By Yen Duong
One of the younger members of the storied Kennedy family, former congressman Patrick Kennedy, has become an advocate for mental health and addiction treatment after going public in the late 2000’s with his own struggles with substance use and bipolar disorder.
In 2017, Kennedy served on the President’s Commission on Combating Drug Addiction and the Opioid Crisis with Gov. Roy Cooper. Some of those recommendations are reflected in the Opioid Crisis Response Act of 2018 recently agreed upon by the House and the Senate. He also wrote a memoir about addiction and mental health, A Common Struggle.
North Carolina Health News sat down with Kennedy before he spoke at an Atrium Health event in Charlotte on Sept. 12.
This interview has been edited for length and clarity.
NCHN: What motivated you to sponsor the Mental Health Parity and Addiction Equity Act, which requires health care providers to cover mental health and addiction treatment the same way they cover physical ailments?
KENNEDY: Mental health and addiction are often left in the shadows of our health care system and treated in a separate and unequal way. They never get reimbursed the same; there’s never the same professional esteem for those who are delivering the care for mental health and addiction. And there’s never the respect for patients who are suffering from chronic illness and who need the same care as if they were suffering from diabetes, but are denied that care out of stigma and bigotry.
KENNEDY: Addiction is a mental illness. I think the opioid crisis is fueled by people trying to treat their psychic pain, and a lot of overdoses are really suicides. We have a suicide crisis that’s off the charts. But has been dwarfed by an overwhelming opioid crisis, which has stolen all the headlines.
NCHN: In North Carolina, the opioid crisis is booming. Do we have a mental health crisis?
KENNEDY: We need a checkup from the neck up, from cradle to grave. We need to be watching out for people’s vulnerability for addiction and mental illness. We need to do a better job at intervening when this is still stage one or two of the disease. The way we still treat this illness is when it’s at stage four.
I guarantee you, if you did a forensic on the health history of people dying of overdose, you would find indicators that would put them in high-risk categories.
NCHN: What is fueling this ‘suicide crisis’?
KENNEDY: There’s great unease in this country about people’s economic status and their future despite the fact that Wall Street’s doing well. I think that we’re in a huge transformation in our economy and the old predictability of having a lifetime occupation and a pension and health benefits—that’s now more elusive. That was precipitated after the 2008 crash. There isn’t a job out there that isn’t being outsourced.
Then Big Pharma over-marketing drugs like Oxycontin, when all the evidence, even back then showed that that was dangerous. And yet, they found co-conspirators, if you will, with the medical establishment, which got swept up in the money. That all influences public policy, which in turn incentivized the treatment of pain over the recognition of the potential consequences of addiction.
NCHN: It sounds like you’re saying that pharmaceutical companies, doctors and politicians are all profiting to the detriment of patients.
KENNEDY: It’s an insidious thing where money influences so much. There’s a financial incentive for doctors to prescribe because [the federal Centers for Medicare and Medicaid Services] won’t reimburse hospitals if the [patient satisfaction] score is low. And if you have an addiction, you know that, because you’re very manipulative because of the nature of your illness, and you can hold your doctor hostage to [prescribe] you whatever you want. If they don’t, you can retaliate through a bad patient report.
NCHN: That gives a lot more power to patients than patients feel like they have.
KENNEDY: I’m speaking from experience. I’m in long-term recovery from opioid use disorder. I played every game in the book and I know how this game is run.
NCHN: Can you tell us about your journey from addiction to recovery?
KENNEDY: I, like many in 12 Step recovery, hit a point of pitiful and incomprehensible demoralization… bottom. I found myself in that awful place.
I feel blessed to have had enough willingness to go to 12 Step recovery and rebuild my life in another city, with not having my old job, my old friends, my old life. I literally changed everything. I went from being a Congressman to not knowing what I was going to do with myself.
I had been in and out of treatment, because we treat these illnesses in an episodic way when what we ought to be doing is treating them as chronic diseases. So, I lived the old model, which was I cycled in and out of hospitals.
I was prescribed Suboxone for two to three years, and it did help.
Suboxone was a real lifesaver for me. I was able to address other things in my life that were compounding and contributing to… my addiction. But that was not ultimately able to sustain me. I was missing the spiritual component, [recovery] really necessitates you being totally honest with another human being.
I was surrounded by people, but you can be alone in a crowded room.
I was [working] on the parity law, which put me in contact with the recovery community. So ironically, even though I was still suffering, I’m leading the charge to ensure that insurance companies don’t discriminate against people with these illnesses.
NCHN: You were struggling with addiction even while you were writing addiction into the act?
KENNEDY: They all knew, but I didn’t know.
When I wrote A Common Struggle, I went back and talked to the people that I used to work with. They said they knew I was a disaster. I wanted to say, ‘How come all of you didn’t do something?’ But that’s really the heart of the ‘common struggle’ that I talk about, and that’s the silence that pervades this issue and prevents us from making any real progress.
NCHN: How can we break the stigma and taboo around mental health issues?
KENNEDY: You need to do it from the bottom up and the top down.
Passing the Civil Rights Act did not cure this nation of racism. That law created a new normal so that my kids grow up and they see integration. The law helps create cultural change because people have to now work together. There’s a new normal.
To make that metaphor with the mental health and addiction movement– they’ve never been part of the health care system, they’ve been on the side, and never included in your medical chart.
So, when your other physicians try to do your checkup, they have no idea what’s really going on with you, because it’s not integrated. So I used to score most of my opioids from my other docs; none of them had a clue. And I had this serious back operation, and boom, they’d write whatever I want.
None of them got any training in addiction at medical school.
Atrium, they’re making sure there’s an [informed] handoff for those with addiction in the ER, which is where a lot of people with addiction present.
They believe in pushing to change the system so that all of their medical professionals get educated. That should be the norm, it will be in 10 years. The question is, how fast do we get there?
NCHN: Tell us about Smart Approaches to Marijuana, your anti-legalization organization.
Today we’re talking about opioids, now it’s fentanyl. There’ll be other substances that are going to come down the line and the bottom line is we have to be taking all of this very seriously. I co-founded SAM because I believe that in five to 10 years, we’re going to have a marijuana crisis in this country.
Youth use rates are skyrocketing, and we’re not talking [low percentages of tetrahydrocannabinol]. Today it’s like we have the fentanyl of marijuana in terms of its potency.
NCHN: Don’t you think legalization would help with research into the effects of marijuana?
We already have Epidiolex medication, which was just approved by the FDA to address people with seizure disorders. That was the Trojan horse for this whole medical marijuana movement and we have Marinol for people with cancer.
NCHN: So you want to keep marijuana illegal?
Marijuana is pretty ubiquitous and I am against people being arrested for using at low levels. It’s wrong. Commercializing marijuana is what I’m against. We don’t need a new Big Tobacco. We don’t need a new Corporate Marijuana that has addiction as its driving force.
NCHN: How can we avoid this corporatization, given that support for legalization is already rising in the U.S.?
You can decriminalize and not legalize, there’s a huge difference there. So you cannot allow pot tarts, gummy bears filled with THC, elixirs which are like Red Bull of THC, brownies, chocolate, all kinds of candies with THC, vaping which is like smoking 98 percent THC. The bottom line is it’s a whole industry, it would not flourish if we did not legalize it.[sponsor]
I want to be clear, I led the fight for drug courts in this country and for expungement of record of drug convictions. There should be pathways to pardon, and possession [shouldn’t] be a conviction at all.
But we cannot be blind to the fact that if it’s being sold all around us, there’s a lower risk perceived in using it because now it’s called “medical marijuana.” If it’s everywhere, kids don’t perceive any harm in it, that’s how things get going.
I am equally for rolling back the concessions we’ve made locally, statewide and nationally to the liquor industry. We allow them to advertise on cable TV. There’s all of these hard lemonades, mixed sodas, soda waters with alcohol and there’s powdered alcohol… we need to be pushing back on that.
NCHN: It seems like you’re a one-man warrior against all forms of addiction.
What people don’t understand is there’s not one addiction and another addiction, they’re all the same disease. They’re all characterized by this compulsion to use and an insatiable need to use more. It’s not to get high so much as to not fall so low.
Initially, people use to get that euphoria, and then they spend the rest of their life to not get the dysphoria, and that’s true of everything, whether it’s marijuana, opioids, cocaine. You’re trying to avoid the crash. If you’re addicted to one thing, you end up substituting other addictions for it if you don’t treat the underlying disease.
NCHN: Do you have any advice for people who might need mental health treatment?[Addicts] are the only ones who can decide [to go for treatment.] No one can do it for them, but what we can do is make sure that when they decide to get help that it’s there for them. They should know that there are people out there just like them who want to help them.
Readers can check https://www.paritytrack.org/report/north-carolina/ to see how N.C. stacks up in terms of the national mental health parity law. If they have a complaint about how their insurance covered mental health versus physical illness, they can learn how to appeal or complain at https://www.parityregistry.org/. Both sites are sponsored by The Kennedy Forum.