WASHINGTON – Rahul Gupta is no stranger to a nationwide addiction crisis.
Substance abuse and overdose defined his tenure as the top health official in West Virginia, arguably the state hardest hit by the pandemic, and before that he was the state’s largest county health official.
But even Gupta, who is now the country’s top drug policy official, admits that the current drug crisis in the United States is unlike anything he’s seen before. More than 108,000 Americans Death from an overdose every year. The state medicine supply More lethal than ever. And despite the focus on opioids, cocaine and methamphetamine addiction rates are on the rise, too.
However, Gupta’s selection as director of the White House Office of National Drug Policy, ushered in a new era of federal drug policy. As the first physician to hold the position, he says he will adopt new strategies, including harm reduction tactics, that aim to reduce the risks of drug overdose, death and disease rather than a hardline stance and limited to abstinence.
However, addiction treatment is still so Stigma chases him, the lack of use of existing drugs, and the ongoing debate about some harm reduction techniques. The controversy came to a head last week in California, where Governor Gavin Newsom vetoed a bill to allow supervised injection sites — essentially clinics where people can use illegal drugs under medical supervision to prevent overdose.
Gupta met with STAT this week to discuss the ongoing crisis and the Biden administration’s efforts to address it. While he was cautious about Newsom’s decision, Gupta took several positions far more aggressive than any of his predecessors: calling doctors for their part in poor treatment outcomes; Assuming that addiction is medicine buprenorphine widely misunderstood; and advocating for emergency management, a new addiction intervention that offers rewards — often cash — in exchange for stopping drug use.
The following conversation has been edited for length and clarity.
Which public health crisis do you predict will lead to more deaths in the next five to 10 years – Covid-19, or drug addiction and overdose?
We have a dying American [of a drug overdose] Every five minutes around the clock, more than 300 per day. Obviously drug overdoses have been here before, and they will be here after, Covid-19. The expectation is that they will continue to rise unless we implement the president’s strategy.
Given that, why isn’t the public addressing a crisis that kills 100,000 Americans every year with greater urgency?
Well, this was such an urgent priority for the president, that he even talked about it in the State of the Union. He said we have to overcome the opioid crisis, and the first two items on his loneliness agenda were this and the mental health crisis. He sees the connection between the two. This management understands it.
One reason for this indifference is stigma. Right now, we use all kinds of terms that are derogatory to people. Clearly, our stigma prevents many people from seeking help and others to offer help. Both – in societies, but also in health care. The stigma in my profession is no less than what we see in societies and individuals.
methadone, a drug used to treat opioid addiction, is only available through opioid therapy programs or OTPs, and often requires patients to come in person each day to receive one dose. Should it be more widely available?
I’m interested, in fact, in setting up an interagency working group on methadone.
Here’s the bottom line: Less than 1 in 10 people who need treatment are able to get it, and the president’s strategy calls for universal access to treatment by 2025.
The way we will get there is by reducing stigma, expanding access to treatment, removing the barriers that are now in place – making sure the regulatory framework matches the need of the hour.
People also express concerns about diverting or misusing another addictive drug, buprenorphine, even though it is used to prevent drug cravings and treat withdrawal symptoms. Do you think there is a misunderstanding about what buprenorphine actually means?
So the answer is yes – I’ll give you a straight answer. But let me put that in context: I’ve actually talked to people who have used buprenorphine that people might say is “converted.” They often tell me that they want to get treatment. Either they were unable to find someone to treat them, or they were in line where they would get an appointment 30 days later than that time, at least.
When you suffer from addiction and substance use disorder, you don’t have 30 days to wait and stop using drugs. People seek treatment and take action on their own. It is emblematic of the need to expand access to buprenorphine, and ensure that more providers prescribe it; More pharmacies stock it; And more manufacturers are making sure that happens and that the supply chain continues; It is accessible and affordable.
The federal government has spent several billion dollars in the past year on Covid-19 vaccines and treatments. Why aren’t there similar nationwide efforts to purchase naloxone, the drug used to reverse opioid painkiller overdoses?
We have 108,000 people die annually from overdoses, and three-quarters of them are from opioids — which, by definition, means that these overdoses are reversible with naloxone. We know that every dollar invested in naloxone has an impact Approximately $2,800 in revenue.
We’re doing everything we can on the federal government’s side, and I’ve had great conversations with them [health secretary] Xavier Becerra on this matter. We are making sure that when countries receive funding from SAMHSA, they have plans to distribute and acquire naloxone, including plans for how to distribute to high-risk populations. This includes harm reduction programs and urgent care clinics.
We’re also looking at an over-the-counter approach.
We’ve talked a lot about how the medications used to treat opioid addiction are heavily used. But what does a good drug policy look like for substances that do not have an approved drug treatment, namely methamphetamine?
while we work with Nida To consider pharmaceutical therapies, we recognize that there are many good treatments available for stimulant-based disorders, such as emergency management and motivational interviewing.
For example, California just got an approved 1,115 exemption that allows $599 per year to be used for emergency management. [the practice of offering rewards, including money, in exchange for refraining from drug use]. It is an evidence-based, data-driven, proven treatment for people – in the absence of any other pharmaceutical option. We certainly encourage more states to consider these methods.
I’ve said many times that this administration has historically been open to minimizing damage. Were you disappointed that California Governor Gavin Newsom opposed legislation that would have allowed a few supervised injection facilities to open there on a trial basis?
First of all, this is the prerogative of the governor. We basically said that we are always looking to understand clinical efficacy and research emerging harm reduction practices. Obviously, having said that, we know that there is a lawsuit against the crack house in court already [concerning Safehouse, a proposed supervised injection site in Philadelphia] – So as far as the court is concerned, we try not to make any policy-related comments yet.
This article was supported by a grant from Bloomberg Philanthropies.