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Q&A: What Should We Be Doing About the Opioid Crisis?

patrick kennedy

March 14, 2018 -- Former Congressman Patrick Kennedy has been a key voice in the national debate about the opioid epidemic. A recovering addict himself, the Democrat from the legendary Kennedy political family has called for policy and financial commitments from the federal government to help fight the problem.

Kennedy has also tried to draw the connection between addiction and mental health. While in the U.S. House of Representatives, Kennedy sponsored legislation that requires insurance companies to treat mental illness, depression, and addiction the same as they treat illnesses of the body. The bill, known as the Mental Health Parity and Addiction Equity Act, was signed into law in 2008.

Kennedy is also a member of President Donald Trump's Commission on Combating Drug Addiction and the Opioid Crisis. He spoke with WebMD recently about the current crisis, his own experiences with addiction, and what America should be doing. Here is an edited version of the conversation.

WebMD: You've often said if we had the will to end this epidemic we could do it today. If we did have that will, what would we be doing?

Kennedy: When it came to Zika, we had all the money we needed. And we didn't even know how to treat or interdict it. We were totally in the dark. But the money was there.

In this case we know exactly what works and yet there's no money there. In this case, obviously we're losing upwards of 200 people a day.

When HIV/AIDS hit, we were spending $24 billion a year to tackle a crisis that claimed 53,000 Americans. And now we're losing far more than that, 64,000 in a conservative count, and we can't even get half a billion.

WebMD: Many of the people who read our work on opioids are concerned about how they will continue to get opioids. These are people with chronic pain who aren't abusing them but have used these drugs for years with medical instruction. In many cases they already face more difficult hurdles to filling prescriptions. What should they do?

Kennedy: We do have a major epidemic of real physical pain and we have an epidemic of perceived physical pain, combined with real psychic pain, which is driving a lot of the overusage.

The fact of the matter is there is no one-size-fits-all. Real pain needs to be constantly tackled in terms of new and emerging ways to treat it. And there are several new, emerging ways to treat it. When we did our commission hearing, we heard from several companies that were dramatically reducing the needs for opioids, from hospitals, especially from surgical pain because there are new types of interventions. We heard from pharma about how we had several promising approaches coming down the line. We need to be finding ways to treat pain aggressively.

We found, when I was in Rhode Island, we did a survey of those who had lost loved ones in these hospitals. And then a big source of outrage was they lost their loved ones in agonizing pain and that their pain wasn't properly being treated. I don't think anyone wants us to risk those days again. I do worry that the pendulum can come back so strong that we can end up ignoring the very legitimate need to treat in pain.

I'm concerned the pendulum will swing back to underprescribing from overprescribing. We just need something different to prescribe, to maximize all these options.

WebMD: There have been many, many stories about people who have become addicted to opioids being taken advantage of in various ways. Whether it's manufacturers of medications to treat addiction hiking prices or so-called addiction treatment centers that string addicts along long enough to drain their benefits or bank accounts. How should someone who needs help get it?

Kennedy: It's really incumbent upon the medical community to step up and serve patients. We're looking at this as an addiction or mental health problem when this is a medical problem. The AMA (American Medical Association) to date has done very little to try and move this whole discussion forward. They're even missing in action on helping to facilitate more prescribing of buprenorphine, for example, which is the [medically preferred] form of treatment for opioid use disorder. And, frankly, the most cost-effective. You could give someone full-year coverage of opioid use disorder, solve the cravings, prevent the overdose, and provide mental health cognitive behavior therapy and do it at a fraction of a cost to fly someone down to (a rehab center) or one of these fly-by-night treatment places in sunny places.

The insurance industry needs to be more proactive. In-patient treatment is not customarily indicated for an opioid use disorder.

Most of these places detox people first, which everyone says is the worst thing to do in one of these cases. There is not a question of what to do here. It's really we have to shame some of these big medical societies and big insurers to stop complaining and do what we know works. (Insurers have been) too easy to blame the current system as not being evidence-based. Well, sure it's not evidence based in a lot of cases. That's because it's never been paid for through the normal course of reimbursement. It's been starved for money. And now they won't give it money.

WebMD: What have you learned from your own experience in recovery? What would you tell your younger, addicted self, and what would you tell Patrick Kennedy on his first day of sobriety?

Kennedy: I'd say this is the single most important decision period of your life. And that worry about economic professional security and worry about what people think of me – they're all fleeting and beyond any ability for anyone to control. This, making a decision on one day at a time, to make this the No. 1 priority, is the best thing you can do to ensure your chances to have everything you want. It's really the only sure answer that is going to give you the best probability, like these Olympic athletes, that you're going to have a chance to medal.

WebMD: What is your struggle today? I know former addicts of all stripes say they're not cured they're recovering. How do you manage it on a day-to-day basis?

Kennedy: I struggle with other things that could become slippery slopes to me falling back into addiction. They center around the seven deadly sins. Anything that feels too good you have to quickly take a look at yourself.

WebMD: The president's opioid commission: You've said it's a sham. What exactly is happening there? Does the White House have an interest in addressing this problem?

Kennedy: What the commission did was good. We produced some good work. The idea that we were being organized so as to facilitate some bold response to this epidemic -- that's a sham. It's now been laid bare that there really was no interest anywhere along the way to tackle this challenge aggressively.

When the president gave his speech at the White House after the commission I thought this could really become something. His speech was very powerful. But then, you know, we waited and waited, and the next thing that happened was a nearly $2 trillion tax cut. You're saying we need $200 billion over 10 years if we're going to be anywhere near the vicinity of HIV/AIDS. Now we're passing a tax cut that is going to cost $2 trillion over 10 years. Don't tell us there isn't enough money. It's about politics.

WebMD: What could we do to have the most impact in next 2 years?

Kennedy: We need to have a template for how we're going to spend this ultimate settlement. I don't think there's any doubt there's going to be a settlement. The question is like the tobacco settlement: Will much of that get frittered away and not really go to what could make the biggest impact? And so I think we desperately need to be prepared and have our solutions outlined. The city of New York is seeing a plateauing overdose rate. Rhode Island has seen some great news recently with incarceration and treatment of people who are incarcerated.

The bottom line is we have a whole litany of effective policies that have demonstrated their utility. Medication-assisted treatment. Boom, right off the top. Insuring that all health care [professionals do] screenings for addiction so we are seeing who is at highest risk.

We have the [mental health] parity law which is still disregarded. There isn't a state in this country where insurers are adhering to federal law on mental health and addiction. If you ever got the insurance companies to kick in what they really should be spending on this issue, you'd see a dramatic change. And of course we need to crack down on those unscrupulous providers [to make sure] they actually produce the treatments that have the best chance of improving people's conditions. That can make a big difference. Obviously early intervention is the mother lode of all our future efforts.

This is something Republicans and Democrats should get behind. ... We really relegate our country to future second-class status because the new armies that are going to steal our way of life are not going to be military and they're not going to be some economic force. The new armies are going to be depression, anxiety, and addiction. Those are the things that are going to undercut our national security and relegate our country to a lower standard of living.

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