White House Funds Move of 'War on Drugs' to Clinics
Original story HERE. From MedPage Today. Note: Registration RequiredWASHINGTON -- The Obama administration is awarding $22 million in grants to further efforts to move the war on drugs from court rooms and prisons to emergency rooms and clinics, the White House announced Wednesday.
Three states -- Arizona, Iowa, and New Jersey -- will receive up to $7.5 million over 5 years to screen for and treat people with a variety of substance abuse disorders in different primary care settings and emergency rooms. The program, dubbed Screening, Brief Intervention, and Referral to Treatment (SBIRT), has operated since 1992 but has received renewed emphasis from the Obama administration.
"We know that prevention works, treatment helps, and people get better," Pamela Hyde, administrator of the Substance Abuse and Mental Health Services Administration, said at a press conference.
The Obama administration views drug addiction as a disease and is using a growing scientific literature on addiction to treat drug abuse, Hyde said. Its aim is to treat addiction through the healthcare system as its primary form of drug control, rather than prosecuting drug offenders with criminal charges.
SBIRT, which has screened more than 1.5 million people across the country, works by conducting a simple screen on every patient a hospital or clinic treats. Patients who test for abusing substances such as drugs and alcohol are given brief counseling, which mostly consists of a 5-to-10-minute educational talk. Those who are deemed high-risk are referred to a specialist for additional treatment.
A core principle of the program is to integrate mental and physical health screening and treatment, officials said. Hyde noted that 92% of mental health patients who have substance abuse issues don't receive the care they need.
Law enforcement leaders are on board with this "medicalization" policy and are even leading the way. "This program represents the future of drug control policy in our nation," said Gil Kerlikowske, director of the White House's Office of National Drug Control Policy.
At Boston Medical Center, 18% of the more than 143,000 patients that healthcare providers screened over a 6-year period beginning in 2006 tested positive for unhealthy substance abuse, said internist Daniel Alford, MD, who runs the SBIRT program in the state. The providers found that 3% needed intervention. After federal funding ended last year, the state of Massachusetts picked up the SBIRT program.
Primary care physicians find the program simple to use because in many cases screening can be conducted with a single question: "How many times in the past year have you had five or more drinks (four or more drinks for women and men over age 65) in a day?" Answers of one or more are considered positive.
"It makes it much more practical in a busy healthcare setting," Alford said at the press conference. Any health worker can conduct the screening test, but it's mostly given by social workers.
He likened the intervention of catching people early in their substance abuse problems to the way a physician would treat those with abnormal kidney function well before they need dialysis and their disease gets out of hand.
In 2008, SBIRT established reimbursement codes that are being used by an increasing number of state Medicaid programs and private insurers to help compensate the substance abuse treatment providers are giving.
Data show the method is proving to work, supporters say. At 6-month follow up, injectable drug use was cut in half. There were improvements in housing rates, arrest rates and unprotected sex incidence.
With the SBIRT funding for Arizona, Iowa, and New Jersey, the program will be in place in areas with high numbers of low-income people and traditionally underinsured who receive care at federally qualified health centers and other clinics. The three states were chosen through a competitive grant process.
