The prob­lem isn’t just pills

The Washington Post Sunday - - SUNDAY OPINION - BY PA­TRICK J. KENNEDY

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.”

DAR­REN MCCOLLESTER/GETTY IMAGES

The pre­scrip­tion medicine Oxy­Con­tin at a Wal­greens drug­store in Brook­line, Mass.

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