February 23, 2015

Sen. Whitehouse: Let’s Lift the Stigma on Addiction and Recovery

As Prepared for Delivery

*This speech was delivered at an event about addiction and recovery co-hosted by the Alliance to Prevent the Abuse of Medicines, Roll Call, and the U.S. Chamber of Commerce. It was held at the Chamber’s headquarters in Washington, DC.

Good morning, and thank you for the kind introduction, Beth (Bronder, Roll Call  publisher).  Thank you also to the Alliance to Prevent the Abuse of Medicines, Roll Call, and the Chamber of Commerce for hosting this important discussion on prescription drug abuse. 

I want to acknowledge, in particular, Rhode Island’s own CVS Health—a member of the Alliance from my home state that partners with the public health community to address prescription drug abuse. We’re also joined by another Rhode Islander, Tom Coderre, who is working at SAMHSA and was a state senator and friend for many years in Rhode Island.

I am honored to join Governors Baker and McAuliffe and my colleague and friend, Senator Rob Portman of Ohio, in speaking with you today.

On a national level, deaths by overdose have more than doubled since 1999.  In my home state of Rhode Island, as in many others, drug overdoses have passed automobile accidents, to become the leading cause of accidental death.  Almost 7,000 people are treated daily in emergency rooms for the misuse or abuse of drugs and 120 people die every day of drug overdose. 

More than half of those drug overdose deaths are related to pharmaceuticals.  Of those pharmaceutical overdose deaths, approximately 70 percent are overdoses of prescription painkillers. 

Prescription painkiller addiction has touched every region, state, and demographic.  Among women, for instance, prescription painkillers account for four times more deaths than do cocaine and heroin combined. 

And of course prescription painkiller addiction often leads to heroin use — it can be cheaper, and easier to obtain.  

Americans in the military are prescribed three times as many painkillers as civilians, and prescription drug addiction soared throughout the wars in Iraq and Afghanistan.  These problems followed veterans home, to the point where Rhode Island has set up special courts to divert veterans coming into the criminal justice system into better systems of treatment and support.

With all this evidence around us, Senator Portman and I last year hosted a series of forums in the Senate on different aspects of substance use, and on the challenges facing those seeking recovery.  The forums brought together academic experts and researchers, treatment and prevention advocates, state and local law enforcement representatives, and individuals in recovery — as well as strong bipartisan Senate participation.

With input from over fifty groups and the private sector, we drafted the bipartisan Comprehensive Addiction and Recovery Act of 2014.  Earlier this month, we reintroduced the bill in the new session of Congress, with a bipartisan slate of cosponsors.  Representatives Sensenbrenner and Conyers have introduced identical legislation in the House, likewise with the support of Democrats and Republicans. 

The bill is designed to encourage states to adopt comprehensive responses to substance abuse.  It authorizes grants for prevention and education efforts, treatment programs, development of alternatives to incarceration for individuals battling addiction, and support for those in, or seeking, recovery.  It would provide resources for law enforcement preparedness with naloxone, while encouraging states to provide civil liability protection to first responders who administer the drug.  The bill also creates incentives for states willing to strengthen and improve their prescription drug monitoring systems—steps which will be essential to curbing addiction to prescription drugs. 

Our bill makes sense from a prevention and recovery standpoint, but it also makes fiscal sense.  After all, the overall cost of prescription drug abuse, from health care- and criminal justice-related costs to lost productivity, is steep—as much as $70 billion a year.  We know that prevention is cheaper than treatment; and we know that treatment, in turn, is both cheaper, and more likely to lower recidivism, than locking folks up.    

I’d like to ask you today a big thing and a small thing. 

The big thing is to help lift the stigma about addiction and recovery.  Addiction is a tough illness, and recovery is a hard but noble path.  Men and women who walk that path deserve our support, our encouragement, and our admiration.  Be big about lifting the stigma, and celebrating the successes.  Be generous about understanding the setbacks.  And be proud of the recovery community.  That’s the big thing.

The little thing is to look at your local prescription drug monitoring programs.  I’ve been interested in this issue since I fought with DEA over their insistence that physicians maintain paper prescription records for controlled pharmaceuticals.  Now that electronic prescribing is widespread, it provides a data field that can be very helpful. 

Why is Doctor X, a podiatrist, prescribing so much oxycodone?  Why does Patient Y visit five doctors and five pharmacies and get painkillers from all of them?  Who is prescribing 50 pills at a time for temporary back sprain?  Why has this physician practice quadrupled its opioid prescription?  Why are opioids suddenly being prescribed from this address that’s never had an MD associated with it before? 

These are questions worth looking into, now that we have the data — but too often it doesn’t happen.  Let’s fix that.

The technology upgrades that may be required to improve state prescription drug monitoring programs may be expensive, but pill mills, and doctor shopping by those addicted to painkillers, costs the insurance industry — and the rest of us — much more.  Don’t forget the statistics I opened with of those who show up dead or in emergency rooms because of prescription painkiller overdoses.  That cost in heartbreak may be the worst cost of all. 

It is time to come together across regional, professional, and partisan divides to respond forcefully to this epidemic. 

Thank you all for what you are already doing as researchers, advocates, health care professionals, and journalists to meet this challenge.  Let’s keep going.