David K. Mineta

Fact-Finding Trip Brings Deputy Director Mineta to Nashville

Last month David K. Mineta, deputy director of Demand Reduction for the Office of National Drug Control Policy flew to Nashville for a brainstorming session with Meharry Medical College officials and student leaders. Mineta was seeking input and expertise as he prepares to refine the country’s response to substance abuse and treatment options in the 2011 National Drug Control Strategy.

Mineta said his department has oversight for “all things that will try to reduce our domestic demand for drugs.” He added that includes both abusive use of prescription pharmaceuticals and illicit drugs and encompasses prevention and treatment programming. He added that Demand Reduction is also at the starting point of launching a recovery branch. Mineta and colleagues have engaged in a number of roundtable discussions as they have traveled the country.

The 2011 document, which is slated to be finalized next February, will build off current strategies and move prevention, treatment and recovery efforts forward within the substance abuse field. Mineta said an area of focus, and one of the reasons he chose to come to Meharry, is the push for greater involvement of primary care in the fight. He also referenced Meharry’s commitment to speaking for and caring for typically underserved communities.

“With the passage of the Wellstone-Domenici Parity Act for behavioral health and then also with healthcare reform, for the first time substance abuse services … treatment services and mental health services … are really taking a huge step up,” he said. “For the first time you see that (treatment for) substance abuse services can be offered in parity along with other chronic care illnesses. One of the areas that we think is really important is to engage primary care in treatment of substance abuse disorders,” he said.

Mineta added that just as primary care providers screen for depression or other illnesses, they could also screen for substance abuse issues. “For substance abuse disorders and treatment thereof, in some ways we feel like this is one of the neglected areas of healthcare,” he said, adding that it seemed like a natural fit to have such a prominent medical school with strong ties to primary care weigh in on strategies to strengthen the 2011 plan.

In addition to the primary care perspective, Mineta was pleased to have input from the dental school. “One of our signature initiatives is around prescription drug abuse, and prescription drug abuse of largely pain killers. It turns out also that for prescribers in the country dentists prescribe the most pain killers out of any specialty,” he said. He added that it was also important to speak with students about their training around substance abuse disorders, which he said is still lacking in most medical schools.

Rahn Bailey, MD, FAPA, chairman of Psychiatry and Behavior at Meharry and executive medical director of the Lloyd Elam Mental Health Center, said he was eager to discuss the links between substance abuse and overall health.

“First and foremost, we’re very interested in this duality between physical and mental health.” He said that many of his patients with a mental health disorder and/or substance abuse issues also often battle chronic illnesses and that the medical concerns are the ones that cause the greatest morbidity and mortality. “We’ve got to figure out a way to fix that problem. It looks like a donut hole. You have issues on one end for one item, on the other for another item. The two don’t really work well together, and when they don’t, the patient is going to end up with a bad outcome.”

Another area of interest is in addressing the unique issues of patients with a mental health dual diagnosis such as clinical depression or bipolar disorder compounded by substance abuse. “It’s highly unlikely we get that person well the first time we treat them. It takes a longer period of time and more continuity of care.”

Like Mineta, the avenues mental health parity laws have opened to patients have encouraged Bailey. “Parity is essential for us to have a fighting chance to treat these patients optimally.”

Bailey said it meant a lot to have the opportunity to sit down with Mineta and have Meharry’s message be heard. He said there were certainly synergies between the work being done through Meharry and national initiatives. Bailey added that he believes government interventions, when well coordinated, are a lot more likely to work. 

He applauded the federal government’s effort to engage in conversations with those providing hands on care to ensure resources are directed in the most effective manner and come to consensus on judging outcomes.

Of the day’s strategy session, Bailey concluded, “I think that’s a large part of what our role is to be like today to ensure we are all comparing apples to apples … to look at how we should start … and more importantly, how we should finish effectively.”

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