VI. Overview of Prevention and Treatment
Approximately 35% of the Federal drug budget is targeted to prevention and treatment of drug abuse and addiction. These programs give states and local authorities flexibility in meeting drug-related challenges their communities face, including the mounting problem of prescription drug abuse. Our strategies in prevention and treatment of prescription drugs are both targeted specifically to prescription drugs and to programs that enable prevention, intervention and treatment of addictions, which can have a significant impact on prescription drug abuse.
Preliminary data suggests that the most common way in which controlled substance prescriptions are diverted may be through friends and family.1 A person with a lawful and medical need for a certain amount of a controlled substance may use only a portion of the prescribed amount and responds to a family member’s complaint of pain, by sharing excess medication. Alternatively, for a family member addicted to controlled substance prescription drugs, the mere availability of unused controlled substance prescriptions in the house may prove to be an irresistible temptation. The solution to this problem lies with the medical community and the intended recipient of prescription medications: medical education programs that inform the physician on how to identify the opioid-seeker, counsel patients from losing control of their prescription medications, reducing the number of doses, if feasible, refer pain patients to specialists, and monitor opioid use, by biometric analysis. Patients require information on strategies to retain control of their medications.
Strategies Specific for Physicians Prescribing Controlled Prescription Drugs: Medical Education. The Medical Profession has been alerted through a number of organizations,
meetings, medical journals, and medical associations and via pharmaceutical companies of the mounting problem of prescription drug abuse. Notwithstanding the responsible and considered response of the medical community, current statistics indicate that a more concerted effort is required to diminish this escalating public health problem in our society. The administration recognizes the need for a closer partnership between the general medical community, and pain and addiction specialists. To this end, we are organizing several events later this year to facilitate the dissemination of pain and addiction information to the general medical community. Representatives of the medical and pharmaceutical communities will be called together to develop an concerted, effective strategy of change to address this public health problem. It will encourages medical professionals, pharmacists and pharmaceutical companies to take a leading role in educating physicians and patients as to the importance of retaining control of prescriptions medications with abuse liability. ONDCP is also convening a medical conference to assemble leading medical professional associations to focus on medical education on addictions, and specifically on prescription medications.
Multi-Disciplinary Dissemination of Prescription Drug Strategies: Fentanyl. In response to deaths reported in eight states to be associated with fentanyl-laced heroin and cognizant of the view that illegal manufacture and distribution of fentanyl poses unique challenges, ONDCP is convening a Demand Reduction Forum in Philadelphia this Friday, July 28/2006. The forum brings together law enforcement and public health officials, treatment providers, and prevention specialists from Federal, State, and local government to discuss response mechanisms and techniques and the threat to public health arising from abuse of fentanyl. By Friday July 21, 2006, over 100 professionals have registered to attend this important conference.
Other recent outreach efforts include two meetings in Chicago convened by the Chicago Police Department, the Drug Enforcement Agency, and the Chicago High Intensity Drug Trafficking Area, a weekly inter-agency telephone conference initially convened by CDC and SAMHSA to share information on recent developments, and warning alerts sent out by SAMHSA to treatment providers and CDC to public healthcare professionals, including state and local health departments and poison control centers.
Prevention Strategies Specific for People with Access to Controlled Prescription Drugs: Media Campaign. Reductions in prescription drug abuse also require the dissemination of information to various sectors of our society that encounter this class of drugs. Foremost, patients in possession of controlled prescription drugs need to be educated about the legal, social, medical and behavioral consequences of providing a controlled substance to a friend or family member. Patient-parents also need to become aware of the need to restrict access to their drugs. Finally, youth and adults need to become aware of the potentially severe adverse consequences of drugs. ONDCP's National Youth Anti-Drug Media Campaign is addressing the rise in prescription drug abuse by teens. Prescription Drug Use is featured on the Youth and Parents Websites visited by almost two million people a month. The Parent Website has extensive information on the dangers of prescription drugs, ways to prevent this drug use, and resources for parents to help teens who have a problem. All of the parenting resources (handbooks, CD-ROMs, brochures, websites, advertisements, press messages) have solid information on monitoring techniques that are effective against prescription drug use, along with other risky behaviors. The Media
Campaign recently added a specific advice page on how to deal with prescription drug use into their interactive parenting guide.
The Media Campaign is also reaching parents with press outreach; for example, on July 18th Director Walters held a press conference that focused on the need for parents to monitor their teens internet usage to avoid the drug threat. Starting last Friday, a new open letter ad from ONDCP's National Youth Anti-Drug Media Campaign will run in People magazine, alerting parents to the pro-drug influences to which young people are exposed by technologies like the Internet, text messaging, and social networking sites. The ad specifically addresses the risk of prescription and over-the-counter drug abuse by young people. The E-Monitoring Open Letter to Parents also appeared in Sunday's New York Times, as well as top newspapers in 27 media markets across the country and consumer publications like Newsweek. Seven health, parenting, and media education organizations signed the E-Monitoring Open Letter to Parents, including the PTA and the American Academy of Pediatrics.
Established Programs: Community Coalitions. Communities across the country have formed local anti-drug community coalitions that coordinate prevention and intervention efforts. These coalitions bring together community leaders and professionals in health care, law enforcement, and education to provide local, grassroots solutions to the challenges drug and alcohol abuse pose to their neighborhoods. Coalitions work to develop a model for all sectors to work together to change community norms and send the same no-use messages to young people. The Administration supports the efforts of many of these coalitions by providing $79.2 million in the President’s FY 2007 Budget through the Drug-Free Communities (DFC) Support Program. Through the establishment of community coalitions, the DFC program is designed to complement the development and implementation of the Strategic Prevention Framework in communities across America.
Community Coalitions: Prescription Drug Tracking. Currently, there are over 700 funded DFC coalitions, which exist in every state and form the backbone of the Nation’s community prevention system. Under this program, each grantee receives up to $100,000 annually for up to five years to develop a comprehensive community plan to address substance abuse problems. Of the over 700 DCF grantees, 365 work on prescription drug abuse, including education efforts to prevent abuse and the tracking of amphetamines, barbiturates, and oxycodone.
Established Programs: Prevention and Intervention by Biometric Identification: Student Drug Testing. The President stated in his 2004 State of the Union Address that drug testing is an effective part of a community-based strategy to reduce the demand for illicit substances. When implemented in combination with other drug abuse prevention measures, this non-punitive public health tool can reduce the number of youth using drugs illicitly and, by preventing or deterring early-initiation, can also decrease the likelihood of adult drug use. Testing can be used to screen for the abuse of prescription drugs. If a student tests positive, the parents can be notified of the result and can take action if they determine the student should not be taking the drug.
Student drug testing is also an important screening tool that can identify youth who have initiated prescription substance use so that parents and counselors can intervene at an early stage as well as those with a drug dependency so that they can be referred to appropriate treatment. The Office
of National Drug Control Policy works closely with the Department of Education to help interested schools and communities learn more about how to develop and implement a comprehensive, considerate, and safe random student drug testing policy. Regional and State summits with experts in the field and other outreach activities help spread model program elements and increase awareness about this prevention program.
Grants from the Department of Education in 2003 and 2004 in the amount of $2 million and in 2005 in the amount of $9.9 million have afforded 373 schools around the nation the opportunity to enhance and implement student drug testing programs. All grantees screen for opioids and amphetamines. Once a screen shows an opioid positive, the screen is broken down to determine which drug is present. If it is determined to be a prescription drug, then the parent is notified to verify that the student has been prescribed that particular drug. Many more schools have added this strategy to their existing drug prevention programs. These schools recognize the benefits of stopping drug use before it starts and in promoting a safe and drug-free community.
Established Programs: Screening, Brief Intervention, Referral and Treatment (SBIRT). A key component of expanding the Nation’s treatment capacity lies in early detection and engaging health professionals in the identification, counseling, referral, and ongoing medical management of persons with substance use disorders. The Department of Health and Human Services offers grants through the Screening, Brief Intervention, Referral and Treatment (SBIRT) program to States, territories, and tribal organizations to provide effective early identification and intervention in general medical settings. This program is based on research showing that by simply asking questions regarding unhealthy behaviors and conducting brief interventions, patients are more likely to avoid the behavior in the future and seek help if they believe they have problem. The programs are based in clinical settings, a location that has a high propensity to attract higher-risk populations, who through violence, accidents or health-related problems, are seen by medical professionals.
SBIRT expands the continuum of care available for treatment of substance use disorders by matching an individual’s stage of illness to the initial treatment experience and improves linkages among general community-health related services and specialized substance abuse treatment agencies. Universal screening of patients in a general medical setting can significantly reduce drug and alcohol use among non-dependent users, even without accompanying intervention.
SBIRT could help identify a cohort of prescription drug abusers who enter hospital or clinical environments seeking treatment for reasons other than for prescription drug abuse. This cohort would have the opportunity to be shepherded into interventions or treatment programs.
Awards for the program were made in September 2003 to six States and one Tribal Council. In addition to these grants, 12 universities and colleges have received funding to develop a screening and intervention model to be used on campuses. These programs will identify drug problems at an early stage and help reduce drug dependency and addiction in this vulnerable age cohort. The Office of National Drug Control Policy works closely with the Substance Abuse and Mental Health Administration to monitor the success of these programs and to highlight the
benefits of early screening and intervention. As part of the FY07 budget, approximately $31.2 million is requested for this initiative.
Established Treatment Programs. Stopping use before it starts is a priority of the Office of National Drug Control Policy, but treating drug users is critical to demand reduction efforts. From extensive work in the field of addiction science, we know that treatment for drug dependency and addiction—including to methamphetamine—can be effective. The programs we support make significant contributions to closing the treatment gap. At present 8.1 million of the 34.8 million past year drug users in the United States meet the clinical definition of abuse or dependency. Of these, 1.4 million received treatment at a specialty treatment facility. Continued success in healing America’s drug users is predicated on the availability of treatment for the remaining 6.6 million.
Treatment for prescription drug abuse is available. For example, for those who abuse methamphetamine, the Matrix Model is an evidence-based intensive outpatient treatment program created by The Matrix Institute in Los Angeles. It has been tested through research, showing favorable outcomes. It is a manual-based treatment that uses cognitive behavioral therapy, relapse prevention and skill training, all presented in Motivational Interviewing style. Treatment includes educational sessions for client families and other support people. Skill training groups focus on recovery and relapse prevention. The main objective of the program is to provide clients with a behavioral structure and daily skills enabling the eventual development of a clean and sober lifestyle.
Matrix clients were 38 percent more likely to stay in treatment compared with other treatment modalities and were 27 percent more likely to complete treatment. In some sites of the research clinical trail (total of 8 sites), the Matrix condition was associated with significantly longer periods of abstinence. Treatment completion was about 41 percent.
Specific to opioid addiction, SAMHSA’s Center for Substance Abuse and Treatment has Opioid Treatment Program (OT) accreditation grants to: (1) reduce the costs of basic accreditation education and accreditation surveys and ongoing reaccreditation for OTPs; (2) ensure that new OTPs and OTPs that did not become fully accredited before the May 19, 2004, regulatory date become fully accredited under 42 CFR Part 8; and (3) ensure that OTPs maintain their accreditation by undergoing the reaccreditation process every three years.
The President’s FY 2007 budget request includes $1.76 billion for the Substance Abuse Prevention and Treatment Block grant, of which 20 percent is set-aside for substance abuse prevention. These funds are directed to specialty treatment providers, many of whom provide treatment for abuse and dependence of prescription drugs. The President’s budget also includes nearly $556 million in prevention and treatment discretionary grants (Programs of Regional and National Significance), including Access to Recovery.
Administered by SAMHSA, the President’s Access to Recovery (ATR) program is now in 14 States and one Native American organization. Over the three year grant cycle, ATR will provide services to an estimated 125,000 people who seek treatment, but are not able to obtain it, in part, because they cannot afford it. To close the treatment gap, ATR also funds essential recovery
support services not generally provided through conventional Federal treatment resources, such as comprehensive relapse prevention services, transportation, or child-care. Many providers are unable to offer “wrap-around” services, even though they are less costly than services required in the initial stages of recovery, and are of paramount significance to those in recovery.
The President’s FY07 request for ATR is $98.2 million, which includes $24.8 million for an ATR-Methamphetamine initiative. Both the House and Senate appropriations bills eliminated funding for ATR I’d like to take this opportunity to encourage the Committee to look more closely at ATR, and data on outcome measures.
Established Treatment Program: Drug Courts. There are currently in excess of 1,750 drug courts in operation and another 400 in development. Using the coercive power of the courts to alter behavior through a combination of escalating sanctions, mandatory drug sentencing, and rigorous case management to address the individual’s overall needs, drug courts divert non-violent, low-level offenders whose underlying problem is drug use away from prison and into supervised treatment The National Center on Addiction and Substance Abuse (CASA) at Columbia University reviewed and synthesized over 120 evaluations and determined that drug courts provide the most comprehensive and effective control of drug-using offenders criminality and drug usage while under the courts supervision. A National Institute of Justice report demonstrated that, within the first year of release, 43.5 percent of drug offenders are rearrested, whereas only 16.4 percent of drug court graduates are re-arrested. This ratio of re-arrest rates persists in year two following graduation from drug court. Drug courts have not traditionally focused on prescription drug abusers. ONDCP will be working with HHS and DOJ to assess the current status of prescription drug abuse in drug courts and will make recommendations based on our findings. There is strong administration support for drug courts. The President’s FY 2007 budget requests a funding level of $69.2 million for drug courts programs—an increase of $59.3 million over the 2006 enacted level. This increase reflects a commitment to this program.
1 Special data run for ONDCP, Preliminary data from the 2005 National Survey on Drug Use and Health; data are for the first half of the year and are unweighted.
