Pubdate: Sun, 05 Jul 2015
Source: Dallas Morning News (TX)
Copyright: 2015 The Dallas Morning News, Inc.
Contact: http://www.dallasnews.com/opinion/send-a-letter/
Website: http://www.dallasnews.com/
Details: http://www.mapinc.org/media/117
Author: Tod Robberson
Note: This Q&A was conducted by the Dallas Morning News editorial 
board and condensed by editorial writer Tod Robberson.

THE CHANGING WAR ON DRUGS

Michael Botticelli Explains the Focus on Misuse of Prescription Medication

Michael Botticelli, director of the White House Office of National 
Drug Control Policy, is reorienting the focus of the U.S. "war on 
drugs" to make Americans more aware of the dangers posed by domestic 
prescription drug abuse, as opposed to international illicit drug 
trafficking. He shared his perspectives with Points during a recent 
visit to Dallas.

In years past, the "drug czar" has tended to focus on issues such as 
Plan Colombia and fighting international drug cartels. You're taking 
a different track, almost entirely focused on domestic drug consumption. Why?

One of the main reasons we see how people start misusing pain 
medication is [because of the large amount of ] unused medication. It 
sits in the medicine cabinet and, from there, it gets diverted. 
Seventy percent of people who start misusing pain medication are 
getting them free from friends and family.

We have an opioid epidemic in the United States that has been driven 
by the vast over-prescribing of pain medication. [One report 
indicated] that in 2012, we were prescribing enough pain medication 
to give 75 narcotic analgesic pills to every adult over the age of 18.

We want people to be adequately treated for pain, but physicians 
often have very little training on substance use and addiction, very 
little training on appropriate, safe pain prescribing. We, 
unfortunately, also live in a culture that, as consumers, we feel 
like we get better health care if we get a pill, and probably for a 
lot of reasons.

What are you asking regional and local medical boards to do in terms 
of what they're telling doctors - the prescribers?

Part of it is having a good understanding on who should be prescribed 
these medications and who shouldn't. ... Let me give you an example. 
I've been in [addiction] recovery for a long time. I was the state 
director of treatment services for Massachusetts for a long time. My 
medical provider, after a procedure, asked me if I wanted a 
prescription for Percocet. What I said to him was, "I am not the 
person, because of my history, that you should be giving these 
incredibly powerful and addictive substances to."

What we should have done is have a conversation before. "Michael, I 
understand you're in recovery. What does that mean as it relates to 
your pain plan?"

These are not illicit drugs. There are legitimate purposes for these 
drugs. They are prescribed by a physician. ... It's not about 
fighting a cartel. It's about working within a medical and a 
public-health context to deal with this issue.

How is this goal complicated by the change in marijuana policies in 
various states?

We've been opposed to legalization efforts, not from an ideological 
perspective, but from a public-health perspective. A couple of 
things: The evidence is abundantly clear that there are significant 
adverse health consequences to marijuana, and particularly for youths.

We know that kids who use substances, particularly alcohol, tobacco, 
marijuana, from a very young age are [harming their] developing 
brains. It puts them at significant risk for developing addiction. 
It's been linked to poor academic achievement. It seems to 
exacerbate, particularly, issues around mental health issues. A study 
showed that fairly chronic use leads to lower IQ issues.

The other piece that is, I think, particularly problematic is 
watching the development of an industry that, quite honestly, is 
using the same tactics that the tobacco industry has used in terms of 
marketing their substances. I said this before, I think they 
[marijuana marketers] are getting a free pass. One of the areas of 
concern has been the edibles. They're marketed to look like candy.

A long-standing complaint among Latin American leaders is that the 
United States puts too much emphasis on international interdiction 
and too little on reducing demand at home.

Yes, we have to reduce our demand, but it's also a little more 
complicated. Partner nations, as well, have a responsibility to deal 
with some of the endemic issues around corruption, lack of 
opportunity. Think of what's driving this [surge in border violence 
and migration]. It's not just the drug trade, but it's the gangs, 
lack of employment and hopelessness on the part of these kids that 
there is any opportunity for them.

Whether it's [human smuggling] or drugs, these are clearly 
multinational, transnational organized criminal groups. If it's not 
drugs, it's going to be something else. That's why, yes, we have to 
focus on demand, but it really does require a much more holistic 
effort on the part of these countries to deal with these criminal 
organizations. We can take drugs out of the equation, but it's going 
to be something else, unless there's some level of concerted efforts.

The Dallas district attorney, Susan Hawk, has acknowledged entering 
rehab for prescription drug use. Should she have been more 
transparent with voters during the campaign?

We've really been trying to work on and change the language of 
addiction. ... When you refer to someone as a substance abuser, it 
will elicit a more punitive response than a person with a 
substance-abuse disorder. That's because, if you think of abuse, it 
implies intent.

There are a whole host of terms we use in addiction that we don't use 
for [people with disorders] ... you know - junkies, addicts. We even 
call the results of urine tests dirty and unclean. We don't do that 
for any other disease. What we've been trying to do is change the 
language of the field to diminish the stigma of substance use. One of 
the biggest reasons why people don't seek care is shame and stigma. 
They really feel embarrassed, even more so than mental health.
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MAP posted-by: Jay Bergstrom