[K]ILLINGTON — The director of drug policy for the White House says the heroin and opioid epidemic must be framed as a public health issue if there is any hope of stemming the crisis.
Michael Botticelli, director of National Drug Control Policy, delivered the keynote address at the Department of Health’s substance abuse conference in Killington. The conference, organized by the Division of Alcohol and Drug Abuse Programs, brought together social workers, community organizers and public health researchers for a day of workshops and presentations.
The punitive response to addiction treatment has largely been ineffective and inhumane, and has contributed to many of the disparities in the criminal justice system, Botticelli said. If we want to improve outcomes, he said, spending on public health measures has to match spending on law enforcement.
Public health and law enforcement officials know how to address the current epidemic — what’s missing is political will and leadership, Botticelli said. “We have to continue to be open around drug policy issues,” he said.
State officials agreed with Botticelli’s approach to battling the wave of heroin and opioid addiction that has swept Vermont and New England and praised the nearly 300 attendees who are “in the trenches.” Hal Cohen, secretary of the Agency of Human Services, said, “You folks are the front line, the people who are going to make a difference.”
Rick Rawson, a public health researcher who worked with Gen. Barry McCaffrey, the director of drug policy from 1996 to 2001, said Botticelli’s approach is refreshing. With McCaffrey, Rawson said, you knew you were “dealing with a general.” The office of national drug control policy was created as part of Ronald Reagan’s Anti-Drug Abuse Act of 1988, and is widely considered a cornerstone of the war on drugs. The first appointee under George H.W. Bush was conservative firebrand William Bennett.
“Botticell’s the first director of national drug control policy who really has had a prudent public health perspective,” said Rawson.
The new Comprehensive Addiction and Recovery Act (CARA), which was passed by Congress in July but has not yet received funding authorization, reflects Botticelli’s approach. The law is designed to expand life-saving treatment services, prevention and educational efforts, and launch an evidence-based opioid and heroin treatment and intervention program nationwide. It would also strengthen prescription drug monitoring programs and launch a pilot medication assisted treatment program. President Barack Obama has asked for $1.1 billion to fund the act and, according to Botticelli, Vermont would be eligible for $4 million if Congress follows through.
“Vermont and other states have done more than their fair share,” Botticelli said. “It is time for Congress to step forward.”
Botticelli, who previously headed up the bureau of substance abuse services in Massachusetts, said New England has been grappling with the heroin crisis longer than the rest of the country. And though much remains to be done, he praised the progress Vermont has made since Gov. Peter Shumlin made the heroin epidemic the focus of his 2014 State of the State address. Vermont has made naloxone widely available, has a robust syringe service program, and has greatly expanded access to medical treatment for addiction through a hub and spoke model.
According to Cohen, in 2014 there were fewer than 2,000 people in treatment programs. Today there are more than 6,000. Naloxone is widely available. And, according to Chen, opioid prescriptions are down.
“Everybody has a role to play,” said Botticelli. “Vermont recognized this long ago and stood up to the challenge.”
Yet Botticelli also acknowledged that Vermont and the rest of the country are in the midst of a long and painful epidemic. Botticelli, who himself battled addiction, says the stigma associated with drug use is still a major obstacle to accessing treatment. Addiction treatment and primary care need to be better integrated. And drug users need to feel that they can come forward and receive care without being punished or stigmatized.
“It’s a national crisis that manifests itself as a local problem,” Botticelli said. “Local problems require local solutions.”
Scott Tucker, commander of the Rutland City Police Department, led a presentation on Project Vision, the community-based approach to drug intervention that has helped drive down drug-related crime in Rutland City. Tucker said the Vision Center, located on the second floor of the police department, brings law enforcement into contact with social service agencies like the Women’s Network and Shelter and the Department for Children and Families. Together they develop strategies that aim to not only reduce crime but also offer treatment and access to care.
Tucker said three elements have helped make Project Vision a success: relationship building, information sharing and leveraging of resources so that the various organizations and institutions in a community are not working at cross purposes. Tucker says the police department has made some unexpected alliances through Project Vision.
Other presentations covered the role of schools in addressing addiction treatment, the hidden epidemic of substance abuse among older adults, and models of care for high-risk children and their families. Ira Chasnoff, a professor of clinical pediatrics at the University of Illinois, also delivered a presentation and workshops on drug abuse and pregnancy.
