Michael Botticelli served as President Obama's director of National Drug Control Policy, and pushed Congress to pass a funding measure last year making more money available for the treatment of opioid addiction.
Now he's concerned that the proposed Republican health plan will reduce access to health services for people with addiction.
"We know that people with addiction, and particularly in the opioid epidemic, need access to high quality health care in general," Botticelli told NPR.
"We know that many people who are injecting drugs have viral hepatitis. We've seen outbreaks in parts of the country with people with HIV. ... People need access to high-quality, comprehensive health care if they're really going to deal with these issues."
Botticelli discussed access to addiction treatment with NPR's Robert Siegel, including how the proposed Republican health plan differs from the approach taken by the Obama administration and the broad societal effects of widespread opioid abuse. The interview has been edited for length and clarity.
On historically sparse coverage of addiction treatment
We knew going into the Obama administration that, historically, only a small percentage of people were able to access [addiction] care in the United States, about 10 percent, largely based on their inability to pay, not having insurance coverage, or having insurance coverage that didn't cover addiction treatment services. So a large part not only of the Affordable Care Act but of our work with Congress was to pass the President's budget proposal to give states and local [governments] additional resources for this.
On the societal cost of addiction
I would say we all pay the price for untreated addiction. Certainly we know that it raises health care costs. We know that untreated addiction actually has other costs to it, associated with crime and prison costs, that drive up our taxes. We have seen what historically has been a bipartisan effort to really use addiction treatment to make sure that we're not filling our jails and prisons with people. So we're all paying the cost for this.
Given the magnitude of this issue, I've been hard-pressed to find a family that hasn't been impacted by addiction and particularly the opioid epidemic.
On Congressional support for addiction treatment funding
We had a tremendous amount of bipartisan support. Every member of Congress understands the impact that addiction, and particularly the opioid epidemic, has been having on their communities. Then-candidate Trump certainly heard this on the campaign trail, and quite honestly promised access to treatment as one of the prime strategies. So it's... perplexing to me that members of Congress who support this [proposed health care] bill know the devastating effect that not having, and ratcheting back, addiction coverage is going to have, particularly for people in their districts.
On the potential effects of decreased access to addiction treatment
I think it's not hyperbolic to forecast that we're going to see dramatic increases in mortality associated with drug overdose deaths [if the proposed bill goes into effect.] I think we're likely to see a significant impact on our emergency departments. Certainly we know crime rates go up with people with untreated addiction. ... We know that untreated addiction has a nexus to homelessness. So the implications for this are profound, not only in terms of the mortality that we see with drug overdoses, but in health and human services and public safety systems.
On controlling the drug supply in the U.S.
Our approach to drug policy under the Obama administration really tried to strike this balance between supply and demand. In my interactions with the Mexican government, I made very clear that the United States has an obligation to reduce the demand for drugs, which we know will continue to prompt supply, but that the Mexican government had a responsibility as well to help us in this battle by reducing the supply, particularly of heroin and fentanyl that we see.
I have a lot of concerns in terms of the rhetoric that we hear now. Are we going to see the same of cooperation from the Mexican government to meet their obligations in this battle?
ROBERT SIEGEL, HOST:
More reaction now to the Republican proposal on health care and specifically the impact it could have on addiction treatment. Michael Botticelli was President Obama's director of National Drug Control Policy. His office successfully pushed Congress to approve a billion dollars in new spending to fight the opioid epidemic, including expanding access to treatment. And Michael Botticelli joins us now. Welcome to the program.
MICHAEL BOTTICELLI: Thanks, Robert. It's good to be with you again.
SIEGEL: Members of Congress and Health and Human Services Secretary Tom Price have talked about trimming the essential health benefits guaranteed under the Affordable Care Act. Are you at all worried that they might cut mental health and substance abuse disorder services?
BOTTICELLI: That's a significant concern. You know, as you mentioned, the Affordable Care Act not only in increasing coverage but made addiction treatment and mental health coverage one of the 10 essential health benefits that we see. We have a long history to show where without those federal mandates, insurance companies, Medicaid programs really pay short shrift to addiction treatment as part of their benefit package.
SIEGEL: What do you say to people listening right now who say, you know, we're middle aged. Our children are off our insurance. We really don't use drugs. And we'd like to buy a policy that doesn't cover addiction services.
BOTTICELLI: I would say we all pay the price for untreated addictions. You know, certainly we know that it raises health care costs. We know that untreated addiction actually has other costs to it associated with crime and prison costs. So we're all paying the costs for this. And, you know, I have to say this, Robert, you know, given the magnitude this issue here, I'd be hard pressed to find a family that hasn't been impacted by addiction and particularly the opioid epidemic.
SIEGEL: About 30 percent of people who get Medicaid - through the expansion, at least - have a mental health or substance abuse disorder. What happens to them as states pull back on the expansion of Medicaid?
BOTTICELLI: Well, I think it's not hyperbolic to forecast that we're going to see dramatic increases in mortality associated with drug overdose deaths. I think we're likely to see a significant impact on our emergency departments. I would venture to say that we'll see dramatic increases in people in our jails and prisons. We know that untreated addiction has a nexus to homelessness. So the implications for this are profound not only in terms of the mortality that we've seen with drug overdoses...
BOTTICELLI: ...But across our Health and Human Service and our public safety system.
SIEGEL: I want to ask you about what seemed to be a trend in public sentiment and in the sentiment of politicians and lawmakers over the past year or two, which was that it's time to treat opioid addiction in particular more as a medical issue than as a juridical problem.
Some cynics would say when the opioid addiction turned very white, America found a soft spot for addicts. Do you still have a sense that that sentiment is dominant in Washington? Or was that up until Election Day? And has it all gone away?
BOTTICELLI: I don't know if that kind of prevailing focus and emphasis is going to prevail. I hope it is. I think that, you know, both at the local law enforcement level and the state and national level, we've fostered that kind of approach to this problem. I would like to think that we've turned the corner and that we won't go back to kind of tough on crime, incarcerate people with addiction. But I think that that's a question that remains unanswered at this point.
SIEGEL: You served a Democratic president. We associate Democrats with belief in a robust federal government that addresses problems and at least coordinates around the country. Republicans now control both houses of Congress and the White House. And the party takes a very dim view of the federal government.
Explain what it is that someone from your vantage point at the White House dealing with drug policy, something that's mostly going to be dealt with by hospitals and policemen all across the United States, what's so vital in a federal role for that? Or can we think more in terms of federalism dealing with the problem?
BOTTICELLI: You know, we've needed federal mandates and federal controls on this issue. Addiction has been largely ignored by our health care system, by both Medicaid and private insurance. And I think without the provisions of the Affordable Care Act and federal parity laws, quite honestly that we would not have seen such a robust response in terms of increased access to treatment. So we need these protections. And people with addiction need these protections to ensure that they're going to have access to care.
SIEGEL: Michael Botticelli, who was director of National Drug Control policy under President Obama. Thanks for talking with us today.
BOTTICELLI: Thank you, Robert.
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