On July 9, the White House released the 2014 National Drug Control Strategy(obamawhitehouse.archives.gov), which, it explained, "builds on the foundation laid down by the Administration's previous four Strategies and serves as the nation's blueprint for reducing drug use and its consequences."
Drawing from the consensus perspective that addiction is a disease, the science-based report focuses on the latest research addressing drug abuse in the United States. The strategy reviews the progress made in fighting prescription drug abuse during the past four years and recommends an expansion of community-based efforts to prevent drug use before it begins. This approach also includes empowering health care professionals to intervene with patients at the earliest signs of substance abuse and expanding access to treatment programs when necessary.
2014 Strategy Explained
Michael Botticelli, acting director of the Office of National Drug Control Policy (ONDCP) and President Obama's top drug policy adviser, led a news conference(www.ustream.tv) to announce the strategy.
Botticelli immediately put a face on the substance abuse crisis by opening with an explanation that he himself is in long-term recovery from substance use disorders.
- On July 9, the White House released the 2014 National Drug Control Strategy, recommending an expansion of community-based efforts to prevent drug use before it begins and empowering health care professionals to intervene with patients at early signs of a substance abuse disorder.
- Examples abound of family physicians actively fighting drug abuse, including Hughes Melton, M.D., who became a substance abuse expert in his small community out of necessity.
- One of the simplest tools physicians can use to help successfully combat the national drug problem is to make sure they recognize the signs and symptoms of substance abuse.
"I am speaking about my recovery because for too long, the stigma associated with the disease of addiction has quieted too many of our fellow Americans who have struggled with this disease," he said. "For far too long, having a substance abuse disorder was seen as a moral failure, a matter of weakness, rather than being recognized as the disease that it is."
He followed this admission with some startling CDC statistics:
- Drug overdose deaths now surpass homicides and traffic crashes as the leading cause of injury death in America. Most of this is driven by the use of opioids.
- About 110 Americans, on average, die every day from drug poisoning deaths. Prescription drugs were involved in more than half of the 41,300 drug poisoning deaths in 2011. And opioid pain relievers were involved in nearly 17,000 of these deaths.
According to Botticelli, the strategy represents an alternative approach to combating drug abuse, outlining 100 ongoing actions that are the building blocks of drug policy reform.
"We know that preventing drug abuse before it begins, particularly among young people, is the most cost-effective way to reduce drug use and its consequences in America," he said. "That is why this strategy lays out actions for expanding national and community-based programs including our drug-free community support program."
Botticelli continued by explaining that the strategy also calls on the medical community to expand activities such as screening, brief intervention and referral to treatment to empower health care professionals to intervene at the first signs of trouble. Chapter 3 in the strategy document addresses health care's role in fighting substance abuse.
In addition, Botticelli added, the Patient Protection and Affordable Care Act offers patients suffering from drug abuse problems health coverage that wasn't available to many patients previously.
"The Affordable Care Act, for the first time in history, requires insurance companies to cover treatment for substance abuse disorders just like they would cover any other chronic disease like diabetes or hypertension," Botticelli said. "This expands access to addiction treatment for the millions of Americans who need it."
Finally, Botticelli noted, the federal government is growing increasingly concerned about the potential for transitioning from prescription opioid abuse to use of heroin and injected drugs, so the strategy also addresses the rising threat of heroin abuse.
Creative Tactics for Combating Drug Abuse
Examples abound of family physicians actively participating in the fight against drug abuse. One such example is Hughes Melton, M.D., who is chief medical officer for Virginia operations for Mountain States Health Alliance and works out of Johnston Memorial Hospital in Abingdon.
Melton also is the medical director and founder of HighPower, P.C., a patient-centered medical clinic in Russell County built on the foundation of a company he had previously established. Named the AAFP's 2011 Family Physician of the Year, Melton became a substance abuse expert out of necessity.
As soon as Melton and his partners arrived in Russell County and started C-Health, HighPower's predecessor, in 2000, they saw substance abuse was a significant issue that they needed to be proactive in treating.
"My partners tried to make a point of prescribing responsibly and not be part of the problem," Melton told AAFP News. "I took it a step further in getting involved more in treatment with the patients. Initially, I was involved in a local treatment center and then brought it in-house at C-Health."
The HighPower facility that Melton now runs specializes in addiction treatment, pharmacy consultative services related to mental health and women's health, and it also offers primary care to a small group of patients. His wife, Sarah Melton, Pharm.D., works as a clinical pharmacist at the facility, collaborating with the clinic's two physicians to identify the best medications for each patient, particularly those with a history of addiction. The staff of nine full- and part-time staff at HighPower includes the Meltons and several substance abuse and peer recovery counselors.
Drawing on the group approach to therapy long used during addiction recovery, Melton said he decided to see substance abuse patients in a group setting rather than in individual sessions, partly because there were initially many patients and only one of him.
"There is a very important group therapy dynamic for the disease of substance abuse," he said. "So group visits allowed me to make the best use of my time as well as incorporate a group counseling support group as part of the care process within the clinic."
This year, HighPower has treated around 90 patients for opioid abuse. Since the program first began at C-Health, Melton estimates the number of patients treated to be about 300.
Recognize Substance Abuse
One of the simplest tools physicians can use to help combat the national drug problem successfully is to make sure they recognize the signs and symptoms of substance abuse.
While working in the emergency department a week ago, Melton said a patient came in complaining of stomach cramping and chills. She was wearing a sweatshirt in the summer and had the sleeves pulled down, so only her fingers could be seen.
"I suspected opiate withdrawal, and when she reluctantly removed the sweatshirt at my request, I noted scars from cutting and current track marks," he said. "In a nonjudgmental way, I explained that these findings suggested substance abuse and asked if that is a problem for her."
Melton and the patient then had a five-minute, honest discussion about her disease of addiction and he referred her to a local treatment center.
"This is a classic example of the most basic and important intervention," Melton said. "The treatment consisted of education that addiction is a chronic relapsing disease, nonjudgmental encouragement to seek treatment and no controlled substances given to the patient."
Even as the National Drug Control Policy called for broad-based community involvement in fighting substance abuse, Sarah Melton said she and Hughes worked with the Medical Society of Virginia and the state health department to blitz the state, educating prescribers about prescription drug abuse. So far this year, the group has reached 2,000 prescribers, she said.
This fall, the topic they plan to cover during those sessions will be women who become pregnant while taking opioids, which leads to neonatal abstinence syndrome, she said.
In addition, as an associate professor of pharmacy practice at the Gatton College of Pharmacy at East Tennessee State University (ETSU) in Johnson City, Tenn., Sarah Melton has been directly involved in helping to bring the Generation Rx(pharmacy.osu.edu) educational program to elementary, middle- and high-school students in Southwest Virginia. The initiative is intended to increase public awareness of prescription medication abuse and to encourage health care providers and other community members to prevent abuse.
When pharmacy school members present the program, they always open with a testimony from an ETSU College of Pharmacy student who has been touched by prescription drug abuse, she said.
Pharmacy student Chris Lopez, for example, opened presentations by explaining that his mother died from an opioid overdose when he was 15 and in high school. "That is what drove him to get into health care and to try to make a difference with prescription drug abuse," said Sarah. Lopez has now graduated from the pharmacy school, is currently a resident at a local hospital and is planning to do a good portion of his research at the facility in prescription drug abuse, she added.
The ETSU pharmacy school also is the only school that currently offers a prescriber toolkit(etsugenerationrxprovidertoolkit.weebly.com) as part of the Generation Rx program. The toolkit is a video product that allows presenters to visit prescribers' offices and educate them about protecting their practices and patients when prescribing controlled substances. Specifically, the video shows what should not happen during an exam room encounter.
In general, said Hughes, said there are many great toolkits available physicians can use to become more knowledgeable about speaking to patients with substance abuse.
"A small amount of involvement by a physician can go a long way," he said.
Related AAFP News Coverage
Success in Fighting Opioid Abuse Demands Multifaceted Approach
Policy Changes, Education, Community Involvement Play Key Roles
More From AAFP
Pain Management & Opioid Abuse
White House news release: Obama Administration Releases National Drug Policy Strategy Emphasizing Public Health Approaches to Nation's Drug Problem(www.whitehouse.gov)
(July 7, 2014)