A Frank Exchange of Views on America’s Addiction Crisis

[Published 2018]

Last week at the National Rx Drug Abuse & Heroin Summit, where Dr. Robert DuPont and I gave a presentation on Long-Term Recovery: The Essential Roles of Families and Addiction Treatment Provider, it was clear that all segments of the addiction medicine sector – treatment providers, payers, government agencies and non-governmental agencies – are trying to come together to solve the addiction crisis we face in this country. This sentiment was confirmed at an informal roundtable dinner that Dr. DuPont and I hosted while in Atlanta, bringing together many of the top thought leaders on this topic for a frank exchange on the successes we’ve seen and concerns we have going forward. It was a terrific experience, discussing topics such as standards of care and goals of addiction treatment, prevention, reimbursement and sector infrastructure. The conversation was encouraging.

This dinner brought together people from all sides of the sector. What was apparent is that it’s not just families that are engaged in an active crisis situation, but also providers, payers, researchers and policymakers. We came away with a consensus that it’s important for us to continue with our dialog, but we also need to put our thoughts into action. Among the concerns voiced were that Congress is eventually going to ask how the money provided to the address the opioid addiction crisis has been used to save lives. It’s a legitimate question; one we must be able to answer. If research doesn’t change the way we treat addiction, if we don’t connect our actions to outcomes, and if we don’t have the people or infrastructure in place to deliver the services, we will miss our opportunity to help those who need it most. In addition, we discussed the issue of whether or not there will ever be a long-term funding commitment to do what needs to be done to fight the overarching addiction crisis beyond the opioid crisis.

A topic we all agreed upon is the need for addiction treatment standards of care. The AMA, Shatterproof, CIGNA, Blue Cross Blue Shield Association and Caron are all approaching the improvement and implementation of addiction treatment standards from our own sector perspectives. We need to advance these standards and move to put projects into action.

So, when are we in addiction medicine going to come up with a comprehensive approach? There are many different initiatives to establish standards, to promulgate evidence-based addiction treatment, to improve the way we pay for addiction treatment. That’s great. Yet these efforts are often disconnected from others working on the same solutions. This dinner was an informal way and part of Caron’s efforts to start the process of coordinating our efforts.

What’s striking was the broader dialog at the Rx Summit and the willingness to explore the questions:

I’m curious to see how we will continue, not just the dialogue – which is a good thing - but also our ability to enact real and lasting change.

Lives are on the line. We all know it. There’s an urgency in our conversations, and yet, at the same time, there is also a lag, and sometimes a hesitation, to take action.

We all acknowledge that our country’s current approach to addressing the disease of addiction needs to change – stigma continues to be a barrier, we aren’t patient-focused, we aren’t focused on outcomes and we aren’t paying for treatment in the right ways – yet we hesitate to help each other in ways that will improve the lives of countless people affected by addiction.

Thank you to all those who joined Dr. DuPont and me for dinner. I enjoyed the conversation thoroughly. Hopefully, what we shared will help the sector attack these issues together and offered new perspectives for the bigger picture.