My worry about what Obama has proposed — and about what his and previous administrations have done to try to address prescription opiate addiction — is that it focuses primarily on restricting and regulating supply and on medical detoxification. In reality, we need to face opiate addiction as part of a wider revolution in the way that we diagnose, treat and insure against mental illness and addiction. When patients are flagged for gaming the system while seeking Oxys, as I was many times, we need to view their situation as a cry for fully integrated medical care, not just a case for opiate detox.
On paper, the president has presided over the greatest expansion of mental-health and substance-use-disorder benefits in American history. My father, Sen. Ted Kennedy (D-Mass.), and I were proud to have been part of that effort, first with the Mental Health Parity and Addiction Equity Act of 2008 — which made it illegal to discriminate in care and coverage for diseases of the brain — and then the Affordable Care Act, which built upon and codified those parity protections. But the Obama administration has still not put in place many of the enforcement mechanisms necessary to make these measures a reality in our day-to-day medical lives. And the public-health epidemic of prescription opiate addiction brings this failure into sharp focus.
We will not be able to address this new and troubling addiction issue until we embrace the idea that all addiction care, and all mental health care, needs to be delivered in a radically different, holistic way — fully integrated into the rest of our medical care, and no longer viewed, as it has too often, as palliative care for moral failings or “demons.”