Former Drug Czar Michael Botticelli On How The Trump Administration Could Affect Addiction Services

By Britni de la Cretaz 02/13/17

The former drug czar spoke candidly about his concerns regarding the way addiction services may be handled under the new administration.

Michael Botticelli
Michael Botticelli Photo via YouTube

Under the Obama administration, Michael Botticelli headed the Office of National Drug Control Policy (ONDCP). As our “drug czar”—the nickname for the director of the ONDCP—Botticelli helped shaped the federal response to the opioid and addiction crisis on a policy level. He is in long-term recovery himself and, because of his own experience, preferred to be called the Recovery Czar.

He recently chatted with Kaiser Health News to discuss concerns he has about how addiction services will be affected as the new administration takes over.

One of Botticelli’s biggest concerns is how the GOP’s promise to repeal the Affordable Care Act, also known as Obamacare, could affect access to addiction treatment. “We had a whole host of initiatives, but one of the main components was to ensure people had adequate access to treatment,” Botticelli explained. “When you look at data about why people are not able to get treatment, not having access to insurance is one of the major reasons people cite.”

The number of Americans who may lose health coverage without the ACA ranges from 20 to 30 million. As of now, President Trump has been unclear about what he would replace the ACA with, if and when it is repealed.

Botticelli’s concerns were echoed by Constance Scharff, Director of Addiction Research for Cliffside Malibu, after Trump was elected last fall. “We need to be able to make plans for how many people can afford to access healthcare,” she told The Development Set.

Scharff argued that, regardless of what President Trump’s healthcare plan might be, providers need to know so they can plan accordingly. Currently, there is a shortage of available treatment beds for folks who need help. But if insurance isn’t willing to pay for the beds and people who need help can’t pay out of pocket, treatment centers could go from having too few beds to too many.

Botticelli is also concerned about what might happen to the people who already have health insurance if their insurance stops covering the care they need—services that range from mental health care to treatment for other diseases like HIV or hepatitis C. “If there is a significant disruption in people’s ability to access treatment, it has a devastating impact,” says Botticelli. Especially if Medicaid is slashed; its expansion has allowed many people to receive coverage for services they couldn’t access before.

Botticelli expressed concern about losing momentum in terms of the progress made to adequately treat addiction. “Any drug policy that’s going to be effective has got to be based on science and research,” he said. “The research that the National Institute of Drug Abuse and National Institutes of Health funded to understand addiction as a brain disorder and not a moral failing made us pivot to a drug policy that was based on scientific principles.”

Meanwhile, as Mother Jones notes, President Trump’s pick to lead the Office of Management and Budget, South Carolina Representative Mick Mulvaney, isn’t sure whether or not the government should fund scientific research.

Botticelli says that President Trump’s team has not been in contact with him at all in regards to the policies he promoted or the work that he did to address the opioid crisis. He says, “It’s giving me and other people pause about to what extent this administration considers this a priority … [finding solutions] really requires a comprehensive response. And a dedicated response.”

Botticelli indicated that he hasn't seen that from this administration, noting that President Trump only found out about the issue of opioid addiction while on the campaign trail.

Botticelli noted that the border wall that Trump has proposed seems to be almost the entirety of his plan to fight drug addiction in the U.S. (This plan has since been removed from his website. The White House’s website currently does not list addiction as one of the issues they intend to address.)

“The entirety of the response can’t be, ‘We’re just going to build a wall to stop the flow of drugs coming in from across the border,’” said Botticelli. “This was an epidemic that was created by legally prescribed drugs, here in the United States, and so we need to make sure we’re doing everything in our power to make progress.”

Earlier this week, President Trump spoke to a roundtable of county sheriffs where he acknowledged that there needs to be a multi-pronged approach to fighting the opioid epidemic. He mentioned supporting an expansion of access to “abuse-deterring drugs,” which he expressed support for on the campaign trail as well. “They're out, and they're very hard to get,” he said. “Stop the opioid epidemic. We've got to do it.”

He then went on to say, “We're going to stop the border. We're going to stop -- we're not going to have the drugs pouring from the border like they have been,” again stressing his border wall as the main component to the fight against opioid addiction.

Though his term as drug czar has concluded, Botticelli told Kaiser News that he does want to stay involved in the fight against addiction. “This has been my life’s work, and I have every intent to continue that.” 

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Britni de la Cretaz is a freelance writer, baseball enthusiast, and recovered alcoholic living in Boston. Follow her on Twitter at @britnidlc.