The problem isn’t just pills
Last week, President Obama announced a multipronged effort to address the epidemic of addiction to prescription opiate painkillers in this country. This is long overdue and, unfortunately, like most action on addiction and mental illness, comes after the problem has reached Stage 4 — and is that much harder to treat — when it could have been diagnosed and treated at Stage 1, or perhaps even prevented altogether.
I bring a unique perspective to this issue, one I would prefer I did not have. For 10 years, I sat on the House Appropriations Committee, overseeing every federal agency charged with addressing this subject. And during much of that time, I was addicted to prescription opiate painkillers myself. I would keep them in an aspirin bottle in my jacket so nobody would think it was strange when I popped one during an appropriations hearing.
I was one of those people you read about. I started taking OxyContin for back pain and then started seeking it for other, psychic pain. And when the original prescribing doctor wouldn’t give me more — after I explained that I lost my pills in my luggage, down the sink, the dog ate them, whatever — I could always find another who would write a prescription. You don’t have to be a congressman or a Kennedy to do this. All drug-seeking behavior is pretty much the same, as is society’s response to it: Mostly we ignore it, and when we decide to do something, our approach is usually limited and focused on impeding supply and shaming users rather than treating substance-use disorders and other mental illnesses as medical problems.
Now that I have been sober and well for more than four years, I can see the cycles of my illness. There were too many times when I went away to be medically detoxed from opiates but refused to look at the bigger picture: that if I wasn’t treated for my underlying mental illness as well as my addiction, and if I wasn’t treated as if both conditions were chronic illnesses instead of passing emergencies, I would never be truly healthy and sober.
My worry about what Obama has proposed — and about what his and previous administrations have done to try to address prescription opiate addiction — is that it focuses primarily on restricting and regulating supply and on medical detoxification. In reality, we need to face opiate addiction as part of a wider revolution in the way that we diagnose, treat and insure against mental illness and addiction. When patients are flagged for gaming the system while seeking Oxys, as I was many times, we need to view their situation as a cry for fully integrated medical care, not just a case for opiate detox.
On paper, the president has presided over the greatest expansion of mental-health and substance-use-disorder benefits in American history. My father, Sen. Ted Kennedy (D-Mass.), and I were proud to have been part of that effort, first with the Mental Health Parity and Addiction Equity Act of 2008 — which made it illegal to discriminate in care and coverage for diseases of the brain — and then the Affordable Care Act, which built upon and codified those parity protections. But the Obama administration has still not put in place many of the enforcement mechanisms necessary to make these measures a reality in our day-today medical lives. And the public-health epidemic of prescription opiate addiction brings this failure into sharp focus.
We will not be able to address this new and troubling addiction issue until we embrace the idea that all addiction care, and all mental health care, needs to be delivered in a radically different, holistic way — fully integrated into the rest of our medical care, and no longer viewed, as it has too often, as palliative care for moral failings or “demons.”
I applaud the president and the stakeholders he brought together last week to announce new training for medical professionals in opiate prescribing, public-service announcements on the subject and a broadening of the certification of physicians who can offer “medicationassisted treatment” for addictions — drugs that help block cravings or the actions of opiates — so that more patients can get and stay in recovery. But I urge the White House to think bigger. Prescription opiate addiction is not an isolated problem, and it shouldn’t be dealt with in a line-item way: It reflects our larger failure to integrate addiction and mental illness care into our general medical care. The pills don’t cause this problem, they exploit a vulnerability in our medical safety net.
This vulnerability can be addressed only if this administration — and the next one — commit fully to enforcing the protections of the Mental Health Parity and Addiction Equity Act and the Affordable Care Act. These protections require full disclosure by all medical insurers of how they make medical-management decisions on approving, refusing or prematurely shortening care for addiction and mental health. We need to be able to determine, once and for all, if the same criteria are being used for brain-disease care as for treatments of disorders of any other organ. Medical insurers — including the nation’s biggest insurer, the federal government through the Centers for Medicare and Medicaid Services — are not fulfilling their responsibilities under these laws. We have to hold them accountable, just as we have to hold doctors and pharmacists accountable for the way they prescribe and dispense medications; hold pharmaceutical companies accountable for the way they promote medicines; and hold patients accountable for misusing their medications.
I call on our president, and everyone who wants to be president, to offer bolder, more comprehensive plans to revolutionize our treatment of addiction and mental illness. There can be no health without mental health.
The writer, a Democrat, represented Rhode Island’s 9th Congressional District in the House from 1995 to 2011, and is co-founder of the Kennedy Forum on mental health and addiction and co-author of the new book “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction.”
The prescription medicine OxyContin at a Walgreens drugstore in Brookline, Mass.