The first meeting of the US Commission on opioid dependence hears calls for a ‘health-based approach’ to addiction, but ignores harm reduction


The first meeting of the US Commission on opioid dependence hears calls for a ‘health-based approach’ to addiction, but ignores harm reduction

19 June 2017
Kimberly Grinberg

On Friday June 16, 2017, the President’s Commission on Combating Drug Addiction and the Opioid Epidemic held its first meeting at the White House. The meeting occurred after months of a lack of clarity regarding the Commission’s position within the federal government. Although established by executive order in late March 2017, the Commission’s role had remained unclear since its inception.

Observers questioned what relationship the Commission would have with the Office of National Drug Control Policy (ONDCP), an organization already established to provide federal guidance on drug-related issues. The Commission’s role became even less clear when a New York Times Article published in May of 2017 claimed a document obtained from the Office of Management and Budget showed that President Trump’s budget proposal intended to remove 95% of funding from the Office of National Drug Control Policy.

Richard Baum, President of ONDCP, later stated that this 95% figure was inaccurate and clarified the role of the Commission in relation to ONDCP. The Commission serves to review the state of drug dependence and the opioid epidemic and make recommendations to the President regarding how the federal government can best address the opioid crisis. Baum further explained that the Commission is staffed by the ONDCP. The White House has underpinned Baum’s explanations, writing that the Commission’s role is to review the state of drug addiction and the opioid epidemic and make recommendations regarding how the federal government can best address the opioid problem. The Commission is also charged with monitoring drug dependence treatment services, identifying and reporting on best practices for drug prevention and examining the effectiveness of state and federal prescription drug monitoring program, as well as writing a report advising the President on these issues, among other responsibilities. It was in this context that the first meeting was publicly held.

The Commission’s membership includes New Jersey Governor Chris Christie (chair), Massachusetts Governor Charlie Baker, North Carolina Governor Roy Cooper, former U.S. Representative Patrick Kennedy, and Dr. Bertha Madras of Harvard Medical School, all of which were present for the June 16th meeting. Following statements by U.S. Secretary of Health and Human Services Tom Price and and U.S. Secretary of Veterans Affairs David Shulkin, nine stakeholders and non-profit organizations working in the field of drug dependence spoke about addressing drug addiction in the United States.

Major themes emerged early in stakeholder presentations, including calls for increased access to ‘medically-assisted addiction therapy’ (that is, substitution treatment), access to long-term drug treatment programs and the need for comprehensive and integrated solutions that did not glorify one response over another. The need to diversify approaches to reducing drug dependence was echoed by Roy Cooper, Governor of North Carolina, who stated “we cannot arrest our way out of this problem”. Many participants insisted that the issue of parity was central to the problem and questioned why drug use was treated less seriously than physical diseases such as cancer. Stakeholders also voiced concern about stigma and the need to understand drug dependence as a health issue, and not a moral failing.

Over the course of the two-hour meeting, a tone of empathy and compassion was employed to discuss individuals dependent on drugs as well as their families. Participating stakeholders stressed that the obstacle to relieving opioid related deaths was not one of a lack of knowledge or understanding. “We know what to do, the money is available, we’ve known for years what to do” stated a representative from the American Academy of Addiction Psychiatry. “It’s really simple, we have the CDC guidelines” said a representative from ShatterProof, a not-for-profit organization dedicated to ending the effects of addiction on families.

But while participants stressed that they already were aware of ways to effectively reduce drug dependence, harm reduction policies – a critical response for many people who use drugs – were unfortunately not mentioned. This is likely a result of the lack of presence of harm reduction representatives invited to testify at the meeting. Some participating stakeholders, particularly from the health and science-based organizations, noted the importance of equipping first responders with the opioid-reversing drug Naloxone. But beyond overdose prevention measures, harm reduction interventions such as needle and syringe programs, the promotion of safe-injection facilities, and increased access to drug checking kits were not mentioned.

The silence on these harm reduction strategies was made worse by the fact that only five days earlier the American Medical Association, one of America’s most esteemed medical organizations, came out in support of piloting safe-injection facilities. And while a common theme of the discussions was the need for a public-health based approach to drug use and dependence, criminal justice reform was mentioned only once by any of the participants (the intervention on criminal justice was made by the American Academy of Addiction Psychiatry). This is particularly concerning in a country where 80% of drug-related arrests between 1993 and 2011 were for simple possession for personal use. As in other parts of the world, it seems clear that any health-based approach will not be possible unless the country reviews its overly repressive stance on drug control.

The Commission is due to submit their report to the President in October of 2017. If the first meeting of the Commission is any indication of this future report’s contents, it is likely that any success the report could have in advising the President on addressing drug use will be diminished by its failure to consider harm reduction strategies.

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