CHARLESTON, W.Va. — Faced with a nationwide epidemic of heroin and prescription drug abuse, the Obama administration announced Wednesday that it will take steps to increase access to drug treatment and expand the training of doctors who prescribe opiate painkillers.
The efforts, which President Obama unveiled at a forum here, are likely to have a modest effect on the steep increase in heroin and prescription drug overdoses, which now kill more people than car accidents each year, and the barriers to treatment that many addicts face.
The administration hopes to double the number of doctors who can prescribe buprenorphine, a drug used to treat opiate addiction, to 60,000 from 30,000 over the next three years. More than 40 medical provider groups have committed to training more than half a million doctors, dentists and others on the safe prescription of opiate medications.
The announcement underscores Obama’s “sense of urgency that we at the federal level can do more to address this issue,” said Michael Botticelli, director of the White House Office of National Drug Control Policy.
Obama sat onstage with others for a discussion that included questions from the audience, and much of the focus was on treating drug abuse as an illness rather than a crime. One West Virginia woman, Carey Dixon, gave an emotional account of what it was like being a family member of an addict, fearful of phone calls and the absence of phone calls. At one point, Obama reached out to touch her shoulder. Later, he said he thought of his own daughters and his own youthful indiscretions, adding, “There but for the grace of God.”
Wednesday’s announcement is part of a broader effort to fight opiate addiction and crack down on the overprescribing of powerful drugs. There has been a steep increase in the number of heroin overdoses nationwide, with deaths from the drug quadrupling in the past decade. Many who abuse heroin initially used prescription painkillers.
“This is such an epidemic. You cannot arrest your way out of this mess,” said Charleston Police Chief Brent Webster, who has served in the city’s police department for 20 years.
The Obama administration this year proposed $133 million in new spending to curb overprescribing, increase the amount of overdose data collected and expand access to Naloxone, a drug that can reverse the effects of an opiate overdose. In August, the administration announced an initiative to pair drug enforcement officers with public health workers to trace heroin routes, and it tightened prescribing rules for a popular painkiller.
While offering sympathy, the president had little to offer in the way of money. Congress must act on his budget proposal, and that looks unlikely as negotiations drag on to keep the government open. Obama said repeatedly that this should not be a partisan issue, but like many other proposals, funding for drug treatment faces an uphill battle.
The Obama administration’s drug policy is largely predicated on the idea of shifting people with drug problems away from the criminal justice system and toward treatment, a tactic that members of both parties have embraced.
The plan announced Wednesday also doubles the number of providers that can prescribe Naloxone. Additionally, CVS plans to expand the number of states where its pharmacies will dispense Naloxone without a prescription, and Rite Aid will train 6,000 pharmacists on Naloxone use over the next year.
Obama issued a memorandum Wednesday instructing federal agencies to train the doctors they employ in proper prescribing of opioids and to identify barriers to medication-assisted treatment for employees enrolled in their health-care plans.
Despite the announcements, many barriers remain to treatment, with many addicts unable to access the help they need because of insurance rejections or overburdened facilities.
The Affordable Care Act requires insurers to treat addiction like any other medical condition. But that portion of the law went into effect for many insurance plans only in January. Obama said the government should “push a little bit more” on insurance companies to offer coverage.
“The notion that you’re going to cover a broken leg but not going to cover an illness in which your child might die? That doesn’t make sense,” he said.
In West Virginia, a law passed this year allows emergency responders, medical personnel, and friends and family members of addicts to administer Naloxone.
West Virginia — the home of Health and Human Services Secretary Sylvia Mathews Burwell — is the epicenter of America’s opiate epidemic, where more than a decade ago people started getting hooked on prescription drugs.
According to the Trust for America’s Health and the Robert Wood Johnson Foundation, West Virginia has the highest rate of drug overdose deaths in the country — 33.5 per 100,000 people — accounting for more than one-third of the state’s overall injury deaths.
David Grubb, a member of the audience who has five daughters, one of whom is fighting heroin addiction, made a plea for more treatment facilities. After rescuing her from one overdose, Grubb said he called addiction hot lines and was told that there was a three-month wait for a spot in a treatment facility.
“It took forever to find a place for her. Right now, she’s in Michigan. Why can’t we have more of these facilities here in West Virginia, close to home?” Grubb said to applause.
Botticelli is a champion of using opiate drugs including buprenorphine for medication-assisted treatment, a practice that is controversial. The drugs are prescribed by a doctor who monitors the patient and tapers the dosage, eventually weaning the person off opiates.
The administration plans to expand a pilot program in which medication-assisted treatment is offered to people in federal prisons. The corrections system typically does not offer treatment, forcing people to detox while incarcerated. They often relapse after being released. The White House has also made drug court funding contingent on the court offering medication-assisted treatment.
“That doesn’t make sense to me, just sending out more medication-assisted treatment,” Rep. Tim Murphy (R-Pa.) said in an interview earlier this year.
The Department of Health and Human Services plans to additionally change the rules on medication-assisted treatment; currently, doctors can prescribe to only 30 patients in the first year after being approved to dispense the medications, and they are capped at 100 patients.
The administration is working to take a federal approach to an issue that is often tackled at the state level. Many states have made it easier to access Naloxone as a way to curb the number of overdose deaths. The drug has saved many lives, and some states have made it available without a prescription. But some treatment advocates are leery of relying too much on the drug, which doesn’t steer addicts away from heroin.
The president made a reference to his own addiction to nicotine and his use of Nicorette gum. “Nicotine is as addictive as anything else,” he said. But he said if it was possible to get smoking rates down, more effective education, limits on advertising and treatment could bring down other addiction rates, too.
Vermont Gov. Peter Shumlin (D), who dedicated his entire state of the state speech last year to heroin abuse, said reducing overprescribing of opiates must be a priority.
“I am incredibly encouraged by the steps President Obama is announcing today, especially his efforts to further the conversation about how we deal with pain management in America,” Shumlin said in a statement.
Obama said the nation also needs to cast away the shame of addiction.
“We can’t fight this epidemic without eliminating stigma,” he said. “With no other disease do we wait until people are a danger to themselves and others. . . . This is an illness, and we’ve got to treat it as such”
Meeting on a side street near the Roosevelt Neighborhood Center before Obama spoke, leaders of some local social service groups said they could use even more support from Washington.
Standing in front of a group of blue plastic kindergarten chairs on a grassy lawn, Carey Jo Grace, a community organizer with the Our Children, Our Future Campaign, said that at least one of the 30 chairs held a child who would eventually die of a drug overdose. Obama, she said, “has the power to do something about it with the stroke of a pen.” She said that West Virginia needs more money for rehabilitation programs. West Virginia’s Department of Health and Human Resources estimates that the state has about 60,000 people in need of treatment competing for 750 beds.
“There are people who need to drive hours if their name comes up on a waiting list,” she said.
“More funds for treatment is just critical,” said the Rev. Jeff Allen, head of the West Virginia Council of Churches. But, he added, pastors had to do more to “change the culture of churches to take away any shame so people can turn to their pastors and congregations.”
Marc Fisher in Washington contributed to this report.