Michael Botticelli, Director of the Office of National Drug Control Policy

322 - MONDAY, MARCH 14, 2016 Michael Botticelli

(Music)

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, spring is around the corner , the time of the year
when the cherry blossoms bloom in Washingto n and we make our annual tr ek
there to the National Association of Community Health Centers .

Margaret Flinter: Our annual spring time sojourn and when we look forward very
much to do some important work, improving the health and well - being of entire
comm unities and really get ting a chance to learn from best practices all around
the country and share with other people in this important movement.

Mark Masselli: We are dealing with many complex issues underlying poor
health. Community Health Centers acros s the country have increasingly become
centers for community support for a variety of social determinants that directly
impact health. And our care delivery model which embeds behavior al and dental
care within the primary care setting is one that’s being replicated outside of the
Community Health Center world.

Margaret Flinter: Well as we all know Mark, when you facilitate both the provider
care teams’ ability and the patients’ ability to meet all of their health needs in one
setting, we see better outco mes and there is plenty of evidence for that , a nd part
of that integration is about behavioral health and substance abuse and medicine
a l together . Certainly one concerning aspect that we deal with now in health care
is the rising tide of drug addiction an d that is something that our guest today
knows quite a bit about.

Mark Masselli: Michael Botticelli is the Director of the Office of National Drug
Control Policy at the White House . He is overseeing the President’s campaign to
battle the opioid epidemic in this country , now the leading cause of accidental
deaths in America.

Margaret Flinter: Very important, and looking forward to hear ing what the
nation’s Drug Czar , though I understand he doesn’t like that title Mark, but what
the nation’s Drug Czar ha s in the way of solutions which is very complicated
issue.

Mark Masselli: You know, it's also interesting to note that the normally
contentious United States Senate put aside their differences on this issue and
pass ed by 94 to 1, Margaret , the President’ s Comprehensive Addiction and
Recovery Act.

322 - MONDAY, MARCH 14, 2016 Michael Botticelli

Margaret Flinter: Great to see this show , even if it ‘s rare of bipartisanship . I think
it does speak to just how important the issue is to everybody .

Mark Masselli: Lori Robertson also checks in , the M a nagin g Editor of
FactCheck.org. She is always on the hunt for misstatements spoken about
health policy in the public domain .

Margaret Flinter: And no matter what the topic, you can hear all of our shows by
going to www .chcradio.com .
Mark Masselli : And as always , if you have comments, please e - mail us at
[email protected]
, or find us on Facebook or Twitter . We love hear ing from
you.
Margaret Flinter: We will get to our inte rview with Michael Botticelli in just a
moment.
Mark Masselli: But first, here is our producer Marianne O’Hare with this week’s
Headline News.
(Music) Marianne O’Hare: I am Marianne O’Hare with these Health Care Headlines. The
senate has overwhelming ly passed their version of the President’s opioid abuse
b ill. The bipartisan Comprehensive Addiction and Recovery Act ear marks
hundreds of millions of dollars to combat the nation’s opioid addiction crisis on a
number of fronts. There were almost 50,000 deaths from opioid overdoses in
2014 alone. It's now the leading cause of accidental death in America.
Speaking of addiction, CVS is amping up its anti - smoking campaign . The
national pharmacy chain suspended all sales of cigarettes in 2014 and ha s
earma rked another $50 million to promote smoking cessation partnerships via
their thousands of pharmaci es across the country. W hile the nation’s smoking
rate is down to about 15% , there is still an estimated 450,000 smoking - related
deaths each year.
A young w oman who had been the first American woman to receive a uterus
transplant has suffered organ failure only a few weeks after the surgery . The
surgery had been pronounced a success at the Cleveland Clinic where it took
place. It's still very much in the ex perimental stage although one woman in
Sweden gave birth after receiving a successful uterus transplant last year.
People taking Metformin , a common Type 2 diabetes medication for several
years , may be at h eightened risk for Vitamin B 12 deficiency and ane mia , that
according to a new analysis from long - term data. Metformin helps control the
amount of sugar or glucose in the blood by reducing how much glucose is

322 - MONDAY, MARCH 14, 2016 Michael Botticelli

absorb ed from food and produce d by the liver, and by increasing the body’s
response to the hormo ne insulin. Vitamin B12 deficiency may lead to nerve
damage which can be severe and irreversible.

And want to avoid heart disease and early death, well leave the office and
embrace some me time. Recently release d study shows those who worked 75
hours pe r week or more , double d their risk for a ngina, stroke, hypertension and
heart attack, and increasingly , in this connected world , i t’ s more impossible to
leave the office behind than ever before.

I am Marianne O’Hare with these Health Care Headlines .

(Mus ic)

Mark Masselli: W e are speaking today with Michael Botticelli, Director of the
Office of National Drug Control Policy at the White House where he is
coordinating the administration ’ s effort to combat the rising opioid abuse crisis.
He joined ONDCP as deputy director in 2012. Mr. Botticelli previously served as
the Director of the Bureau of Substance Abuse Services at the Massachusetts
Department of Public Health , as well as in leadership roles at the National
Association of State Alcohol and Substanc e Abuse Directors. He earned his B.A.
from Siena College and his Masters in Education from St. Lawrence University .
Michael , welcome to Conversations on Health Care .

Michael Botticelli : Great . It's good to be here .

Mark Masselli: Hey, you have got s ome great news out of the Senate. The word
bipartisan is surprising to come out of the senate. They just passed the
Comprehensive Addiction and Recovery Act . Anything you can tell the public on
what’s exciting about this that got great bipartisan suppor t in the senate ?

Michael Botticelli : Well, the issue of opioid addiction has gotten a tremendous
amount of attention in Congress as well as a tremendous amount of bipartisan
support . We have worked very effectively with Congress as it relates to this an d
we are really happy to see they brought bipartisan support of CARA . The bill
contains many of the components that we have been working on at the White
House , but I will say that we also acknowledge the fact that we need funding and
funding as soon as po ssible to deal with this epidemic. So the President has
proposed $1.1 billion in treatment funding in his FY17 budget and we look
forward to working with Congress in terms of more action, but specifically how we
can make sure that our states and locals ar e getting the resources they need to
deal with this epidemic.

Margaret Flinter: Well Michael, opioid addiction has exploded across the
demographic and economic and geographic wise . Hard to almost even say that
drug overdose is now the leading cause of a ccident al death in this country,

322 - MONDAY, MARCH 14, 2016 Michael Botticelli

47,000 overdoses reported in 2014, and I am pretty sure the number in 2015 will
be higher. So the President appointed you as the nation’s Drug Czar last year
and really gave you charge to confront the crisis on multiple fr onts . Maybe for
our listeners , how in your eyes have we got ten to this point and what are the big
barriers to moving forward?

Michael Botticelli : This has been such a personal issue for all communities and
all people across United States . I am amazed w hen I talk to people how they
have personally known someone who ’ s overdose d , who ha s gotten addicted,
who have gotten a prescription for these pain medications when they haven't
wanted them. You ask me how did we get here, and we know that one of the
main drivers is th e over - prescribing a prescription pain medication in the United
States . I think it was a well - intended effort to try to appropriately deal with pain in
the United States but the pendulum has swung so far in the other direction that
we are pr escribing -- this w as a 2012 study that show ed that we are prescribing
enough pain medication to give every adult American 75 pain pills, and these are
often given by well - intended prescribers who have little to no training on
addiction, little to no train ing on safe and effective opioid prescribing. And you
can look back to the beginning of this and watch the direct correlation between
the volume of opioid medications we ’ re prescribing and the number of overdose
death . These medications are often mismark eted by the pharmaceutical
companies and portra yed as safe and effective and that got communicated to
many patients a nd we are paying the prize for that . We have seen just a
dramatic escalation of addiction and overdoses as well as things like neonatal
ab stinence syndrome , viral hepatitis that have been tracked to the opioid
epidemic.

Mark Masselli: Y ou know , we salute Former First Lady Nancy Reagan who
kicked off a campaign of Just Say No, and it really did reflect the feeling of the
country at that tim e that this is a matter of choice. And then it seemed to be
followed by the stick approach , even small amounts of drug possession ,
enormous overflowing of our prison systems. Can you help us get an
understanding of why Just Say No as well as the punitive criminal approach in
the w ar on drugs has failed and where are we now?

Michael Botticelli : You know , I do think that Former First Lady deserves a
tremendous amount of credit , calling attention to the fact that prevention and
particularly prevention for youth was a priority . But we have now just a much
larger toolbox in terms of knowing what is effective in evidence - based prevention
and effective treatment . Our job at ONDCP is to make sure that we are
implementing those kinds of programs through our fed eral grant processes and
we have over - relied on those punitive approaches that I think we have learned
that those approaches do relatively little in terms of reducing crime, reducing
recidivism if we are not dealing with the root cause of why people became
incarcerated and that was a result of their addiction. I think we also need to be
open and candid that that kind of approach ha s ha d a disproportionate impact o n

322 - MONDAY, MARCH 14, 2016 Michael Botticelli

communities of color. So we understand that drug policy reform is also about
reforming our criminal justice system, and I hear that echoed back to me by local
law enforcement who clearly understand that we can ’t arrest and incarcerate our
way out of this problem.

We have see n law enforcement step to the table in very dramatic ways in terms
of r educing overdoses. Law enforcement has a key role to play in keeping our
communit ies safe from drug trafficking organizations and from crime . Arrest and
incarceration do little to reduce drug use and crime in our communities, and we
have just seen tremen dous progress, and again, tremendous consensus , no
matter what your political stripe is that that should be our approach to drug policy.
So it's I think really heartening to see that we can continue to focus on making
sure that we are reserving our law en forcement and punitive responses for those
people who do need to be in jail, but we are looking at opportunities to divert
people away from the criminal justice system, get them the care and treatment
that they need. When you look at the people who do get t o treatment , very often
it ’s as a result of their involvement with the criminal justice system. I think it's
unfortunate that we have let people get to the point where it's an involvement
with the criminal justice system that finally get s them into care o r treatment .

Margaret Flinter : I want to try and go upstream couple of steps as I know
everyone does around prevention , and you talked about the overprescribing of
opioids for pain management . We ha d CDC Director Tom Frieden on this show
no t long ago who said providers play a very dangerous game with these highly
addictive drugs because you don’t know which of your patients will become
addicted very quickly. But I wonder if you could talk to us about the approach
that you are taking that help reduce t he reliance in the medical community on
opioid prescriptions for pain management, and also is there a corollary to
approaches that you are taking with the pharmaceutical industry?

Michael Botticelli: You know, I think when you look at our drug policy, it stresses
a number of different initiatives that we think are important. One, we talked about
the importance of primary prevention. The good news is that actually the vast
majority of kids in this country don’t use drugs or alcohol or tobacco so we want
to focus on primary prevention. But we also want to focus on things like
screening and brief intervention in primary care settings. You know, I often use
my own story as an example. I was a kid who came from a home like many
homes that had addiction in it. I started drinking from a very young age and it
became problematic over the course of my youth and young adulthood . You
know , I don’t recall ever being screened or having an early intervention by
anyone in the medical community. So we have been call ing for things like
universal screening and early identification intervention before these problems
become very acute . But t o the o p i oid issue specifically , and I am sure Dr.
Frieden talked about this that the CDC will soon be releasing what we think are
very reason able prescribe r guidelines to really prevent the misuse of these
medications to really diminish the over - prescribing of these drugs.

322 - MONDAY, MARCH 14, 2016 Michael Botticelli

You know , the other piece that we have been focusing on is drug disposal
programs . We know that about 70% of p eople who start misusing prescription
pain medications are getting them free from friends and family and they are often
diverted from people’s medicine cabinet s . So we have been working with the
drug enforcement administration to support drug disposal pro grams , to allow
people to empty their medicine cabinets of these highly addictive medications.
And then the other area that we are focusing on is the use of prescription drug
monitoring programs . You know , these are state - run databases th at give
prescrib ers information on someone’s prescribing history to really minimize the
chances that people are going from multiple doctors and multiple pharmacies to
get their prescriptions . So we are really trying for a wide variety of efforts to do a
better job at pre venting drug use from happening in the first place but also really
looking at preventing the misuse and addiction associated with these
medications.

Mark Masselli: We are speaking today with Michael Botticelli, Director of the
Office of National Drug Con trol Policy at the White House where he is
coordinating the administration’s effort to combat the rising opioid abuse crisis.
You know , you oversee a $26 billion agency and you have got a number of
arrows in your quiver and law enforcement still plays an important role , and just
an incredible flow of heroine coming into this country and maybe you could tell
our listeners what’s being done to interrupt the flow and how’s law enforcement
pie ce of the puzzle being directed?

Michael Botticelli: You know , one of the risk factors that go into why someone
uses drugs is availability and price and we have seen tremendous amount of
success in other areas , particularly tobacco use and alcohol use where we have
looked at price and availability as t w o good public heal th strategies . One of the
reasons why people have been transitioning from prescription drugs to heroine
has been the availability and price and purity of heroine in many of our streets .
So stopping the supply of drugs that are coming into the United Stat es , working
with domestic law enforcement and reducing the availability of these drugs is
really important , but what we have also been calling is building partnerships
between public health and public safety .

Even our public safety folks know that reducin g the supply and availability is only
one part of the problem. Our strategy is all about that balance between supply
and demand , and with the President’s FY17 budget it marks the first time in the
history of our office where we actually have balanced fund ing between supply
and demand . So one of the programs that our office funds is called the High
Intensity Drug Trafficking Area , funds that are given out at the county level to
reduce the flow of trafficking and criminal organizations that move in these dr ugs .
But I am also happy to say that they work hand - in - hand with public health and
they understand that we need this kind of comprehensive and 360 degree

322 - MONDAY, MARCH 14, 2016 Michael Botticelli

approach to this if we are really going to make significant inroads into drug use in
the United State s.

Margaret Flinter: Well Michael , there is sort of always the big issue about
treatment , right , and capacity and availability, but there are patients who really
need that, they need an inpatient or residential treatment , and mostly we hear
about cuts , r eductions, over - demand . What’s your take on that and what’s being
done to increase the capacity to provide the kind of intensive residential
treatment for people who really need that in order to make prog ress in
overcoming their addiction?

Michael Bottic elli: We have largely treated addiction just kind of in the acute
phases and very episodically and we haven’t kind of implement ed a paradigm of
addiction treatment according to chronic disease . First and foremost is the
Affordable Care Act . We know one of the main reasons why people don’t get
treatment is because they can’t afford it or because of insurance , and the
Affordable Care Act makes substance use disorder treatment one of the 10
essential health benefits. The other one is implementing the Affor dable Care Act
with parity with other health conditions. So we know that there ha ve been
historic in equities in insurance reimbursement in not treating addiction the same
way we do with other medical conditions. So implementing parity becomes very
import ant to make sure that insurers are offering these benefits . But even with all
those advance s we know that there are many, many people who still can ’t get
treatment or can’t get specific access to a whole continuum of care and that’s
why the President prop osed over a billion dollars to support , enhance treatment
efforts.

And the last area that I will talk about which is particularly important in an o p i oid
epidemic is we have three highly effective medications for the treatment of opioid
use disorders and w e know when you c ombine those with other behavioral and
recovery support that they do far better than treatment without these
medications. So we have spent a lot of time and effort and money ensuring that
people have access to those medications. Health a nd Human Services put out
$100 million to community heath centers to support incorporation of addiction
treatment and particularly medications into community health centers around the
country because we know that sometimes people don’t have access to a bri ck
and mortar treatment program but also have access to community health center.
We have been working to increase the number of physicians who have gotten
training to administer these medications. So we are really moving on a number
of f ronts to ensure t hat people have access to a whole continuum of evidence -
based care but particularly medication - assisted treatment.

Mark Masselli: We have been speaking today with Michael Botticelli , Director of
the Office of Drug Control Policy at the White House . You can learn more about
their work by going to www.whitehouse.gov./ondcp , or you can follow them on
Twitter at Botticelli44, and if you are dealing with an immediate crisis and need

322 - MONDAY, MARCH 14, 2016 Michael Botticelli

help please call 180066 for help. Michael , thank you so much for your leadership
and your work in this important area and for joining us o n Conversations o n
Health Care today.

Michael Botticelli: Great . It's good to be with you and thanks for the wor d.
Thank you.

(Music)

Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care reform and policy.
Lori Robertson is an award - winning journalist and managing editor of
FactCheck.org, a nonpartisan, no nprofit consumer advocate for voters that aim to
reduce the level of deception in US politics. Lori, what have you got for us this
week?

Lori Robertson: Well will look at two claims from a recent democratic presidential
debate on gun deaths and childhoo d poverty . First , Hillary Clinton said that on
average , 90 people a day are killed by gun violence in our country . It's a claim
she has made before and it requires some context. Annual gun death s do
average about 90 people a day but only a third of thos e are homicides. Most gun
deaths are suicides , a violent act but not a crime as some voters ma y think
Clinton ’s claim is right . According to the most recent figures from the Centers for
Disease Control and Prevention, 63% or 21,175 of the 33,636 firearm deaths in
2013 were suicides. Homicides totaled 11 , 208 , and the rest were unintentional
discharges , legal intervention or war, and undetermined.

Senator Bernie Sanders also repeated a claim that “We have the highest rate of
childhood poverty of almost an y major country on earth. ” His campaign
previously told us the senator was referring to a report from the Organization for
Economic Cooperation and Development . However , among the 38 countries
th
listed , the US ranked 7 highest in relative childhood pover ty. That’s behind
Turkey, Israel, Mexico, Greece , Romania and Bulgaria. And that’s my fact check
for this week. I'm Lori Robertson, managing editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's m ajor political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com . We will have FactCheck .org's Lori
Robertson check it out for you here on Conversations on Health Care.
(Music) Mark Masselli: Each week Conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives. No parent wants to hear th eir young child’s chronic health issues require complex and risky surgery ,

322 - MONDAY, MARCH 14, 2016 Michael Botticelli

but that was exactly the case for three - year - old Mia Gonzalez . Her doctors
discovered the cause was a severe aortic abnormality that would eventually kill
her without intervention. Dr. Redmond Burke , Head of the Pediatric
Cardiovascular Surgery at Nicklaus Children ’s Hospital in Miami would once
have deemed her condition inoperable. So we chose a new tactic, create d a 3 - D
printed model of her actual heart to offer surgeons a chanc e to map out an
approach to the complex surgery.

Dr. Redmond Burke : This was printed out because she was thought to be
inoperable, and by having this type of model we were able to conceive of an
operation that hadn’t been done before , connecting the smal l veins from her
lungs up to her heart.

Mark Masselli: Dr. Burke said he carried the heart around with him for weeks
analyzing the problem from every conceivable angle.

Dr. Redmond Burke : Her operation was extremely successful and she is
recovering ver y well in the hospital now and is just about ready to go home , and
now her life instead of being measured in terms of days and weeks is going to be
measured in terms of years and decades.

Mark Masselli: Dr. Burke said that prior to 3 - D printing technolog y like this , they
would have deemed her case to o risky to chance . While scientist s say creating
stem cell generated 3 - D printed organs for implementation is still years away , this
method of deploying 3 - D t echnology could help surgeons everywhere create
wo rkable solutions to complex surgical problems. A 3 - D printed model of a
patient ’ s organ , offering surgeons a visual tool to help tackle complex surgical
dilemmas , leading to better surgical outcomes , now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Health Care. I a m Margaret Flinter.

Mark Masselli: And I'm Mark Masselli, peace and h ealth.

Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org and brought to you by
the Community Health Center.