WORCESTER – It’s been almost two weeks since President Donald J. Trump called the opioid crisis a national emergency, but President Barack Obama’s former drug czar told a packed community forum Tuesday at Worcester City Hall that the current administration hasn’t shown signs of bringing leadership and resources to the problem.
Without that support, Michael Botticelli told the crowd, “What we do at the state and local level matters even more.”
He called on local communities to address the opioid epidemic as a public health crisis, by working on prevention, ratcheting down opioid prescriptions, getting people into treatment, improving access to medication-assisted treatment, and meeting the needs of people at highest risk of opioid overdose death, including people with mental health disorders and those coming out of correctional facilities.
Massachusetts has led the country in these efforts, he said, but there is more to do.
He called on health care organizations, law enforcement, policymakers and citizens to work together because “it’s multi-faceted.”
He also called on people in recovery to speak up. “If we know someone, it changes our perception about this,” said Mr. Botticelli, who has spoken openly about his own history of drug and alcohol abuse. “Part of this has to be about our own coming out as people in recovery,” to “blow the lid off the secrecy and silence” that’s been part of addiction.
Mr. Botticelli was sworn in as the director of the Office of National Drug Control Policy in February 2015. He previously served as the director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health.
In March, Mr. Botticelli was appointed to head the new Grayken Center for Addiction Medicine at Boston Medical Center.
Mr. Botticelli’s talk came the same day the Department of Public Health released the latest statistics on the opioid epidemic in Massachusetts.
Opioid-related deaths declined by an estimated 5 percent in the first six months of 2017 compared to the first six months of 2016.
And while the updated numbers show that there were an estimated 2,107 deaths from overdose statewide in 2016, the rate of increase slowed to 17 percent from 2015. By comparison, there was a 31 percent increase in opioid-related deaths in 2015 from the year prior; and in 2014 there was a 40 percent increase from 2013.
The mix of what’s killing people continues to shift to fentanyl, away from heroin and prescription painkillers. The rate of fentanyl present in opioid-related deaths with a toxicology screen reached 81 percent in the first quarter of 2017. It surpassed heroin, which was present in 39 percent in the first quarter of 2017.
Benzodiazepines, including sedatives and anti-anxiety medication, were found in approximately 57 percent of opioid-related deaths, and cocaine was present in approximately 42 percent of these deaths in the first quarter of 2017.
In the city of Worcester, opioid-related overdose deaths dropped to 59 in 2016, from 81 in 2015.
Citing the hint of progress in the new data, City Manager Edward M. Augustus Jr. said in his introduction to Tuesday’s forum, “Maybe we’re bending the curve a little bit here.”
But he called the issue of rallying the community to combat the crisis “a war of 1,000 deaths.” Fear stemming from lack of understanding of addiction as a disease often leads to neighborhood resistance, he said.
“Everybody is theoretically in favor of more treatment,” Mr. Augustus said, “just not so much when it’s near where they live or where they work.”
“It’s untreated addiction that drives crime in our neighborhoods,” Mr. Botticelli said, citing a report out of Johns Hopkins University. He said the biggest reason people don’t seek treatment is because of the stigma.
Mr. Botticelli recapped that in the Obama White House, the focus on drug addiction shifted to a balance between treating it as a public health issue and a public safety issue. Previously, since the drug policy office was started in 1988, resources had largely been spent on law enforcement interdiction strategies.
“Our biggest response was a punitive response,” he said about traditional drug policy. “Historically we treated this as a moral failing.”
Mr. Botticelli highlighted successes in recent years, including law enforcement agencies’ work to divert people to treatment; increasing availability of the overdose-reversing drug naloxone among first responders; making it possible for more health care providers to treat patients with buprenorphine, or Suboxone; and allocating more funds to states for addiction services in the 21st Century Cures Act.
The Affordable Care Act, known informally as Obamacare, expanded insurance coverage for drug treatment along with comprehensive care and significantly changed the focus, according to Mr. Botticelli.
“You can’t simultaneously declare an emergency and destroy the way people get care,” Mr. Botticelli said, questioning Mr. Trump’s resolve to address the drug crisis while promising to end Obamacare.
Mr. Botticelli added that he was disappointed that U.S. Attorney General Jeff Sessions had called for federal prosecutors to pursue severe penalties, including a return to mandatory minimum sentences, which disproportionately affected people of color.
He said, “The tell-tale sign will be not just that he (Mr. Trump) issues an emergency but what actions come along with it.”
During the question-and-answer session, Mr. Botticelli urged communities to “think about prevention,” because there will always be some type of drugs available.
And he said local groups need to think carefully about where retail marijuana establishments are located and how their products are marketed. A Denver Post analysis found the vast majority of pot shops there were in poor communities and communities of color.
“I’m afraid we’re going to trade one set of inequities for another set of inequities,” Mr. Botticelli said.