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White House Plan To Tackle Heroin Abuse Focuses On Treatment


Delaware will receive a chunk of the federal funding under this new program. And that's where we reached Michael Botticelli today after the program's announcement. He's the director of National Drug Control Policy. And I put this hypothetical question to him - if half the heroin or opioid addicts in the 15 states in this program all wanted treatment, would there be sufficient programs and facilities to handle them?

MICHAEL BOTTICELLI: We know already, Robert, that our - many of our treatment systems are operating at capacity, have long waiting lists. Many parts of the country don't have a specialty treatment program, but they do have a community health center. So focusing on increasing the capacity within our hospital systems and primary care facilities becomes really important for us. So, you know, it's often a huge moment in time when someone finally decides that they want to seek care. And we should have treatment on demand, you know, when people, you know, are ready to make that decision. It might not come again and so we want to make sure that we continue to support the expansion of treatment when people are ready to make that step.

SIEGEL: Heroin and prescription opioids differ in that heroin is produced illicitly, but prescription drugs are produced by drug companies. Are the manufacturers of prescription opioids doing enough, first, to limit production to no more than what's medically necessary and, second, to safeguard their product?

BOTTICELLI: I actually think, you know, when I look at what are strategic opportunities here, that we need to continue to focus not just on the medications themselves, but more importantly how they are prescribed. A 2012 study by the CDC showed that we are now prescribing enough pain medication to give every adult American 75 pain pills. And we know that people need access to these life-saving medications, but we also know that we are prescribing way too much of it. We are prescribing it in quantities that are greater than what's needed. And physicians and prescribers are not appropriately monitoring these. And one of the things that we are proposing is mandatory prescriber education on safe and effective opiate prescribing. I don't think in the throes of this epidemic that it's too much to ask a prescriber to take a limited amount of medical education that they do not get in medical school around safe and effective prescribing.

SIEGEL: But if I hear you right, I mean, the gateway to the illicit market in the U.S. is the doc's prescription pad, is medical prescription by MDs and other medical professionals.

BOTTICELLI: You're entirely correct. Even though we know that only a small percentage of people who have misused prescription pain medication transition to heroin, four-fifths or almost 80 percent of newer heroin users started misusing pain medication. And when you track back, Robert, to the beginning of the dire consequences that we've seen, you can see almost a perfect correlation between overdoses and other significant consequences tracked to the overprescribing of prescription pain medication.

SIEGEL: It sounds like we're back to where we were over a century ago when heroin stepped in where morphine dropped out. It repeats itself, this cycle.

BOTTICELLI: I think it does, but I - you know, I think part of the challenge that we've seen, Robert, is, you know, historically heroin use was really part of a much more urban experience, largely with people of color. And I think that we've seen that change both demographically and geographically. And I think that's put particular challenges in this program. So, you know, we are seeing a younger cohort, a whiter cohort often from suburban and rural areas who didn't necessarily really know about heroin. And that also includes our law enforcement that weren't suspecting heroin in those communities. And that's why the initiative today becomes really important for us to make sure that we are working with law enforcement communities and particularly in suburban and rural areas about identifying heroin trafficking, about encouraging them to carry naloxone, which is this incredibly miraculous overdose drug that many law enforcement communities have been doing it. So while heroin has been around for a while, I think the challenge is that it's a different demographic and in parts of the country where we weren't expecting or didn't - haven't historically seen heroin use.

SIEGEL: Michael Botticelli, thank you very much for talking with us today.

BOTTICELLI: Great, thank you, Robert.

SIEGEL: Mr. Botticelli is director of National Drug Control Policy. He spoke to us from Newark, Del. Transcript provided by NPR, Copyright NPR.

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