Addiction In The Pandemic: An Interview With White House Leader On Drug Control Policy
When the Centers for Disease Control and Prevention released drug overdose death data last December, it warned about the impacts the ongoing pandemic has had on the addiction crisis.
“The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard,” CDC Director Dr. Robert Redfield said in a statement. “As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences.”
Only four states in the U.S. saw a decline in overdose deaths. Deaths increased in the remaining states. The rate of overdose deaths in Kentucky increased by 27% and in West Virginia by 31.7% — both were higher than the national increase of 21%.
In a series of stories about the addiction crisis during the pandemic, the Ohio Valley ReSource spoke to Acting Director of the White House Office of National Drug Control Policy Regina LaBelle. ONDCP develops and oversees the administration’s National Drug Control Strategy and budget.
LaBelle answered questions about barriers to addiction treatment, temporary policy changes during the pandemic, and what actions need to be taken to address overdose deaths.
OVR: The opioid epidemic was declared a public health emergency by the Trump administration. Yet the latest CDC overdose death data published in December showed that over 81,000 people died, making it the highest number of overdose deaths ever recorded in a 12-month period. What immediate action is necessary to address drug overdose deaths?
LaBelle: So I think one of the most important steps we need to take is to recognize that our addiction overdose death problem didn't happen overnight. And it's not going to get fixed overnight. We have to develop a treatment infrastructure around this country that makes sure that we can get people the treatment they need, the services they need, when they need it. And we're just not there yet. I mean, there are 20 million people in this country who have some form of substance use disorder, and only about 11% of people get treatment. So we have this huge gap between where we want to be and where we are today. We have to have a long-term plan to address that huge treatment gap, and also to prevent substance use from ever occurring. And that's not just not something we can do overnight. I started at ONDCP in 2009, when we were pretty much in the beginning of this opioid epidemic, what was then an opioid overdose epidemic, which has evolved over time. We're in a better place than we were then. But we still have a long way to go.
OVR: Why do you think that we are in a better place now?
LaBelle: So I think we're in a better place because number one I think there's a general acceptance about the types of treatment that work to prevent overdoses, the types of treatment that helped people. We're much further along in terms of our support and recognition of the importance of recovery— that addiction treatment is not something you go in for 20 days and you come out and you're transformed. Certainly you're transformed, but you need support, ongoing support, and it is not ‘one-size-fits-all.’ We have to have cultural competence in our approach to addiction treatment. We have to recognize that people come to addiction treatment with all sorts of other needs — child care, they may have co-occurring conditions. So these are not simple solutions. But we have a lot more money than we did before. And again a greater recognition of the importance of long-term, ongoing recovery support.
OVR: Kentucky, Ohio and West Virginia have rapidly distributed Naloxone during the pandemic. Is that a solution that could immediately help with overdose deaths?
LaBelle: Yeah, getting Naloxone in the hands of at-risk people is very important. And as I said, when we were here when I was here in the office last time, one of our first steps was to get it in the hands of first responders. And we did that because of overdoses. It was primarily in rural areas, and first responders were the first on the scene. And that is often the case, but not always the case. So we need to make sure that Naloxone is readily distributed. Laws have changed around the country to make sure that people can be co-prescribed Naloxone if they're on high doses of opioids — that it's available, readily available, without a prescription in a community pharmacy. Drug free community Coalitions often work with local groups to make sure it's distributed to at-risk groups. So yes, that's another issue that we have to take on.
OVR: West Virginia was granted federal funding for efforts to combat the opioid crisis and is running deviated bus routes to take people to and from treatment. How will the office address some of the biggest barriers to treatment that have been made worse by the pandemic?
LaBelle: So a really great thing that happened last year, at the beginning of the pandemic was that ONDCP, HHS (U.S. Department of Health and Human Services), DEA (Drug Enforcement Administration) looked at some of the biggest barriers, regulatory barriers, to access to treatment. And those were revised during the public health emergency around the opioid response. Many of those revisions have allowed people access to treatment during this pandemic during times of social distancing. And so, we'll be looking at which of those, with the interagency, which of those changes should be made permanent. So that we can make sure that, what you're talking about, you know, that it's difficult to get transportation to treatment, much of that will be eliminated. Now, I also failed to mention the importance of telehealth. And that is obviously really important in rural areas as well, to get people access to treatment. I've spoken with physicians, addiction treatment providers in Tennessee who said that the ability to do telehealth has been kind of a game changer for their ability to connect with their patients. And it's really helped to retain people in treatment during this very uncertain time.
OVR: Will the temporary telehealth policy become permanent so doctors can continue addiction treatment in that way?
LaBelle: So I think that's definitely something to look at. One of our preliminary questions is, is it a regulatory change? Do you have to go through the rulemaking process? Is it an administrative change, or does it take legislation? So those are some of the fundamental questions we have to answer initially. However, I know that as of the last congressional session, I'm not sure if it was reintroduced. Senator [Rob] Portman from Ohio had legislation that was introduced that would make some of those telehealth provisions permanent. So, we'll make sure to stay on top of that in this new congressional year.
OVR: Just so I’m clear, what can the Office of National Drug Control Policy do when it comes to looking at those temporary changes?
LaBelle: The intent of the office is to develop policy, and then to make sure through its statutory authority, that the budget of all of our drug control agencies follow those policies so that they are adequate to support the policy, the strategy that's in place. Now, we will have a statement of drug policy priorities we have to send to the Hill in the spring. Our strategy is not due till next year, but we will have to work with federal agencies to make sure that their funding lines up with the drug control strategy that we develop.
OVR: Addressing racial inequity associated with current drug policies is one of the office’s top priorities. What does an equitable policy look like? And what policy changes can be expected?
LaBelle: So I want to clarify that these are the first 100 day priorities that were developed over the course of the transition. And in keeping with the Biden-Harris administration's approach to everything that we do has to have an equity lens. So what that looks like is making sure that we have culturally competent treatment: We have culturally competent prevention, that we recognize that how we treat someone, a person of color, in one part of the country may not be the same as that type of treatment or other services the person needs in another part of the country. So it's really developing and expanding culturally competent programs.
OVR: I don’t know if this would be something your office looks at, but would that include looking at and reducing jail sentences for people who are arrested with drugs?
LaBelle: In writing the drug strategy, we'll be looking at how we can look at diversion programs — Diversion programs to help people get treatment. You shouldn't have to only get treatment because you got arrested and ended up in jail. How can we divert people away from incarceration? And also when they're incarcerated, how do we make sure that they get the type of treatment that they need so that their condition isn't something [that] is just held in abeyance while they're incarcerated, and then, they tend to overdose when they leave because they're not getting the type of treatment they need? So certainly, the criminal justice aspect of this will be something that we'll be working on with our interagency partners.
This interview has been edited for length and clarity. The order of some questions has been changed to highlight issues of greatest relevance for the region.