Michael Botticelli served as President Obama's director of National Drug Control Policy, and pushed Congress to pass a funding measure last year making more money available for the treatment of opioid addiction.
Now he's concerned that the proposed Republican health plan will reduce access to health services for people with addiction.
"We know that people with addiction, and particularly in the opioid epidemic, need access to high quality health care in general," Botticelli told NPR.
"We know that many people who are injecting drugs have viral hepatitis. We've seen outbreaks in parts of the country with people with HIV. ... People need access to high-quality, comprehensive health care if they're really going to deal with these issues."
Botticelli discussed access to addiction treatment with NPR's Robert Siegel, including how the proposed Republican health plan differs from the approach taken by the Obama administration and the broad societal effects of widespread opioid abuse. The interview has been edited for length and clarity.
Interview Highlights
On historically sparse coverage of addiction treatment
We knew going into the Obama administration that, historically, only a small percentage of people were able to access [addiction] care in the United States, about 10 percent, largely based on their inability to pay, not having insurance coverage, or having insurance coverage that didn't cover addiction treatment services. So a large part not only of the Affordable Care Act but of our work with Congress was to pass the President's budget proposal to give states and local [governments] additional resources for this.
On the societal cost of addiction
I would say we all pay the price for untreated addiction. Certainly we know that it raises health care costs. We know that untreated addiction actually has other costs to it, associated with crime and prison costs, that drive up our taxes. We have seen what historically has been a bipartisan effort to really use addiction treatment to make sure that we're not filling our jails and prisons with people. So we're all paying the cost for this.
Given the magnitude of this issue, I've been hard-pressed to find a family that hasn't been impacted by addiction and particularly the opioid epidemic.
On Congressional support for addiction treatment funding
We had a tremendous amount of bipartisan support. Every member of Congress understands the impact that addiction, and particularly the opioid epidemic, has been having on their communities. Then-candidate Trump certainly heard this on the campaign trail, and quite honestly promised access to treatment as one of the prime strategies. So it's... perplexing to me that members of Congress who support this [proposed health care] bill know the devastating effect that not having, and ratcheting back, addiction coverage is going to have, particularly for people in their districts.
On the potential effects of decreased access to addiction treatment
I think it's not hyperbolic to forecast that we're going to see dramatic increases in mortality associated with drug overdose deaths [if the proposed bill goes into effect.] I think we're likely to see a significant impact on our emergency departments. Certainly we know crime rates go up with people with untreated addiction. ... We know that untreated addiction has a nexus to homelessness. So the implications for this are profound, not only in terms of the mortality that we see with drug overdoses, but in health and human services and public safety systems.
On controlling the drug supply in the U.S.
Our approach to drug policy under the Obama administration really tried to strike this balance between supply and demand. In my interactions with the Mexican government, I made very clear that the United States has an obligation to reduce the demand for drugs, which we know will continue to prompt supply, but that the Mexican government had a responsibility as well to help us in this battle by reducing the supply, particularly of heroin and fentanyl that we see.
I have a lot of concerns in terms of the rhetoric that we hear now. Are we going to see the same of cooperation from the Mexican government to meet their obligations in this battle?
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