W.Ashington — Rahul Gupta is no stranger to the national addiction crisis.
Drug use and overdoses defined his tenure as West Virginia’s chief health official. This is probably the state most affected by the epidemic, and before that it was the state’s largest county health officer.
But even Gupta, now the chief drug policy officer in the United States, admits that the current U.S. drug crisis is unlike anything he’s ever seen. Over 108,000 Americans die from overdoses each year. The country’s drug supply is deadlier than ever. Rates of cocaine and methamphetamine addiction are also soaring, despite the focus on opioids.
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But Gupta’s election as director of the White House Office of National Drug Control Policy has ushered in a new era of federal drug policy. As the first doctor to hold this position, he says Harm will employ new strategies, including his reduction tactics. It aims to reduce the risk of overdose, death, and illness in drug users in lieu of a hard-line, abstinence-only attitude.
Still, addiction treatment is plagued by ongoing debates about stigma, the overuse of existing drugs, and certain harm-reduction techniques. The governor has vetoed a bill allowing supervised injection sites.
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Gupta was interviewed by STAT this week to discuss the ongoing crisis and the efforts of the Biden administration. took the position of He argues that the addiction drug buprenorphine is widely misunderstood. Contingency management is a novel addiction intervention that offers a reward (often cash) in exchange for stopping drug use.
The conversation below has been edited for length and clarity.
Which public health crisis is expected to kill more people in the next 5-10 years? Covid-19, or drug addiction and overdoses?
americans are dying [of a drug overdose] Over 300 times a day, every 5 minutes for 24 hours. Clearly, there have been drug overdoses before, and there will be beyond Covid-19. And they are expected to continue to rise unless they implement the president’s strategy.
Given that, why isn’t the public more urgently addressing the crisis that kills 100,000 Americans each year?
Well, this is an urgent priority for the President, and in his State of the Union address he spoke about it. He said we must beat the opioid crisis. The first two items in were this and the mental health crisis. He sees a link between the two. This administration understands that.
One reason for that indifference is stigma. Now we use all kinds of derogatory terms towards people. We clearly have a stigma that prevents so many people from asking for help and from others offering help. The stigma in my own profession is the same I see in communities and individuals.
Methadone, a drug used to treat opioid addiction, is only available through opioid treatment programs (OTPs) and often requires patients to come in daily to receive a single dose. Should it be made more widely accessible?
In fact, I’m interested in setting up an interagency working group on methadone.
Here’s the gist: Less than 1 of his 10 people in need of treatment can get it, and the president’s strategy calls for universal access by 2025.
The way we get there is by reducing stigma, expanding access to treatment, and removing barriers that currently exist. Make sure the regulatory framework is suitable for the needs of the time.
Buprenorphine is used to prevent cravings and treat withdrawal symptoms, but concerns have also been raised about the diversion and abuse of another addiction drug, buprenorphine. Think there’s a misunderstanding?
So the answer is yes — I’ll give you the straight answer. But let me contextualize it. I’ve actually talked to people who have used buprenorphine. They either couldn’t find someone to treat them, or waited in line to get an appointment at least 30 days later.
If you suffer from an addiction or substance use disorder, you don’t have to wait 30 days to quit. People seek treatment for themselves and take action. This symbolizes the need to expand access to buprenorphine and ensure that more providers are prescribing buprenorphine. More pharmacies stock it. And more manufacturers are confirming it’s happening, and the supply chain continues. It’s accessible and affordable.
The federal government has spent billions of dollars on Covid-19 vaccines and treatments over the past year. Why isn’t there a similar nationwide effort to purchase naloxone, a drug used to curb opioid overdoses?
108,000 people die each year from overdoses, three-quarters of which are from opioids. So by definition, these overdoses can be reversed by naloxone. For every $1 he invested in naloxone, he found a return of almost $2,800.
We are doing the best we can from the federal side. [health secretary] Xavier Becerra on this. Confirming that the state plans to distribute and acquire naloxone as it receives his SAMHSA funding. This includes planning on how to distribute to high-risk populations. This includes harm reduction programs and emergency care clinics.
We are also considering an in-store approach.
We’ve talked a lot about how the drugs used to treat opioid addiction are underutilized. What does drug policy look like?
While we are working with NIDA to explore pharmaceutical treatments, we recognize that there are many excellent treatments available for stimulant-based disorders, such as contingency management and motivational interviewing. I’m here.
For example, California has approved a 1115 exemption that allows $599 per year to be used for contingency management. [the practice of offering rewards, including money, in exchange for refraining from drug use]This is an evidence-based, data-based, proven treatment for people — when there are no other drug options. We will definitely see more states consider these approaches. We encourage you to
You have said many times that this administration has historically been open to harm reduction. Are you disappointed that California Governor Gavin Newsom rejected a law that would allow pilots to open supervised injection facilities?
First, it is the governor’s prerogative.We’ve basically said that we’re always trying to understand the clinical efficacy and research of emerging harm reduction practices. i know [concerning Safehouse, a proposed supervised injection site in Philadelphia] — So, as far as the courts are concerned, I’m still refraining from commenting on policy.
This article was supported by a grant from Bloomberg Philanthropies.
