INDIANAPOLIS – A scourge of heroin and prescription drug abuse calls for more aggressive approaches to treatment, according to nation’s drug czar, who also wants Indiana officials to ease up putting drug offenders in jail.
In a speech Thursday, Michael Botticelli, director of the White House Office of National Drug Control Policy, pressed for measures that Indiana lawmakers so far have been reluctant to endorse — expanding needle exchanges for intravenous drug users, wider access to the overdose-reversing drug naloxone, and more medication-assisted treatment using methadone and similar drugs.
“All across this country, I’ve heard from federal, state and local law enforcement that we cannot arrest our way and incarcerate our way out of this epidemic,” Botticelli said.
His comments to about 800 people at the state's annual Prescription Drug Abuse Symposium focused on efforts by the federal government to fight opiate addiction and stop the overprescribing of narcotic painkillers.
It comes as Indiana and other states face an increase in deadly overdoses from opioids, which now kill more people than automobile accidents.
Botticelli said the Obama administration is pushing efforts to expand access to naloxone, a drug that reverses the effects of overdoses and is now available without prescription in 14 states.
Indiana has resisted granting easy access to the drug; critics say it would encourage drug use by giving addicts a way out of an overdose.
Botticelli also said the federal government wants to double the number of doctors who can prescribe opioid-based medications used to wean addicts off heroin.
Indiana lawmakers are wary of using taxpayer money for medication-assisted therapy, favoring an abstinence approach.
Botticelli called for rapid expansion of programs that distribute clean syringes to intravenous drug users to stem the spread of infectious diseases such as HIV and Hepatitis C.
A public health emergency - like one declared in Scott County before Indiana allowed a needle exchange program in response to an HIV outbreak - is too late, he said.
“A smart public health approach to both HIV and the prescription drug crisis requires us to take action now,” he said. “We know there is no time to wait.”
Botticelli met skepticism from some in the audience who, during a question-and-answer period, noted the struggle to get public and private health insurance to pay for drug treatment. Botticelli said he's hopeful that will change as the Affordable Care Act requires insurers to treat addiction like any other medical condition.
But also he decried the current state of addiction services, saying addicts often must be arrested or “hit bottom” before accessing care.
“We do not do this with any other disease,” he said.
He also warned that making services available isn't enough, if people with addictions are too ashamed to seek help.
Botticelli is a recovering alcoholic who didn’t get help until he was arrested on a drunken driving charge in 1988. He entered a court-mandated treatment program for alcohol abuse.
It was a wake-up call. Soon after, he left his job as a university administrator and began working at a substance-abuse treatment center. From there, his interest in drug policy, on the state and federal level grew. He joined the Office of National Drug Control Policy in 2012 and took over as director last year.
He’s the first person in substance-abuse recovery to hold the position of federal drug czar since it was created in the 1980s by President Ronald Reagan.
“No matter where I go, I hear about the role that shame and stigma play in keeping people from seeking care,” he said. “Having access to treatment recovery support is inconsequential if people are too ashamed to ask for help.”