Opioid addiction is the most pressing public health crisis of our time. It is a chronic, medical condition that can impair health and function and is characterized by repeated use of a substance despite harmful consequences.

In this segment, Michael Botticelli, one of the nation's leading addiction experts, who served as the Director of National Drug Control Policy at the White House under President Obama and is currently the Director of Boston Medical Center's newly established Grayken Center for Addiction Medicine, joins the show to discuss how policy makers, clinicians, patients and families in crisis from across the country are turning to BMC because of its expertise and leadership in caring for patients with opioid addiction. 

Among the busiest, most comprehensive treatment centers for behavioral health and addiction treatment in the country, BMC has established a formal Addiction Center to help turn the tide on this national opioid crisis.

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Michael Botticelli is one of the nation’s leading opioid addiction experts

Michael Botticelli

Michael Botticelli is one of the nation’s leading opioid addiction experts, and served as the Director of National Drug Control Policy at the White House under President Obama. He was the first person to hold the position who was also in long-term recovery from a substance use disorder and who came from a public health background. Now, he has returned to Boston where he previously served as Director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, to serve as the Director of Boston Medical Center’s newly established Grayken Center for Addiction Medicine.


Melanie Cole (Host): Addiction is the most pressing public health crisis of our time. It’s a chronic medical condition that can impair health and function and is characterized by repeated use of substance despite harmful consequences. My guest today, is Michael Botticelli. He’s one of the nation’s leading addiction experts and served as the Director of the National Drug Control Policy at the White House under President Obama, and he is currently the Director of Boston Medical Center’s newly established Grayken Center for Addiction Medicine. Welcome to the show, Michael. Everyone’s heard that opioids are a huge issue in the country. Tell us a little bit about what’s going on and some stats about opioid addiction.

Michael Botticelli (Guest): Sure. First of all, thank you for having me. It’s great to be here. As we discussed, opioid addiction is probably our most pressing health crisis that we have here. It’s estimated that about 2 million Americans have an opioid use disorder that requires care and treatment. Perhaps the most staggering figure that we have is the incredible number of people who are dying on a daily basis – both here in Massachusetts and nationally, every day from an opioid use disorder. In 2015, the last time that we had national figures, there was about 33,000 people who died of an opioid use disorder. Here in Massachusetts, that figure was about 1,900 people who died in 2016 of an overdose. This has been a huge issue not just here in Boston, but in Massachusetts and nationally. 

Melanie: Why do you think this got so out of control, Michael?

Michael: One of the reasons that we know it got out of control was often, I think, a well-intended push by the medical profession to do a better job at treating pain. But treating pain with very, very addictive prescriptions opioids. One of the main drivers of the epidemic has been the widespread overprescribing of prescription drugs – again, here in Massachusetts and in the rest of the nation. 

We know, despite some of the claims of the pharmaceutical industry that these are highly addictive substances, and we have seen a tremendous amount of addiction start by people taking high doses and long durations of these medications. We know that people have often gotten prescriptions for 30 days, or 60 days of these medications and they have gotten diverted from people’s own homes and medicine cabinets. We know many people start down the path to addiction by using or taking someone else’s prescription drugs. 

Part of what we really need to do here at Boston Medical Center and around the country is re-educating our medical professionals on safe and effective opioid prescribing. Governor Baker here in Massachusetts passed pretty aggressive state laws limiting the amount that people get from a first prescription and consulting databases that allow prescribers to check to make sure that people have not got multiple prescriptions from multiple doctors. While we know this is a complex problem that requires multiple strategies, we know that reigning in the overprescribing of prescription pain medication is particularly important. 

Melanie: Michael, before we talk about how to curb the epidemic, what are some signs and symptoms of opioid addiction that somebody either might recognize in themselves – and while that might be a little more difficult, some loved one might recognize some of these things. How would you even know?

Michael: Sure. We know that there are some general signs and symptoms of addiction in general that people should pay attention to. One is that people lose interest in activities that they used to be really engaged in, that their peer group changes, that their grades slip -- particularly for a student, you see a drop in academic performance – and see some change in behaviors. 

Particularly with opioid use disorder, you see people being incredibly drowsy or sleepy. You often see them manufacturing ailments or pain to make sure that they are trying to get these medications. We know that there are many, many signs and symptoms. I have talked to many parents and loved ones over the years in my work, and often, I think parents and loved ones ignore some of those early warning signs. They see them, but they minimize them, and they don’t believe that it’s a problem. My suggestion is don’t ignore those symptoms. If you see something – it’s almost like the warnings that we hear at airports – if you see something, say something. That’s always been my watchword and recommendation is that if you see something that really appears to be out of the ordinary for behavior for your loved one and you suspect that there might be a problem, reach out to a professional and ask for help and get good guidance. 

Melanie: Michael, Boston Medical Center has been working to both curb this epidemic and help treat people with opioid addiction. What is Boston Medical Center doing now, and what are some of the plans for the future?

Michael: Sure, Boston Medical Center has a long history of dealing with addiction and treating addiction in a number of different ways. I think that that work has tremendously accelerated with just the huge opiate epidemic that we have here in Boston and Massachusetts. There are a number of things that I think are happening here that I think are really notable. One is – we know that often it can be hard, even with all of the treatment we have here, and in Massachusetts, it can be very hard to get into treatment. Boston Medical Center, with funding from the state, opened what’s called a Faster Path Program. It’s really an urgent care center for people with opioid use disorders who might end up in the Emergency Room, or who need access to treatment. It’s where they can walk in and be able to get help and assistance in finding and getting in treatment capacity. 

We have done a tremendous amount of work here to increase the capacity of our primary care programs to do good treatment using highly effective medications. In our primary care clinic, we have a number of physicians and nurses who are able to treat people with addiction. We have opened a youth and young adult treatment program here at Boston Medical Center. We have really, I think, implemented a wide variety of programs to make sure that particularly people have ready and available access to care and treatment when they need it, which we know is really critical at this time. 

Melanie: Tell us about the Grayken Center. How did that come to be, and what do you see the role of the center now and five years from now?

Michael: Sure, we were incredibly fortunate that Boston Medical Center -- despite its long history of doing really great innovative work and care -- realized we need to do more and really need to accelerate the work that we’re doing. We’re very, very fortunate to have identified the Grayken family -- who have talked about how they, as a family, have been impacted by addiction -- to really give a history gift to the hospital of 25 million dollars over the next five years. As we’re launching the Grayken Center, part of our work is to accelerate the great work that’s happening here in treatment innovations, to continue to develop and accelerate innovative treatment models that do a great job at getting people into recovery. 

Continue to focus on medical education – one of the areas the opioid epidemic has really taught us is we need to do a better job of integrating issues of addiction into medical school, nursing school, dental school, schools of public health. We’ll continue to do that as well as contributing to adding to our knowledge base of how we effectively deal and treat people with addiction. We’re incredibly fortunate through the generosity of the Grayken family to be able to continue to accelerate our work here. What we hope to have happened is that this work will not only have significance for our patients here at Boston Medical Center, but these will continue to be national models and even international models for how we treat people with addiction, particularly within our healthcare institutions. We’re incredibly fortunate to have this kind of gift and particularly at this time when we know we need to do a better job of identifying and treating people with addiction.

Melanie: And let’s talk – we only have a few minutes left – but let’s talk about stigma. It’s just really starting to be seen as a disease, addiction, rather than a moral failing. How do you think we can get the general public to see this as the disease that it is? Wrap it up for us, with your best advice, about seeking help if you are someone who has an addiction problem, or if you have a loved one that has an addiction issue?

Michael: We know that stigma plays a big role in one, keeping people from seeking care, and often delaying people from seeking care. People feel ashamed and embarrassed to talk about it, whether that relates to their own personal issues with addiction or those of a loved one. Part of what we have to do is acknowledge that this is a disease, it’s not a moral failing -- to treat each other with love and kindness and support, and make sure that we are talking about this in an open and honest way. 

I also think – I’ve been a person in long-term recovery, and I also want to make sure that people in long-term recovery talk about their path and their journey. We know one of the best ways to diminish stigma is to talk openly and candidly about our struggles -- about our path. This is no different than any other disease, and we want to make sure that we create programs that treat people with dignity and respect so that people don’t feel that shame and stigma that is unfortunately attached to this. I think we need to continue to educate the general public about the disease of addiction -- that this is a disease, that it’s not a moral failing. How we work with our law enforcement officers and the general public I think is really important because again, I have heard too many times and too many stories of parents and loved ones who have been ashamed and embarrassed to talk about this. I do believe that that is changing and I do believe that we can continue, through the Grayken Center, and through work that’s happening throughout Massachusetts and the country, to really help diminish some of the stigma and shame that’s still associated with addiction. 

Melanie: Thank you, so much, for being with us today, Michael. It is absolutely such important information, and we applaud all of the great work you’re doing there at the Grayken Center. You’re listening to Boston Med Talks with Boston Medical Center, and for more information, you can go to BMC.org, that’s BMC.org. This is Melanie Cole. Thanks, so much for listening.