December 5th, 2016

To Obama And Biden: Farewell And Thank You

When President Obama and his administration took office, I had no expectation that they would emerge as great champions of alcohol and drug addiction treatment. A recently released summary details the impressive list of their achievements.

As in recent administrations, the person initially appointed as White House “drug czar” came from law enforcement rather than a treatment background. Later, new ground was broken with the appointment of Michael Botticelli who not only is treatment-focused but also is the first drug czar openly in recovery from a substance use disorder.

Regarding alcohol and drug addiction, the administration inherited four complex issues on which it moved forward in productive ways:

  1. Insurance parity for substance use disorders. People with addictions have faced difficulties accessing treatment compared to people with other chronic diseases such as diabetes and hypertension. Differences in coverage have been a major, if not the only, barrier constructed by insurance companies. The administration built on decades of work to redress this discrepancy, culminating in the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA). The final step was to establish the Mental Health and Substance Use Disorder Parity Task Force. A summary of its work was just released listing the actions that the administration is taking ensure that the Parity Act was being implemented.
  2. Medication-assisted treatment. The number of patients for whom a doctor can prescribe buprenorphine for addictions to heroin and prescription painkillers was increased with the condition that psychosocial interventions are also part of the treatment plan. In 2017, nurse practitioners and physician assistants will be allowed for the first time to prescribe buprenorphine.
  3. Overprescribing of opioid medications. Reversing years of misinformation promulgated by the manufacturers of opioid pain medication, the Centers for Disease Control issued guidelines for a more balanced use of opioids in managing pain. Hydrocodone, the most commonly prescribed opioid, was moved to a more restricted category in the Drug Enforcement Administration’s scheduling system for controlled substances including prescription medications.
  4. Cannabis. The Justice Department issued a memorandum to prosecutors not to interfere with state laws that have liberalized cannabis as long as the process is well regulated.  The announced expansion of the number of DEA-registered marijuana manufacturers alleviated the bottleneck on cannabis research. An even greater boost to research would have resulted from cannabis being moved out of the most restrictive Schedule 1. The DEA, however, was unwilling to allow this, and a congressional initiative to establish a special category for research failed.

I’m watching for early clues as to the direction the new administration will take on these issues and look forward to sharing my observations with you when indications appear.

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