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Policies that promote effective systems of care  for substance use disorders Keith Humphreys Senior Policy Advisor, White House ONDCP Professor of Psychiatry, Stanford University Career Research Scientist, Department of Veterans Affairs
Substance Use Disorder Care is a major focus of NDCS, but not the only one ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Can Countries Achieve “Tipping Points” with Substance Use Disorder Treatment? ,[object Object],[object Object],[object Object]
In U.S., about one in six persons meeting diagnostic criteria for illicit drugs received specialty treatment Total needing treatment for illicit drugs = 7.559 million . Source:  SAMHSA,  2008 National Survey on Drug Use and Health  (September 2009). 8/2009 13
Proportion of all heroin addicted individuals in methadone maintenance, 1993 Source: MacCoun, R. J., & Reuter, P. (2001).  Drug war heresies .  Cambridge, UK: Cambridge University Press.
France subsequently dramatically expanded opiate agonist treatment Emmanuelli, J., & Desenclos, J-C. (2005). Harm reduction interventions, behaviours and associated health outcomes in France, 1996-2003.  Addiction, 100 , 1690-1700.
..And apparently achieved a tipping point 1996-2003 ,[object Object],[object Object]
Only historical U.S. example ,[object Object],[object Object],[object Object],References: Musto, D., & Korsmeyer, P. (2002).  The quest for drug control .  New  Haven: Yale University Press; Massing, M. (1998).  The fix .  New York: Simon and Schuster.
How will the Obama Administration Increase the Quantity of Care for Substance Use Disorder?
Patient Protection and Affordable Care Act of 2010 ,[object Object],[object Object],[object Object],[object Object]
The Spectrum of Substance Use Disorder Specialty Treatment ~ 2,300,000 Abuse/Dependent – 25,000,000 “ Harmful Users” – ??,000,000 Little or No Use
What is SBIRT? ,[object Object],[object Object],[object Object],[object Object]
Administration SBIRT proposals ,[object Object],[object Object],[object Object]
Selected Administration initiatives for treatment of addicted individuals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Will all this increase in quantity produce a “tipping point”?
A brief but important word about expanding treatment in developing countries
International Demand Reduction ,[object Object],[object Object],[object Object]
Expanding quantity does not resolve concerns about quality
Alcohol dependence was last among 30 medical conditions in proportion of care received as evidence would recommend Source: McGlynn E., et al., (2003). The quality of health care delivered to adults in In the United States.  New England Journal of Medicine, 348 . Senile cataract 78.7% Breast cancer 75.7% Prenatal care 73.0% Hypertension 64.7% Asthma 53.5% Diabetes Mellitus 45.4% Urinary Tract Infection 40.7% Atrial Fibrillation 24.7% Alcohol Dependence 10.5%
Common quality issues ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],References:   Uchtenhagen A., Stamm R., Huber J., and Vuille R.  (2008) A review of systems for continued education and training in the substance  abuse field.  Substance Abuse   29 , 95-102. McLellan, AT, Carise, D, Kleber, HD. (2003).  Can the national information treatment infrastructure support the public’s demand for quality care? .  Journal of Substance Abuse Treatment. 25, 117-21 .
What policies might improve the quality of care?
Improving quality is a challenge: Dr. Zoe D. Katze
Incentivizing particular care processes: VA example ,[object Object],[object Object],[object Object]
Rates of identifying substance abuse in VA versus other systems
Administration Proposal: P4P for States ,[object Object],[object Object],[object Object],[object Object]
A market-based approach to quality:  Access to Recovery ,[object Object],[object Object],[object Object],[object Object]
Embedding specialty care within medicine to improve quantity and quality at once ,[object Object],[object Object],[object Object]
Other potential advantages to expanding substance use disorder care within mainstream healthcare systems ,[object Object],[object Object],[object Object]
Two care systems for such expansion, proposed in President’s 2011 Budget ,[object Object],[object Object]
Summary ,[object Object],[object Object]
Summary, continued ,[object Object],[object Object],[object Object]
-  The End  -

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Health reform and other policies around substance abuse treatment systems ondcp 4.2010

  • 1. Policies that promote effective systems of care for substance use disorders Keith Humphreys Senior Policy Advisor, White House ONDCP Professor of Psychiatry, Stanford University Career Research Scientist, Department of Veterans Affairs
  • 2.
  • 3.
  • 4. In U.S., about one in six persons meeting diagnostic criteria for illicit drugs received specialty treatment Total needing treatment for illicit drugs = 7.559 million . Source: SAMHSA, 2008 National Survey on Drug Use and Health (September 2009). 8/2009 13
  • 5. Proportion of all heroin addicted individuals in methadone maintenance, 1993 Source: MacCoun, R. J., & Reuter, P. (2001). Drug war heresies . Cambridge, UK: Cambridge University Press.
  • 6. France subsequently dramatically expanded opiate agonist treatment Emmanuelli, J., & Desenclos, J-C. (2005). Harm reduction interventions, behaviours and associated health outcomes in France, 1996-2003. Addiction, 100 , 1690-1700.
  • 7.
  • 8.
  • 9. How will the Obama Administration Increase the Quantity of Care for Substance Use Disorder?
  • 10.
  • 11. The Spectrum of Substance Use Disorder Specialty Treatment ~ 2,300,000 Abuse/Dependent – 25,000,000 “ Harmful Users” – ??,000,000 Little or No Use
  • 12.
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  • 15. Will all this increase in quantity produce a “tipping point”?
  • 16. A brief but important word about expanding treatment in developing countries
  • 17.
  • 18. Expanding quantity does not resolve concerns about quality
  • 19. Alcohol dependence was last among 30 medical conditions in proportion of care received as evidence would recommend Source: McGlynn E., et al., (2003). The quality of health care delivered to adults in In the United States. New England Journal of Medicine, 348 . Senile cataract 78.7% Breast cancer 75.7% Prenatal care 73.0% Hypertension 64.7% Asthma 53.5% Diabetes Mellitus 45.4% Urinary Tract Infection 40.7% Atrial Fibrillation 24.7% Alcohol Dependence 10.5%
  • 20.
  • 21. What policies might improve the quality of care?
  • 22. Improving quality is a challenge: Dr. Zoe D. Katze
  • 23.
  • 24. Rates of identifying substance abuse in VA versus other systems
  • 25.
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  • 28.
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  • 32. - The End -

Notas do Editor

  1. We don’t know the answer to this question Evidence from some diseases as well as from the very limited addiction evidence we has suggests the tipping point may require a massive expansion, for example from the 1 in 6 for drugs to 1 in 3. That’s what I mean by order of magnitude, may have to double the number of people who get SBIRT or treatment to see massive population level changes, but that could be off in either direction by a good way We do believe that the actions so far this year and through FY2011 are in the right direction to produce this…we also recognize that there is more work ahead in the coming fiscal years.