It may seem like an unusual assignment to task the U.S. secretary of agriculture with finding solutions to the epidemic of heroin and prescription opioid abuse that’s sweeping the nation.
But Tom Vilsack, the former Iowa governor who is the longest serving member of President Obama’s cabinet, is up to the job. His agency, the U.S. Department of Agriculture, oversees a wide range of programs that benefit rural America, where the addiction problem has taken a significant toll.
And Vilsack grew up with a mother who abused alcohol and pills.
“My memories are, as a young child, watching my mom try to commit suicide on one occasion,” Vilsack recalls, and “having her distance herself from our family, going up into the attic of our home and drinking and taking prescription pills to ease the pain of a difficult life.”
Earlier this year, President Obama asked Vilsack to lead an inter-agency effort to address heroin and opioid abuse in rural America. The secretary appeared on Connections to discuss his ideas on how the federal government can help those with substance use disorders. The conversation is part of KET’s Inside Opioid Addiction initiative.
Addiction and Rural Communities
Although Americans aren’t suffering from more pain than they historically have, they are receiving an astounding number of prescriptions to treat that pain.
Since 1999 there’s been a 300 percent increase in the number of prescriptions written for opioid-based painkillers, according to Vilsack. In the year 2012 there were nearly 260 million prescriptions written, enough for every American adult to have a bottle, according to the Centers for Disease Control.
While those medications are generally dispensed with good intentions, Vilsack says too many people have become hooked on the painkillers. Then when they find themselves wanting a stronger high for a cheaper price, they turn to heroin.
Vilsack says the level of drug abuse is greater in rural America because the available jobs tend to be ones where people are more likely to be injured. Their visit to a doctor for relief may inadvertently send them down the path toward a deadly addiction.
But those who develop a substance abuse problem and live a small town can face additional challenges. Vilsack says more than three-quarters of rural communities lack addiction treatment facilities and professional counseling services. Then there’s the problem of getting people into treatment when it is available.
“Oftentimes it’s harder for rural folks because of their self-reliant, independent nature to acknowledge that they may have a problem, or for family members to acknowledge that there may be a problem within the family,” Vilsack says.
The Federal Government’s Response
Vilsack says his federal inter-agency effort will focus on four areas:
- Expanding prevention education
- Ensuring treatment availability in all parts of the country
- Creating more support services for those in recovery
- Helping addicts get the mental health services they need rather than sending them to jail
President Obama has requested $1.1 billion in the 2017 federal budget to combat the heroin and opioid drug crisis. Vilsack says most of that money would go towards increasing treatment facilities and expanding the use of medically assisted treatment, which uses specialized medications to help reduce the cravings for addictive drugs and the effects of detoxification among those in recovery.
The rest of the money will fund more treatment specialists, counselors, and medical professionals to deliver those services, as well as prevention and educational outreach.
“The key here is for Congress to understand it’s not enough to authorize programs that we’re already doing,” Vilsack says. “The key is that Congress combines that with additional resources so that we are really comprehensively and effectively dealing with this issue.”
The secretary also wants the Agriculture Department to take a more active role in the problem by continuing to fund telemedicine services, which uses broadband technology to connect rural doctors and health clinics to specialists around the country. Vilsack says telemedicine can be a useful tool for providing mental health counseling and substance abuse treatment in underserved areas.
The USDA also supports economic development efforts in rural communities. Vilsack says that’s critical because he contends people may be more likely to fall into addiction if they feel like there’s no hope for a better life.
“It is incumbent on us to understand the economic basis of a lot of the challenges that we face in rural America,” Vilsack says. “That’s why it’s important for us to redesign and revitalize the rural economy and I think there is a way to do that. … What people need to know is that there’s a plan, there’s a strategy, there’s a vision, and I think once they see that, then they begin thinking their tomorrow can be better than their today.”
Alternative Treatments for Pain
The fight against drug addiction will also require more of individuals, the pharmaceutical industry, and state officials, says Vilsack. He says patients who seek medical help for pain should be willing to ask their doctor if taking an opioid-based painkiller is absolutely necessary for their condition, or if non-addictive drugs or other treatment options, like physical therapy, might work for them.
He adds that medical schools can do a better job of training their students about alternatives to traditional pain medicines and how to limit prescriptions for opioid drugs.
As for drug companies, Vilsack says they have a responsibility to reformulate their pain medications to make them less addictive, and to make it harder for addicts to abuse them.
Finally Vilsack hopes state governments continue to improve their prescription drug monitoring systems, which are designed to alert medical professionals to patients who may be abusing prescription drugs or who may be “doctor shopping” to find physicians who will prescribe them additional medications.
“The sooner we identify folks who are having trouble, who are going down the road of addiction, the easier it will be for us to help them,” says the secretary.
A Success Story
Vilsack says his mother was fortunate to have recovered from her seven-year addiction to alcohol and pills. On Christmas Day 1963, Dolly Vilsack decided to turn her life around and enter a long-term treatment program. With the support of her family, Dolly went on to reunite with her husband, learn to drive, hold a job, and live in sobriety for 14 years before her death from cancer.
Tom Vilsack says that addicts who are ready to enter recovery must have effective and readily available treatment services and the unflinching support of their families and communities to stay clean and sober. Given what he witnessed as a child, Vilsack admits it took him a long time to stop blaming his mother and see her addiction for what it was.
“I used to think when I was young that my mom was a flawed person, that her character wasn’t what it should be,” Vilsack says. “I now know that it’s a disease.”
The secretary says changing that mindset across society so that those with a substance use disorder no longer feel judged is crucial to winning the fight against addiction.
“Once we begin to make that shift in thought process, I think it’s going to be much easier to get the resources behind the prevention and the treatment and the community support for recovery.” Vilsack says.