There were five forums devoted to topics related to the causes and treatment of addiction with fascinating insights from various speakers.
The primary sponsor was Cigna Insurance, and President & CEO, David Cordani, addressed some sobering statistics in his opening remarks. He noted that opioid addiction is a ‘silent killer’ and causes 30,000 deaths annually in the U.S., 1½ times the fatality rate of auto accidents. Cigna estimates that by 2020, mental health/substance abuse will be the number one health problem in the United States. He pointed out that in a nation with a population of 322,000,000 there are more than 200 million prescriptions written per year and that’s part of the problem as a rising percentage of these are for highly addictive opioid painkillers.
The first forum was entitled ‘Breaking the Cycle of Addiction’ and was a panel discussion that consisted, interestingly, of two professionals who were on the treatment side, one Center for Disease Control and Prevention (CDC) official and a spokesperson representing PhRMA, the pharmaceutical manufacturing trade association. Without going into a point by point summary of their presentations, the addiction treatment people spoke eloquently about the rising numbers of opioid addicted young people that they see, and that addiction is a disease that is rarely funded adequately (by insurance or by local government) to treat successfully. They made an emphatic plea that naloxone (narcon) be as available to first responders as defibrillators have become, in order to save lives—that people routinely die on the way to the hospital that could have been saved. CDC representative Anne Schuchat, MD spoke candidly that the CDC had been slow to respond to the fact that some doctors are over-prescribing narcotic painkillers, and that addiction is as pervasive as it is. She agreed with the treatment professionals that greater availability of naloxone was important and pointed out that each state and each insurance company has different guidelines regarding the prescription of narcotics, so although the CDC can make recommendations, they cannot force compliance among doctors regarding over-prescription of such drugs. Finally, Anne Pritichett, the PhRMA representative, said that consumers of pain medication must be educated as to the risks of narcotic use, and that doctors should be educated as well. She refuted the point raised by Kimberly Kindy, the moderator, that increased manufacturing of narcotics leads to over-prescription by doctors and noted “we’re all learning along the way” in regards to industry accountability.
The next forum ‘Next Steps for Addiction Treatment and Prevention’ was moderated by Susan Blumenthal, MD, former US Assistant Attorney General and Medical College Professor at both Georgetown and Tufts University. She provided some further sobering statistics about addiction and how it touches many more American lives than one may realize. Her stats included:
-One in four US citizens know someone affected by addiction
-One in five are themselves or have a family member affected by addiction
-85% of addicted persons who seek help do not have enough access to treatment
-119 people a day die in the US from drug addiction related causes
Her takeaway point was that addiction should be considered a chronic illness that needs treatment for the patient’s lifetime and rarely does that occur.
The speaker was again David Cordani of Cigna who spoke of Cigna’s commitment to 1) Elevate awareness (of addiction) 2) Elevate detection (at an earlier stage so that treatment can commence) and 3) Use evidence-based treatment methods (such as methadone) along with behavioral health methods to treat both the physical and mental health aspects of addiction.
He pointed out that the 2008 Healthcare Parity Act (MHPAEA) provides that mental health and medical/surgical care be covered equally by insurance companies, yet many (insured) people seeking to pay for addiction treatment still struggle to find adequate care coverage from their insurance companies. Cigna would like to see certification of doctors who prescribe opioids, and to have access to state databases which track individual physicians and the number of opioid prescriptions written. Further, his company would like to see intervention for those physicians who over-prescribe these dangerous drugs.
Next up was Michael Botticelli, Director of the National Drug Control Policy in the White House, who spoke on the complicated issue of treating addiction as a disease rather than a crime. His presentation, ‘A Changing Model: From Criminalization to Compassion’ made the point that by incarcerating addicts, the nation’s prisons become de facto treatment centers (which they are not set up or funded to act as) and criminalization delays people from receiving proper treatment. He addressed the old ‘just say no’ model and the current focus on reducing supply, and pointed out that this does not “magically reduce demand or correlate to public health and public safety”. He spoke to the fact that the US uses 80% of the globally produced opioid market, mostly through prescriptions, and that this correlates neatly with the increased volume of prescriptions written. He noted that 60% of addicts first try opioids by getting them from friends and family. He also urged expanded access to naloxone for law enforcement, schools and other agencies in order to save lives and noted that social stigma plays a role in public policy; that is, until addiction is considered a medical rather than moral issue, it will be a struggle to convince states or change the law to adopt compassionate policies towards addiction.
There was a panel discussion comprised of those ‘On the Front Lines of Addiction’ that made clear the struggles that municipalities and organizations face to gain adequate funding and public acceptance of treatment centers rather than simply arresting and jailing those with addiction problems. All of the speakers told moving personal stories about their own journey and how they were helped not by the courts, but by intervention from trained professionals.
Lastly, US Surgeon General Vivek Murthy spoke about the ‘Three Pillars of Change’ that he sees as a must in order to address the growing problem of addiction in the United States. They are:
- Prevention
- Treatment (both immediate as in naxolone and in terms of medical and behavioral programs that address addiction)
- Culture Change
“Culture Change eats Policy Change for Lunch” was a quote that drew rueful laughter from the crowd in recognition of the fact that the US has traditionally focused on criminalizing addiction and there is critical need for a cultural shift to look at the broader picture in order for the ‘will and the resources’ to be made available to the people most in need of it via public policy on the state and national level.
This presentation on addiction and how pervasive, expensive and difficult to treat it is was extremely informative. It certainly was a sobering look at the other side of Mentor Foundation USA’s work in the prevention of drug addiction—the consequences for those who are unfortunate enough to become addicted. It served as an inspiration to redouble efforts to keep young people from falling into the cycle of addiction, which can become a lifelong battle and chronic health issue that is not solved easily or without great cost.
Video of all these presentations may be found at the following link: https://www.washingtonpost.com/newssearch/?query=coffee%40wapo