Q&A: Bringing addiction care ‘inside the house of medicine’

heart murmur or back pain, there are procedures in place,” Humphreys said. “If I walk in and say, ‘I can’t stop taking oxycontin,’ there should be the same.”

Humphreys spoke about the hopeful signs as well as the challenges in shifting the addiction paradigm.

The Stanford-Lancet report called for sweeping reforms. What has happened in the year and a half since?

Within a month of the report coming out, I did multiple White House briefings, one with the office of the secretary of health and human services. I also did one at No. 10 Downing Street in Britain. A number of things we recommended have begun to take shape. One of those is enforcing parity laws, which require equal reimbursement for physical and behavioral health conditions, to make sure the insurance industry covers addiction treatment adequately.

You’ve emphasized the importance of doctors knowing how to treat addiction. Is there now a path toward that?

Yes, we recommended universal physician training in which every U.S. doctor who prescribes addictive drugs has to get trained on addiction. That just got approved about six months ago—it’s a pretty stunning change, because students at American medical schools get very little training in addiction or pain. Now, if they want to prescribe drugs, all 900,000 practicing doctors must receive continuing education about substance use disorder. The reality is that even doctors who don’t think they are treating addiction are treating addiction. If you work in an emergency room or in family practice…one in four people who come in is going to have a substance-related issue.

Are you seeing a cultural shift in how addiction is perceived?

I’ve seen big strides. We now have a pretty robust recovery movement, which we didn’t have when I started doing this. When the great singer Tony Bennett died recently, his obit mentioned his recovery from cocaine addiction. I don’t think that would’ve happened 20 years ago—and it didn’t seem to diminish him in people’s eyes. But a lot of people are still dying. And when people die, human beings understandably get upset and they want to see the people they feel are responsible for the loss of their loved one punished.

You’ve strongly recommended pulling addiction treatment into medical care. Talk about the barriers that exist.

Addiction treatment stems from three parents: the criminal justice system; social welfare, such as the Salvation Army; and peer fellowships, such as Alcoholics Anonymous. All of them have saved many lives, but they’re not within the house of medicine. Those entities have less funding, and they are more stigmatized and poorly integrated with the health care system. The normal health care system needs to respond to substance use disorders adequately, which means consistent funding.

Currently, Congress gives addiction treatment two years of funding at a time. Two years won’t resolve addiction. You need enduring funding streams, and you need parity—just like patients expect their Blue Cross plan to cover cancer, it must also cover someone who is addicted to alcohol, opioids or any other drug.

While COVID was devastating for addiction, you’ve spotted a potential upside, right?

Although you and I can get on our phone and find real-time data about COVID deaths, finding out how many people died of an opioid overdose takes six months. If we don’t have that data, we cannot tell if certain addiction programs are working. I’m excited about some of the things we’re working on to conduct better population-level studies around addiction. COVID showed what we can do on a national level. We need to make that same kind of commitment to this problem.