Pubdate: Sun, 25 Oct 2015
Source: Washington Post (DC)
Copyright: 2015 The Washington Post Company
Author: Patrick J. Kennedy
Note: The writer, a Democrat, represented Rhode Island's 9th 
Congressional District in the House from 1995 to 2011, and is 
co-founder of the Kennedy Forum on mental health and addiction and 
co-author of the new book "A Common Struggle: A Personal Journey 
Through the Past and Future of Mental Illness and Addiction."


Last week, President Obama announced a multipronged effort to address 
the epidemic of addiction to prescription opiate painkillers in this 
country. This is long overdue and, unfortunately, like most action on 
addiction and mental illness, comes after the problem has reached 
Stage 4 - and is that much harder to treat - when it could have been 
diagnosed and treated at Stage 1, or perhaps even prevented altogether.

I bring a unique perspective to this issue, one I would prefer I did 
not have. For 10 years, I sat on the House Appropriations Committee, 
overseeing every federal agency charged with addressing this subject. 
And during much of that time, I was addicted to prescription opiate 
painkillers myself.

I would keep them in an aspirin bottle in my jacket so nobody would 
think it was strange when I popped one during an appropriations hearing.

I was one of those people you read about.

I started taking OxyContin for back pain and then started seeking it 
for other, psychic pain. And when the original prescribing doctor 
wouldn't give me more - after I explained that I lost my pills in my 
luggage, down the sink, the dog ate them, whatever - I could always 
find another who would write a prescription. You don't have to be a 
congressman or a Kennedy to do this. All drug-seeking behavior is 
pretty much the same, as is society's response to it: Mostly we 
ignore it, and when we decide to do something, our approach is 
usually limited and focused on impeding supply and shaming users 
rather than treating substance-use disorders and other mental 
illnesses as medical problems.

Now that I have been sober and well for more than four years, I can 
see the cycles of my illness.

There were too many times when I went away to be medically detoxed 
from opiates but refused to look at the bigger picture: that if I 
wasn't treated for my underlying mental illness as well as my 
addiction, and if I wasn't treated as if both conditions were chronic 
illnesses instead of passing emergencies, I would never be truly 
healthy and sober.

My worry about what Obama has proposed - and about what his and 
previous administrations have done to try to address prescription 
opiate addiction - is that it focuses primarily on restricting and 
regulating supply and on medical detoxification. In reality, we need 
to face opiate addiction as part of a wider revolution in the way 
that we diagnose, treat and insure against mental illness and 
addiction. When patients are flagged for gaming the system while 
seeking Oxys, as I was many times, we need to view their situation as 
a cry for fully integrated medical care, not just a case for opiate detox.

On paper, the president has presided over the greatest expansion of 
mental-health and substance-use-disorder benefits in American 
history. My father, Sen. Ted Kennedy (D-Mass.), and I were proud to 
have been part of that effort, first with the Mental Health Parity 
and Addiction Equity Act of 2008 - which made it illegal to 
discriminate in care and coverage for diseases of the brain - and 
then the Affordable Care Act, which built upon and codified those 
parity protections. But the Obama administration has still not put in 
place many of the enforcement mechanisms necessary to make these 
measures a reality in our day-today medical lives.

And the public-health epidemic of prescription opiate addiction 
brings this failure into sharp focus.

We will not be able to address this new and troubling addiction issue 
until we embrace the idea that all addiction care, and all mental 
health care, needs to be delivered in a radically different, holistic 
way - fully integrated into the rest of our medical care, and no 
longer viewed, as it has too often, as palliative care for moral 
failings or "demons."

I applaud the president and the stakeholders he brought together last 
week to announce new training for medical professionals in opiate 
prescribing, public-service announcements on the subject and a 
broadening of the certification of physicians who can offer 
"medication-assisted treatment" for addictions - drugs that help 
block cravings or the actions of opiates - so that more patients can 
get and stay in recovery.

But I urge the White House to think bigger. Prescription opiate 
addiction is not an isolated problem, and it shouldn't be dealt with 
in a line-item way: It reflects our larger failure to integrate 
addiction and mental illness care into our general medical care. The 
pills don't cause this problem, they exploit a vulnerability in our 
medical safety net.

This vulnerability can be addressed only if this administration - and 
the next one - commit fully to enforcing the protections of the 
Mental Health Parity and Addiction Equity Act and the Affordable Care 
Act. These protections require full disclosure by all medical 
insurers of how they make medical-management decisions on approving, 
refusing or prematurely shortening care for addiction and mental 
health. We need to be able to determine, once and for all, if the 
same criteria are being used for brain-disease care as for treatments 
of disorders of any other organ.

Medical insurers - including the nation's biggest insurer, the 
federal government through the Centers for Medicare and Medicaid 
Services - are not fulfilling their responsibilities under these 
laws. We have to hold them accountable, just as we have to hold 
doctors and pharmacists accountable for the way they prescribe and 
dispense medications; hold pharmaceutical companies accountable for 
the way they promote medicines; and hold patients accountable for 
misusing their medications.

I call on our president, and everyone who wants to be president, to 
offer bolder, more comprehensive plans to revolutionize our treatment 
of addiction and mental illness.

There can be no health without mental health.
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MAP posted-by: Jay Bergstrom