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Health Care Special Session and Luncheon: Michael Botticelli discusses policies on health care and substance use disorders.

Michael Botticelli took the stage at the Health Care Special Session and Luncheon on Saturday, Aug. 15, 2015, during the American Correctional Association's 145th Congress of Correction. Botticelli is the director of the Office of National Drug Control Policy (ONDCP) and is also in long-term recovery from a substance use disorder (SUD), celebrating more than 26 years of sobriety. He began the session by saying that now is a tremendously important time for discourse on criminal justice reform, the Affordable Care Act and drug policy in the U.S. "Because of the passion and commitment," he said, "there is an opportunity to reduce drug use and its consequences for everybody with SUDs--even those who are incarcerated." SUDs are a very challenging issue in the correctional setting, and it is "truly unfortunate that our jails and prisons had to serve as our de facto mental health and SUD treatment programs."

ONDCP is a component of the executive branch and was created by the Anti-Drug Abuse Act of 1988 to advise the president on drug policy issues. "The mission of our office is simple: to reduce illegal drug use and its consequences," said Botticelli. However, fulfilling this mission is not always simple, and efforts are continually made to restore balance "by creating an unprecedented, government-wide public health and public safety approach that is based on science, not dogma." This approach is guided by three principles: drug use can be prevented by using evidence-based programs; SUDs are a disease of the brain that can be prevented and treated; and, with the right care, people can and do recover.

"The discourse has dramatically changed from a traditional enforcement-only strategy, sometimes referred to as the 'war on drugs,' to an approach that is balanced and one that recognizes fundamentally that SUD is a disease," said Botticelli, asserting that in the past, people with this disorder were seen as morally deprived rather than sick--a view deep in stigma and misunderstanding. "We would not allow an individual with a chronic disease to spiral further into illness before we give them help," he stated. "Yet that is how we have dealt with individuals with the disease of addiction." It often isn't until these people encounter the criminal justice system that they are brought to care.

Botticelli cited facts about SUDs, stating that approximately 34 percent of treatment referrals come from the criminal justice system, second only to individual referrals; only 7 percent of referrals come from a health care provider; and drug test results indicate that between 63 and 83 percent of recently booked arrestees tested positive for at least one illicit drug. ONDCP wants to address these drug-related incarcerations by supporting evidence-based alternatives to incarceration, arrest and prosecution, and by encouraging the development of new strategies that can reduce the risk to public safety while meeting the needs of justice-involved individuals.

"Understanding addiction as a brain disease should be the basis for our programs, our policies and our practices when addressing individuals with SUDs," said Botticelli. ONDCP urges policymakers and criminal justice practitioners to understand the effects this disorder has on individuals, brains, behaviors and communities. The Obama administration is working to reduce mass incarceration, "but if incarceration is necessary, treatment should not stop at the prison door," Botticelli remarked, addressing the need for easy-access community treatment.

Following this, Botticelli brought up what he called "the opioid epidemic." He stated, "Every day in this country, 120 people die from an opioid overdose." According to Botticelli, the administration addressed this issue by creating the Prescription Drug Abuse Prevention Plan, which called on individuals and organizations to do four things: educate prescribers and patients about proper opioid prescribing, establish prescription drug monitoring programs in every state, make sure individuals properly dispose of prescription drugs and reduce the number of pill mills operating nationwide through law enforcement efforts.

Heroin use is also a serious problem nationwide that has been born, in many instances, from the use of prescription drugs. Four out of five new users to heroin started by using nonmedical prescription drugs, "and they are filling your prisons," said Botticelli. While the use of heroin remains relatively low in the U.S. when compared to other drugs, the recent increase has made it a serious public health issue. To combat this problem, Botticelli brought up the positive uses of naloxone, a type of quick-working medication that combats the effects of narcotic drugs. Some law enforcement agencies have begun equipping their officers with naloxone and training them on overdose prevention. "When officers trained in the use of naloxone recognize the signs of an overdose, their ability to administer the drug quickly can mean the difference between life and death," he said.

In addition, Botticelli brought up the uses of medication-assisted treatment to prevent consequences of injection drug use, such as increased risk of hepatitis C and HIV. HIV is a huge risk with injection drug use, he claimed, stating, "In addition to providing services while in custody, continuing care and syringe support services in the community are also important aspects of a comprehensive plan."

"All of us want to reduce the consequences of drug use in our communities and in our criminal justice system," Botticelli concluded. "We may have slightly different challenges, but we share the same goals and the same solutions: effective prevention, evidence-based treatment and recovery support services."
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Title Annotation:ACA's 145th Congress of Correction: Aug. 14-19, 2015
Author:Hedger, Joey
Publication:Corrections Today
Article Type:Conference notes
Geographic Code:1USA
Date:Nov 1, 2015
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