By Benjamin Chambers, January 22 2010
The Obama Administration's new drug control strategy will be officially unveiled in February. Until then, here's two peeks at what lies ahead on the demand reduction side of the policy:
1. The Office of National Drug Control Policy (ONDCP) has begun publishing a newsletter, called the ONDCP Update. (In addition to our link here, you can also find it on the ONDCP Web site at in "What’s New" and in "Publications".) You can find two articles on the strategy there -- one is a brief overview, and the other signals that there will be a new emphasis on recovery as well as prevention, intervention, and treatment.
2. NIATx's ACTION Campaign II sponsored a fantastic webinar with Thomas McLellan, the deputy director of the ONDCP. His official topic was the impact of health care reform on addiction treatment, but he also touched on parity regulations and of course the new national drug control strategy.
I recommend that anyone even peripherally interested in addiction treatment follow the link and check it out -- but especially if you're responsible for running a treatment agency or managing a treatment system. (I had some trouble getting the PowerPoint slides to work properly, but there aren't too many, and Mr. McLellan is quite thorough in his audio presentation.)
I'm not going to try to recreate his presentation here, but I'll touch on a few things that caught my eye and ear. First, here's the five priorities of the demand reduction part of the strategy:
- A National Prevention System
- Engage Primary Care
- Close Treatment Gap
- Specialty Care for Offenders
- Improved Data Systems
An intriguing list, no? McLellan didn't have time to cover all of them, so he concentrated on the middle three. Some of what he did say:
- Addiction treatment should be integrated into primary care. According to federal data, only one out of 10 people who need treatment for dependence on drugs or alcohol are getting it. ONDCP wants to serve many more people, without affecting the current system of "specialty" care -- i.e., funding for existing treatment providers. To do that, it's going to start using the system of Federally Qualified Health Centers (FQHC) and the Indian Health Service to begin getting many more people screened and given brief interventions for drug and alcohol problems.
Also, he pointed out that most medical conditions are not curable; they can only be managed -- just like addiction under the disease model. These other medical conditions are treated initially by primary care physicians, referred out for specialty care, and then referred back to primary care for ongoing management. McLellan asked, why not handle addiction care this way?
- Health reform legislation and parity will mean more funding for addiction treatment. Parity regulations, of course -- which are due out in the next few days -- will require more funding from insurance companies for addiction treatment. Health reform legislation (if passed) would completely change funding for addiction, opening up large amounts of Medicaid funding for it. McLellan said that federal figures indicated that only about 1/3 of addiction treatment agencies knew how to bill for Medicaid (or wanted to); he strongly encourages all agencies to get up to speed on this.
- Treatment agencies should partner with primary care physicians. In the question section of the presentation, McLellan gave an example of how this would work.
- Physicians can currently bill for Screening, Brief Intervention and Referral to Treatment, and they have many patients who have alcohol and drug issues (and the health problems that go with them). But they often lack the staff and expertise to take advantage of it.
- A treatment provider with trained staff can approach a physicians' office (he recommended one with at least four staff) with an offer like this:
"I'll place my trained therapist in your office twice a week for free to do the screening and brief intervention. You can bill for those encounters and get the money. In exchange, however, I'd like to have the referrals for any patients who have more severe alcohol and drug treatment needs."
- McLellan reported that a treatment agency that had taken that advice did very well with it, treating more people, billing more hours, and making more money.
- There will be an Office of Recovery. It wasn't clear to me what it will do, but the focus will be on changing the public perception of addiction recovery, and the need for long-term support as well as acute care.
Hold onto your hats, people. This could be really interesting.
Updated: February 08 2018