Former federal drug policy official Andrea G. Barthwell, MD, who now directs addiction treatment centers in Illinois and North Carolina, pulled no punches in an Aug. 24 talk at the National Conference on Addiction Disorders (NCAD) when discussing today's policy landscape. While Barthwell's talk sought to make sense of the many changes occurring in substance use service delivery and payment systems, she left no doubt that she sees harm reduction and legalization initiatives as a significant threat to the field and the families it serves.
Citing data about the negative consequences of marijuana use among young people, Barthwell used several stages of her presentation to criticize initiatives to legalize marijuana for medical or recreational use. She said the mindset of legalization supporters can be summed up as, “We intend to legalize all drugs.”
Barthwell will participate in an Aug. 25 panel event at the St. Louis conference; it is the annual meeting's second consecutive panel presentation on marijuana policy, this time focusing on how treatment professionals should process and respond to the public's evolving outlook on marijuana policy. The Aug. 22-26 NCAD is presented by the publisher of Addiction Professional and Behavioral Healthcare.
Barthwell's comments about drug policy did not come without some accompanying criticism. One NCAD attendee live-Tweeted from the plenary session room and suggested that she was distorting arguments regarding topics related to harm reduction. One of his posts read, “If she had her way she would use incarceration and coercion for everything.”
Impact of ACA
Barthwell is a practicing addiction medicine specialist who directs the Two Dreams treatment centers in Chicago and the Outer Banks of North Carolina. She formerly served as a deputy director for demand reduction at the Office of National Drug Control Policy (ONDCP). As part of her talk she posted slides depicting numerous tenets that she lives by, including, “In the USA, we have the resources to treat everyone with this disease.”
And while she said the Affordable Care Act (ACA) clearly is bringing an influx of new patients to the front doors of accessible treatment, she added that this has come with new challenges. Families often need to bridge a 30-day wait for newly purchased insurance coverage to take effect, and policy buyers often have encountered quality-related problems that mean that some of the new plans appear less adequate than Medicaid or Medicare coverage, she said.
She focused a great deal of her talk on enforcement and prevention policy decisions that affect non-users of drugs, non-dependent users, and dependent users. She said that harm reduction strategies such as needle exchange cause problems for all of these subgroups, as they legitimize use for some individuals and actively reinforce/encourage use for others.
Barthwell also faulted the field and society at large for not sounding a clearer message about drugs' harms. “We have not done enough to communicate the downsides of these substances to our young people,” she said.
She also called into question some aspects of the use of medication-assisted treatment such as methadone or buprenorphine treatment for opioid addiction. “We have to recognize that medication-assisted treatment maintains an underlying dependence on the person's drug of choice,” Barthwell said.