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We’ve all read enough headlines about addiction and overdose. This conference addressed what to do about it. 

“Health Systems and Addiction: The Use and Misuse of Legal Substances” was a free, status-taking conference designed for a broad audience. It was appropriate for providers who specialize in addiction, but primarily targeted health system executives, practitioners, researchers and policy makers who seek a greater understanding of substance use disorders and the role health systems play within acute-care and community-based care settings.

Public and payment policies shape how these institution-based systems act and this was carefully examined.

National thought leaders brought evidence and insights on the scientific understanding of addiction, innovations in the prevention of misuse of legal substances, and initiatives to treat and manage addiction.

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Read Conference Proceedings

Wednesday, November 16, 2016

Welcome, Acknowledgements, and Introduction to the Format and Major Themes of the Conference

(Video recording)

Session 1: A Conversation Framing the Issues

(Video recording)

This session begins by laying out the major themes, structure and rationale of the conference. A moderated conversation among representatives of key constituencies will examine critical issues surrounding the interface between the use and misuse of legal substances, including from a person-centered perspective. Participants will address emerging perspectives and controversies in policy and practice. This includes what roles the health system should play in improving care and lessening harm, and how this mix is changing.

Session 2: Scientific Foundations - Brain Science and Epidemiology

(Video recording)

The session will explain key aspects of our neuroscientific understanding of how legal substances such as ADHD medications, opioids, and benzodiazepines affect the brain, including what we know now and what is on the horizon. It will also examine the changing demographics affected by legal substances. Poly-substance use will be discussed as well.

Session 3: Changing Landscape of Use and Misuse

(Video recording)

During this session, participants will discuss the balance of use and misuse of legal substances. We will hear how the FDA applies regulatory science to address this balance and learn from three case studies on: opioids, medications intended to treat attention deficit hyperactivity disorder (ADHD), and the science, and social and policy issues surrounding cannabis and cannabinoids.

  • Moderator: Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute
  • Barry Meier, Reporter, The New York Times and Author, Pain Killer: A "Wonder" Drug's Trail of Addiction and Death
  • Alan Schwarz, Author, ADHD Nation and Former Reporter, The New York Times (Slides)
  • Susan Weiss, PhD, Director, Division of Extramural Research, National Institute on Drug Abuse (Slides)
  • Douglas Throckmorton, MD, Deputy Center Director for Regulatory Programs, Center for Drug Evaluation and Research, Food and Drug Administration

Session 4: The Unique and Changing Roles of the Military and Veterans Affairs Health Systems

(Video recording)

The Departments of Defense and Veterans Affairs will both participate and will address issues such as: coordination between DoD and VA as well as with the civilian health system, approaches to person-centered treatment, community-based care, education and training of clinicians, and controversies surrounding the use of integrative therapies.

Session 5: How Providers Are Delivering Addiction Care

(Video recording)

This session is a data-driven discussion among providers to explore the status of knowledge concerning acute treatment for addiction, follow-on maintenance care, and their interplay. Central to this discussion is effectiveness of treatment options including medications like Suboxone and Naloxone, cognitive behavioral therapy, and abstinence programs like AA and NA. Access to and availability of primary care and to facilities along with coordination and transition of care are key topics as well.

Session 6: The Role of Public and Private Payers in Addressing Use and Misuse

(Video recording)

This session will examine the current approaches to payment by public and private payers for the use of legal substances and for the treatment of addiction. Speakers will discuss how payers are working to address a variety of substances, including opioids; and whether and how payers’ policies foster collaboration amongst themselves. The capacity and incentives for using alternative therapies, and parity and essential health benefits will also be discussed.

  • Moderator: Gail Wilensky, PhD, Senior Fellow, Project HOPE; Trustee, ECRI Institute  
  • Doug Nemecek, MD, MBA, Chief Medical Officer, Behavioral Health, Cigna
  • James B. Becker, MD, Medicaid Medical Director, West Virginia Bureau for Medical Services, Vice Dean for Government Affairs and Health Care Policy, Joan C. Edwards School of Medicine, Marshall University
  • Patrick Conway, MD, Deputy Administrator for Innovation & Quality, Chief Medical Officer, Centers for Medicare and Medicaid Services (CMS) (Slides)

Thursday, November 17, 2016

Session 7: How Health System CEOs Perceive and Execute their Roles

(Video recording)

This session is a conversation among the CEOs of three major, geographically and organizationally diverse health systems. Regional variation exists in what substances are legally prescribed or available (e.g., marijuana). The CEOs will discuss among themselves and with the audience the roles they are, and should be, playing to ensure appropriate use of legal substances and to treat people who have misused medications; and their successes and failures. Key issues include: drug testing of health system workforces; the effect of limiting prescriptions on quality ratings; creating drug dependencies in the course of treatment; readmissions and the incentives and disincentives of caring for populations.

  • Moderator/Speaker: Ralph Muller, President and CEO, University of Pennsylvania Health System; Trustee, ECRI Institute
  • Elizabeth Concordia, President and CEO, University of Colorado Health
  • Andrew McCulloch, MHA, President, Kaiser Foundation Hospitals and Health Plan of the Northwest

Session 8: Barriers and Solutions to Effective Prevention of Misuse

(Video recording)

This session will focus on specific efforts and innovations in the prevention of misuse of legal substances. The roles of drug monitoring databases, provider education, and public education will be addressed. We will hear about the integration of care for substance use into primary care settings in a major health system. The role of pharmacists in preventing misuse will also be addressed.

Session 9: Barriers and Solutions to Successful Treatment

(Video recording)

This session continues on and pairs with Session 8. We will focus on patient-centered specific programs and initiatives to treat and manage addiction. We will examine how the criminal justice system is utilizing drug courts as an alternative to jail. Additionally, the impact of information protection and stigma on treatment and research will be examined.

Capstone Session: Is Political Will Overcoming the Tragedy of the Commons?

(Video recording)

In this town hall discussion, Governor Peter Shumlin will look to the future and report on the progress and obstacles encountered since his State of the State address in January 2014 on the drug epidemic in Vermont.

*Funding for this conference was made possible in part by grant number R13HS023720 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Conference Venue

The National Academy of Sciences
2101 Constitution Ave, NW
Washington, DC 20418

ECRI Institute was thrilled to celebrate the 23rd anniversary of our annual policy conference at the historical National Academy of Sciences building dedicated by President Calvin Coolidge as a place “…to lead the public in thinking deeply and seeing how research can explain fundamental problems.” 


This page compiles significant articles and other resources related to the use and misuse of legal substances, addiction, and health systems. Please check back for updated information.

ECRI Institute Research

Additional Articles and Resources