today, contains over $12 billion in Federal funds -- an increase of more than $768 million over FY 2015 – for drug demand reduction programs essential to making our Nation a healthier and safer place. The $1.4 billion funding request for prevention activities increased nearly six percent over the 2015 funding level, and the $11 billion requested for treatment represents a nearly seven percent increase. Together, these funding requests amount to the largest commitment to treating and preventing substance use disorders to date.  

    Consistent with the Administration’s balanced approach to public health and public safety, the Budget also calls for increases for supply reduction programs that disrupt the flow of illicit drugs into our country and reduce drug trafficking domestically.  This includes$9.7 billion for domestic law enforcement activities, a nearly four percent increase over the FY 2015 funding level; $3.9 billion for interdiction, an increase of two percent; and $1.6 billion for international funding, an increase of more than one percent. 

    The Budget requests $85.7 million for the Drug Free Communities program, a local, community-based coalition program supporting nearly 700 local drug prevention groups, and $193.4 million to facilitate greater collaboration across federal, state, local and tribal law enforcement through the High Intensity Drug Trafficking Areas (HIDTAs) Program.

    Reducing drug use and its harms is a complex challenge that requires coordination between a broad array of government agencies at the federal, state and local level, community advocates, non-profits and civil society organizations. The President’s 2016 Budget underscores this Administration’s commitment to a balanced approach that treats drug use as a public health issue and directs valuable law enforcement resources to combating serious public safety threats.