How hospitals can fight the opioid epidemic and more: 5 Qs with former White House 'drug czar' Michael Botticelli

Boston Medical Center in March received $25 million, the largest private donation in its history, to launch the Grayken Center for Addiction Medicine. BMC promptly tapped Michael Botticelli, former director of the White House Office of National Drug Control Policy under the Obama administration, to lead the center.

In 2014, Mr. Botticelli became the first person recovering from substance use disorder to serve as head of the ONDPC, a position commonly referred to as "drug czar," In that role, Mr. Botticelli advocated for the expanded use of the opioid overdose antidote naloxone, pushed for better prescriber education to curb opioid misuse and encouraged the distribution of clean needles to prevent the spread of infectious diseases and hepatitis C.

"Michael was instrumental in getting the fight against addiction to the top of the national agenda … But he also led the way on shaping our country's understanding of addiction as a disease, not a moral failing or character flaw, and that patients with substance use disorder deserve treatment not punishment," BMC CEO Kate Walsh said in March.

Mr. Botticelli recently spoke with Becker's about what hospitals can do to address the opioid epidemic, what healthcare leaders should understand about the crisis and more.

Note: Responses have been lightly edited for length and clarity.

Question: What can hospitals do to address the opioid epidemic?

Michael Botticelli: I think hospitals play a really important role in the response to this epidemic. We have seen issues of addiction go undiagnosed for many years, so one thing hospitals can do is promote things like addiction screening and look at opportunities for not only referrals to treatment, but to initiate treatment. I also think our emergency departments are really good places to provide interventions and in many cases to initiate treatment or medication. Hospitals can also play a huge role in preventing opioid use disorder by tightening their opioid prescribing practices.

Given the mortality we've seen, hospitals should also play a strong role in counseling patients on safe and effective opioid storage and disposal. We also need to do a better job of training residents on the treatment of addiction.

Also, our hospitals are very large employers, and many of our employees are either facing this issue personally or one of their family members is. We have come to understand how damaging the stigmatization of this issue can be, and we certainly know how disruptive addiction can be when it affects a family member. There are many opportunities for hospitals to destigmatize this issue for both employees and patients.

Q: How is the Grayken Center expanding BMC's legacy of innovative approaches to treating addiction? 

MB: BMC is a large hospital ecosystem with a significant Medicaid population. We know our patients are disproportionately affected by addiction and acknowledge the huge human toll the opioid epidemic takes on our communities.

BMC has had a long history of understanding these issues and developing innovative approaches to address addiction. We're doing everything in our power to deal with addiction in the community. There's still lots of room for learning and improvement, along with better medical education and innovative treatments … Our donors really support our work in becoming a world class center for the treatment of addiction.

Q: Can other hospitals replicate Grayken Center's programs for treating addiction?

MB: We are already seeing that in many, many areas. Our staff is being tapped to share their expertise in addiction consultation services, how we have implemented programs to deal with pregnant women with opioid addiction and how we have integrated addiction treatment into our primary care programs. In addition to BMC, I think many hospitals are incubators for these types of innovations. It's important for all of us to share the expertise and lessons learned from what we're doing.  

Q: How do you keep yourself and your staff motivated when caring for patients suffering from addiction?

MB: I will paraphrase one of our primary care physicians who often says, "Watching the dramatic transformation of someone who is in treatment and going through recovery is remarkable." Not only do I think we need people to understand the morbidity and mortality related to the opioid epidemic, but we need to know people can and do get better. People think this is an intractable and untreatable disease, and this couldn't be further from the truth. We need to promote the visibility of people who have gotten better. We can also do a better job of promoting employees in healthcare who are in recovery. When people get the care they need when they need it, they do get better.

Thirty-five years ago, people viewed the HIV/AIDS epidemic as an intractable problem. Now people are talking about the end of HIV. If we treat the disease of opioid addiction, we can solve this problem. We know what works in terms of treating substance use disorder and we have the knowledge to improve care. Now it requires the resources and the leadership to do it.

Q: What is most important for healthcare leaders to understand about the opioid epidemic?

MB: We need to understand that, however well-intended, it was our healthcare system that really drove this epidemic. This was not an epidemic enacted by drug cartels. This started with overprescribing and has exacerbated some very long-standing issues regarding the underdiagnoses of addiction. Our healthcare leaders have a moral and ethical responsibility to do everything they can to put an end to this epidemic.

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