President Barack Obama unveiled a new plan to combat opioid addiction in the United States on Tuesday, emphasizing the importance of making rehab programs available for people of all incomes as a way to stem the recent surge in overdose deaths linked to heroin and prescription painkillers.
Obama's announcement coincided with a speech he delivered at the National Rx Drug Abuse and Heroin Summit in Atlanta. The four-day gathering of politicians, physicians, researchers, counselors and educators has been held annually since 2012, when the Centers for Disease Control and Prevention (CDC) declared opioid addiction a public health crisis. The president joined two recovering opioid addicts and Baltimore's health commissioner on a panel moderated by Dr. Sanjay Gupta, a medical correspondent and practicing neurosurgeon, for a discussion about addiction and treatment.
Obama repeatedly stressed the importance of treating addiction like a public health problem rather than a criminal problem, acknowledging that previous drug epidemics — which were largely seen as a black, Hispanic, or inner-city problems — were heavily policed and dealt with through draconian prison sentences.
"I hope people don't mind me being blunt," Obama said. "Your last year in office, you get a little loose.
"What has made it previously difficult to emphasize treatment over criminal justice is that the problem was identified as poor, minority, and as a consequence, the thinking was, it's often a character flaw in those individuals who live in those communities, and it's not our problem they're just being locked up," he said.
"One of the things that's changed in this opioid debate is that it reaches everybody," he added. "Because it's having an impact on so many people, we're seeing a bipartisan interest in addressing this problem... not just thinking in terms of criminalization or incarceration, which unfortunately has been our response to the disease of addiction."
According to recent data, 28,647 Americans died in the US from opioid overdoses in 2014, including 18,893 deaths linked to prescription painkillers like OxyContin and Vicodin and 10,574 fatalities related to heroin. Research published by the Substance Abuse and Mental Health Administration (SAMHSA) found that 1.9 million Americans were addicted to prescription painkillers in 2014, and another 586,000 were addicted to heroin.
Congress agreed earlier this year to increase federal spending by $100 million to fight the opioid epidemic, bringing the total budget for the cause up to $400 million. The Obama administration is now seeking an additional $1.1 billion as part of the president's 2017 fiscal budget to expand treatment programs for opioid addiction. The proposal would triple the current funding allocated for opioid addiction.
A key piece of the Obama administration's multi-pronged approach focuses on expanding access to buprenorphine, a medication that suppresses opioid withdrawal symptoms, decreases cravings, and blocks the effects of heroin and other related drugs. At the moment, physicians who are qualified to prescribe the drug are only limited to 100 patients. The Department of Health and Human Services (HHS) wants to double that patient limit.
The White House issued a statement on Tuesday ahead of Obama's remarks at the conference in Atlanta noting that HHS funnelled $94 million into almost 300 community health centers across the country in an effort to make buprenorphine more accessible to opioid addicts.
"It's not enough to provide the architecture and structure for treatment. We need to provide an infrastructure to prevent people from falling into addiction in the first place," Obama said in Atlanta.
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A longstanding federal funding ban on needle exchange programs — where intravenous drug users can swap their dirty needles for clean ones to prevent the spread of HIV or hepatitis — was reversed last year. Congress agreed to allocate federal money to staffing and equipping harm-reduction facilities, but stopped short of agreeing to those funds being used for fresh syringes. These programs would be expanded under Obama's new strategy.
On Tuesday, the president also signed a memorandum establishing an inter-agency task force to explore the intersection of mental health and substance abuse. The move signals a retreat by the US government from a view adopted during the decades-long war on drugs that framed addiction as a criminal issue rather than a psychological one. The task force will seek federal parity protections to ensure state Medicaid plans offer the same degree of coverage for mental health and substance abuse as they do for medical and surgical issues.
The Substance Abuse and Mental Health Services Administration (SAMHSA) will also also release $11 million in funds to states who wish to stock up on and distribute naloxone, a drug that can reverse opioid overdoses. Those funds are also intended to beef up drug overdose training for first responders.
The president noted on Tuesday that doctors have been too willing to prescribe heavy-duty pain meds without considering other options. "I was shocked to learn how little time medical students spend on pain management," Obama also said.
"We have a healthcare system which too often is a disease-care system," he said. "We don't spend enough time thinking about how to keep people well, healthy and balanced in the first place. We need to rethink our healthcare system."
The president noted that 60 medical schools across the country had vowed to make pain relief a core part of their curriculums.
"We live in a society where we medicate a lot of problems and we self-medicate a lot of problems," he said. "The connection between mental health [and] drug abuse is powerful. And the line between alcohol, Vicodin and harder, illegal substances isn't that sharp sometimes."
"I was lucky because for whatever reason, addiction didn't get its claws in me, with the exception of cigarettes which is a major addiction but doesn't manifest itself in some of the same ways," he said, referring to a smoking habit that he kicked after reaching the White House. (The president said in 2009 he "constantly" struggles with cigarette cravings, and acknowledged that he has occasionally "fallen off the wagon.")
The president said that federal agents would continue to aggressively pursue drug traffickers, but said the "most important thing we can do is reduce the demand for drugs."
The new bid to fight opioid addiction at the federal level comes two weeks after the CDC issued the first federal guidelines for doctors prescribing opioids, laying out considerations physicians should follow in order to curb rampant abuse of the medications. Data collected by the CDC found that doctors and dentists wrote about 259 million prescriptions for opioid painkillers in 2012 — enough pill bottles to give every American their very own stash.The CDC also found that four in five heroin users became addicted after first using painkillers.
The CDC's bottom line was that physicians should only prescribe opioids in worst-case scenarios, such as end-of-life care. The agency also urged doctors to consider other forms of pain treatment, and recommended that doctors stop testing patients for marijuana use on the grounds that the drug is increasingly regarded as a safer and less addictive alternative to opioids.
On Monday, New York became the first state to require all doctors to send prescriptions to pharmacies electronically, rather than giving their patients a handwritten slip. The so-called e-prescribing is becoming increasingly popular across the country, but New York is the only state that currently mandates it. The new rules are intended to curb painkiller abuse and prevent users from forging paper prescriptions.
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