I just returned from my first National Rx Drug Abuse & Heroin Summit in Atlanta. I was registered for the summit last year too but had to cancel my plans at the last minute after my wife needed urgent skull surgery after the discovery that her breast cancer had spread to the skull and was pushing on her brain. Since then, we have had to learn how to tolerate uncertainty due to one medication regimen after another failing to stop the growth of the cancer. Right now her cancer is finally in a phase where it is responding to treatments for the last couple of months. Who knows how long this phase will last.
Anyways, I was able to go to the summit this year. It had an all-hands-on-deck vibe with sessions with former president Clinton, to multiple US senators and representatives, the directors of National Institutes of Health and National Institute of Drug Abuse, the Surgeon General, the FDA Commissioner, and Kellyanne Conway, the Counselor to the President, all making an appearance. Over the 4 days, the various presentations were organized in multiple tracks, such as the Law Enforcement and Corrections Track, Clinical Track, Heroin & Other Illicit Drugs Track, and so on.
It was incredible to attend informative presentations by some amazing people doing very challenging work attacking the opioid crisis from various perspectives. However, I was struck as much by what was missing from the conversation at the summit as what was present.
First, there were multiple conversations about the rise of stimulant, cocaine and benzodiazepine misuse and abuse in the shadow of opioid abuse. There were insightful discussions about how to respond to the rising abuse of different substances. However, there was minimal, if any conversation about how, even though the ICD-10 and DSM-5 diagnoses are substance-specific, addiction itself is not substance-specific. We can choose to jump around from responding to addiction to one substance to another, but unless we develop strategies to address addiction as a general phenomenon, this game of whack-a-mole will continue forever.
Second, almost all the discussions focused on prevention were about helping teen youth. By that time youth may already have been exposed to many adverse childhood experiences researched in the ACE Study. I was hoping I would learn about more programs that were similar to Nurse Family Partnership and delivered in the earliest years of a child’s life. There is one incredible program – University of Kentucky’s Pathways Beyond Birth – designed to help pregnant women with addiction, that in the process of doing a series of “the next right thing”, has ended up inadvertently becoming a early childhood intervention program, though that’s not how the program presents itself.
Finally, and perhaps most importantly, though one did come across sessions discussing law enforcement and harm reduction, they about law enforcement officers carrying and administering naloxone. Discussions on public policy were missing any conversation about the recommendations of Johns Hopkins – Lancet Commission on Drug Policy and Health, which recommended a broad shift to a public health approach away from a criminal justice approach to addiction.
