Former U.S. drug czar talks substance abuse, treatment

Retired Gen. Barry McCaffrey says far too few chronic drug addicts receive science-based treatment in the U.S. on Thursday, May 29, 2014. Victoria Pelham/The Desert Sun

By Victoria Pelham, The Desert Sun
12:29 a.m. PDT May 30, 2014

LA QUINTA – The nation has come a long way in dealing with substance abuse problems, but a widespread treatment gap and skyrocketing heroin and opiate rates are holding the country back, the former U.S. drug czar said Thursday at the La Quinta Resort and Club before addressing the West Coast Symposium on Addictive Disorders.

The legalization of marijuana for both recreational and medicinal purposes is also creating a prevention and education challenge, said Gen. Barry McCaffrey, a retired four-star general who led the U.S. Office of National Drug Control Policy.

McCaffrey, along with other addiction treatment professionals, called for greater access to care, pointing to benefits of a parity law that, coupled with the Affordable Care Act, would require insurance companies to cover drug-abuse treatment at a level equal to physical health. But he also stressed that further challenges would remain in adapting to the transformation.

"The rate of chronic addiction has gone down dramatically since 1979… It's been by and large a pretty good story," he said. "Having said that, there's 22 million of us who have a chronic substance abuse problem and probably not much more than 3 million of us gained access to science-based treatment in a given year. That's the issue."

About 750 substance-abuse treatment professionals from 38 states will be attending the conference over the next three days, focusing on the changing world of drug and alcohol abuse treatment and the opportunities to improve.

Philip Herschman, chief clinical officer of CRC Health Group, said the challenge will be to fill the gap between people who need treatment and actually seek it.

"It's kind of a two-fold problem: The people that need treatment aren't getting it, and the people that even want treatment aren't able to access it for some reason," he said.

Health care reform will help that process by attracting more people in successful treatment and engaging more conversation about what success in a drug rehabilitation program could mean, he said.

"The issue is going to be how is it really going to be implemented and are the payers really going to like policies and reimburse with that parity," Herschman said.

The payer community might be skeptical at first, McCaffrey said, because, while recovery includes science-based, evidence-based, outcome-based treatment, some of the treatment models are almost an art form. This includes acupuncture and art therapy that are shown to keep patients in treatment in longer, increasing their chances of recovery.

"How do we make sure we get paid for this; otherwise we can't continue our services," the former drug czar said. "It's going to be a tough five to 10 years coming up in which we evolve."

Conference suggestions for adapting included a switch to more outpatient treatment forward, as well as more marketing, adapting to mainstream medicine methods, and the necessity of local data because addiction is a community-based disease. Roughly 20 to 40 percent of substance-abuse treatment facilities are not ready for health care reform, speakers noted.

Consolidation of treatment facilities — as seen last year in the merger of the Betty Ford Center and Hazelden into the Hazelden Betty Ford Foundation — is also seen as a viable step toward getting the right care to the right people and improving the delivery system.

This could help to tackle the increasing rates of heroin use.

Prescription drug abuse surged 500 percent in a short period of time in the last few years as cheap pills such as Oxycontin or Hydrocodone were prescribed sometimes by careless or unwitting doctors.

As public awareness increased of the problem tighter controls were placed on the substances causing less availability and price increases. Despite the drop — and significant improvement in rates of crack-cocaine and methamphetamine use, this has caused a recent shift to the use of heroin and other opiates, mostly imported from Mexico and Colombia into the U.S., drug experts said.

"We don't care what your drug of abuse is; what we care about is achieving a sober lifestyle in which you're not encountering legal, medical, social and work-related problems that devastate the stability of your life," McCaffrey said.

And some of that goes back to marijuana legalization, he said, like in Colorado. He pointed to adolescent drug-use rates that had gone down for 13 years in a row but have been rising for the last four.

"We've got a prevention, education challenge of turning around to eighth-graders through 10th-graders and saying, 'We don't want you binge drinking beer, using ecstasy or smoking pot and here's why: because you have an incredibly enhanced statistical probability of ending up as a chronic drug abuser," McCaffrey said. "We've got to have people speak up and say 'What are we doing? Do we want a stoned society?' "