Remarks by ONDCP Director Jim Carroll at "Turning the Tide – Improving Access to Addiction Care and Overcoming Obstacles to Parity" Event

Office of National Drug Control Policy
Eisenhower Executive Office Building

11:05 A.M. EST

DIRECTOR CARROLL: Good morning everyone. I am so pleased to see engaged leaders who want to ensure we are collaborating to save American lives.

Today, more Americans than ever before need access to effective addiction treatment through their insurers and health plans.

Insurers, benefits managers, health systems, and employers play a critical role in responding to the addiction crisis.

We know that not addressing substance use in the workforce is far more costly than providing access to quality care. Today we have the opportunity to decide how we can better support those in need and save lives.

This cannot be a tradeoff between doing the right thing and protecting the bottom line — and today we will hear examples where it's possible to do both.

I want to start by sharing the story of a family that I met while traveling the country, mom Juli and her son. Juli shared how grateful she was for her family's private insurance.

Her son received treatment through three inpatient programs and several outpatient programs. He was recommended for Suboxone, and their insurance covered this essential medication and the other treatment services he received.

This is when he began to shine- this affordable, accessible care, combining medication and other services, allowed him to feel in control of his life. The medication helped him successfully participate in behavioral therapy, and to begin participating more actively in his family, community, and workplace.

Juli acknowledges that access to quality care, and assistance navigating the treatment system was crucial in saving her son's life. She is so thankful for the comprehensive and compassionate care her insurer supported.

Juli's son needed more than one treatment episodes to achieve remission and begin the journey to long-term recovery.

This series of more-or-less acute interventions combined with ongoing care coordination and support is no different from what is often needed to successfully manage other chronic conditions, such as diabetes, hypertension, or asthma.

Throughout those years of working to address his substance use disorder, the family health insurer stood with Juli and her son.

Our nation's addiction crisis has impacted so many families like Juli's.

According to provisional CDC data, approximately 68,000 American lives were lost due to a drug overdose in 2018. That is approximately 186 drug overdose deaths per day.

The impact of this crisis is not just about the number of fatal drug overdoses. The addiction crisis is putting a tremendous strain on healthcare systems, employers, law enforcement, the criminal justice system, and the broader community.

As I am sure I don't need to tell you, health insurers are similarly burdened as addiction rages unabated.

In 2016, estimates for healthcare costs for drug use were $37 billion.

Employers, insurance companies, hospitals, and publicly funded healthcare systems bear higher costs for employees with Substance Use Disorder, or SUD.

Persons with SUD are more likely to report poor overall health, and co-occurring health conditions are exacerbated by their addiction.

People with an untreated SUD are more likely to have been hospitalized, and their average period of hospitalization is longer than that of individuals without SUD. People with SUD also visit the emergency room more often.

Additionally, research has found that the family members of people with active SUD incur elevated health care costs.

The good news is addressing the problem can help.

When an individual enters recovery, their healthcare utilization and costs among them and those of their family members drop to levels similar to those of the general population.

A statewide study of Medicaid beneficiaries with SUD found that receipt of treatment was associated with annual health care savings of $2,500 per beneficiary.

Another study found that, on average, individuals who receive SUD treatment cost the healthcare system $536 less than individuals with untreated SUD.

Treatment works. Healing is possible.

It needs to be accessible—and not only through specialty addiction treatment programs, but through primary care, emergency departments, inpatient programs, and other settings.

Patients and their families need to be able to access SUD care as easily as they access any other form of specialty healthcare.

When you focus on trying to save a loved one, the last thing you want to consider is the complexities of accessing treatment.

Today, unfortunately, the criminal justice setting refers more people to treatment than healthcare providers.

We need insurers and providers to identify people with a substance use disorder and then coordinating their care so more go into treatment and more come out in recovery.

Care coordination is essential for complex chronic conditions and all insurers, benefit managers, and health systems can make a significant contribution in this area by offering people with addiction the same case management and coordination services people with cancer, HIV or another complex physical condition receive.

I am pleased to see that the U.S. Preventive Task Force has issued a draft recommendation calling for the screening of adults for illicit drug use, including non-medical use of prescription medications.

This is an essential step not only because we badly need substance use prevention services but perhaps more importantly because it provides clinicians a mechanism to ask their patients annually about their substance use.

Only about 12 percent of people with a SUD actually receive treatment. Let me repeat that – only 12 percent of people with a substance use disorder are getting the treatment they need. To put that in context for you, the treatment gap is about 18.2 million people.

We badly need a systematic process where clinicians stop and examine their patient's substance use and make course corrections earlier or get people into treatment who need treatment before they overdose or experience additional harms.

There is also a patient knowledge gap. An overwhelming 85 percent of people who meet the criteria for SUD did not think they needed treatment. THAT speaks to the need for patient education and regular screening.

There are literally millions of Americans who do not realize they are putting themselves, their families, their co-workers, and their communities at risk.

Further complicating people's willingness to seek treatment is the stigma that for too long has been attached to SUD.

We need to continue to educate the public that addiction is a chronic disease and not the reflection of a personal or family failing.

Those we serve need to understand that addiction can be treated; that recovery is possible.

We need employers, communities, workers, and others to understand that – like other chronic diseases – addiction is a medical condition with many contributing factors, not simply a failure of will.

ONDCP is coordinating Federal efforts to address illicit drug use and non-medical use of prescription medications.

With our Federal partners, we are also working with state, local and tribal governments and with the private sector to continue to bend the curve on opioid and other drug use.

Today, we are reaching out to you as necessary partners in these critical efforts.

It will take all of us to defeat this epidemic. This is a battle that we must fight on multiple fronts: in the community, in emergency departments, and across health systems and the business community.

That is why we are reaching out to you to help us ensure that Americans have coverage for and access to the SUD care they need.

You are the ones who can take on these problems and resolve them. I know you can.

I have no doubt that many of you may have already made inroads. I know some of you will be sharing about this in a panel discussion today.

With your concerted efforts, we will reverse the devastation addiction causes, save the lives of our fellow citizens, and build more resilient workplaces and communities.

I look forward to working with you on these important issues.

Thank you.