The President’s Commission on Combating Drug Addiction and the Opioids Crisis released its final report on Wednesday, November 1. That wasn’t the only action or debate of the week on the topic, but it was the most significant.
The Commission Final Recommendations:
The report includes 56 recommendations but falls short on what they might cost to implement. The Chair of the Commission, Governor Chris Christy (R-NJ) said it was on the Congress to now act on the recommendations. Referring to the President, Christie said, “He knows that this is an area where we have to invest, that we have to spend money in this area…That’s Congress’s job…”
The report offers limited detail regarding children and youth but does recommend increased school-based screening of youth through school-based programs. It also states that the incidence of Neonatal Abstinence Syndrome (NAS) admissions increased fourfold between 2003 and 2012 cost going from $61 million in 67,000 hospitals to $316 million in 291,000 hospitals in 2012.
Recommendation 47 deals specifically with children and families. The recommendation encourages the promotion of “best practices” by HHS, SAMHSA, and the Administration on Children, Youth and Families regarding keeping families together (including kinship care), promising models for pregnant and post-partum parents, supportive housing and implementing a “plan of safe care.” The recommendation offers nothing in terms of congressional action, funding and resources or guidance on what the plan of safe care should be.
The overall recommendations are subdivided between:
- Federal Funding and Programs
- Opioid Addiction Prevention (Prescribing Guidelines, Regulations, Education, PDMP Enhancements, Supply Reduction and Enforcement Strategies),
- Opioid Addiction Treatment,
- Overdose Reversal, and
- Recovery, and Research and Development.
The report recommends “block granting funds” to states and that, “there are multiple federal agencies and multiple grants…that cause states a significant administrative burden…” The Commission recommendation indicates that all fifty governors would support uniform block grants of funding, but it is not clear which specific programs would be rolled together. Block grants always have appeal in making it easier for governors and states to spend the funds but many of these block grants grew up because of an unmet need or population. For example, the Regional Partnership Grants (RGPs) under Title IV-B/$20 million came about because larger drug treatment funds were not being used for this underserved population.
For the child welfare community this will be an area to monitor since the $20 million for RPGs was created in 2006 as a substitute for a much larger bill, the Child Protection/Alcohol and drug Partnership Act, that would have funded much larger grants to coordinate drug treatment between state substance abuse directors and child welfare programs.
Another potential area that could assist child welfare is the called for expansion of Drug Courts and Diversion programs to all 93 federal jurisdictions. The Commission indicates that only 44 percent of counties have these courts that divert people from jail to treatment. There is a similar effort such as family drug courts that focus on families in danger of losing their children due to an addition problem.
Like other proposals from other bodies, the Commission has several recommendations dealing with better monitoring and control of prescription drugs. There are many recommendations regarding coordination and enforcement such as interdiction through customs, monitoring of drugs as well as increased DEA enforcement—a recent topic of controversy in Washington. There are also recommendations regarding better data tracking of drug use as well as data to track drug related deaths. The next step for these 56 proposals would be for Congress to fill in the blanks…including the money.
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Forum with Rogers and Kennedy
As part of the week of activity that focused on opioid addiction the news magazine Politico hosted a briefing to discuss what Congress can do to deal with the epidemic. Panelist included Dr Mark Bickett, Johns Hopkins Hospital, Congressman Joe Kennedy (D-MA), JeanMarie Perrone, University of Pennsylvania, and Congressmen Hal Rogers (R-KY).
In some of the opening remarks one of the physicians remarked that 80% of the opioids prescribed in the world are used in the United States even though we are only 5% of the population. There was also a recitation of the numerous statistics that continue to build information about the dramatic impact of opioids on the nation.
Of special interest where the comments of the two Members of Congress, Congressman Kennedy and Congressman Rogers. Rogers is the former Chair of the House Appropriations Committee and he was asked about the recommendations of the Commission. He talked about how he liked some of the potential flexibility that the President’s executive order would allow, and he also pointed to $8 billion that he said was being spent across the government to deal with drugs and the opioid problem. When asked if there was enough money he said no but that there could be some reallocation of current funding. He did then indicate that it was possible that more money was needed.
For his part, Congressman Kennedy, (who spoke before the CWLA this past spring), talked about how complicated the challenge has been in his home state. Kennedy discussed his experience as a prosecutor and the need for greater investment and funding as well as strategies on prevention. Kennedy said a single policy could not solve this, but it had to be a complex and multifaceted approach including law-enforcement and treatment capacity and that it does require more federal funds.
Dr. Jeanmarie Perrone at one point indicated that one in 10 people who are rescued by Narcan and who survive will eventually die from an overdose. She argued that we are failing on some of our strategies and drug treatment when we have had that person and failed. Congressman Rogers did acknowledge that addiction is a disease and it needed to be treated more in that fashion—a growing consensus and shift away from what many members of Congress would have said more than 20 years ago when we were dealing with crack-cocaine epidemics.
Forum at Brookings
On Friday, November 3 the week ended with another panel presentation on opioids at the Health Policy Center at the Brookings Institute. That forum was titled, Policy Approaches to the Opioid Crisis with remarks Sir Angus Deaton, University of Southern California, Congresswoman Ann McLane Kuster (D-NH), and Professor Bertha Madras.
Congresswoman McLane-Kuster opened with remarks about her current position as Co-chair of the bipartisan Heroin Task Force. She discussed efforts in New Hampshire and reflected on some of the bipartisan efforts in the U.S. House. At one point she indicated that there is talk that in the House there may be a “week of opioid legislation” but was uncertain. She also went on to describe certain efforts in New Hampshire offering up at least one local initiative that uses fire stations as “safe zones” for someone with an addiction. The person can go and get referred to help without risk through key nonprofits in the community who are equipped to assist in getting services and treatment. The Congresswoman also made a point of talking about how much of the treatment access that is been provided in her state of New Hampshire could not have been accomplished without the Medicaid expansion under the Affordable Care Act.
Sir Angus Deaton a Presidential Professor of Economics, focused on his recent research which has been eye-opening to many. He has examined the opioid epidemic and its impact on certain white populations. Recent research has indicated that there is an increasing mortality rate for individuals who are older, white and less than a college education. Contributing factors to this mortality is increased drug use, suicide and some health conditions. This increased mortality does not exist with other ethnicities, individuals of color, or even against a similar white population in European countries. The research included a deeper dive on how these increased mortality rates for white 45 to 54 age groups increases for people with only a high school education and increases for people born in the 1950s, 1960s, 1970s and 1980 with the younger age groups experiencing higher mortality.