On Thursday, July 13, Roll Call publications sponsored a forum on Fighting the Opioid Crisis. The forum included introductory remarks by David Hawkings, Senior Congressional Editor of Roll Call, David Cordani, President and CEO, Cigna, sponsor of the event, a discussion with Senator Joe Manchin (D-WV) and Congressman Tim Murphy (R-PA), a discussion on current Legislative Efforts to End the Opioid Crisis with Congresswoman Ann McLane Kuster (D-NH); Dr. Leana Wen, Commissioner of Health, Baltimore, MD; and Cynthia Reilly, Director, Substance Use Prevention and Treatment Initiative, The Pew Charitable Trusts and ending with a discussion and presentation on Successful Interventions for Opioid Addiction with Mayor Nan Whaley, Dayton, OH; Dr. Amy Kilbourne, Acting Director, VA Health Services Research, and Allison Jaslow, Executive Director for Iraq and Afghanistan Veterans of America.

In opening remarks David Cordani discussed what that health care organization was doing and he said that there are more than 2.5 million people with substance use disorders tied to opioid use.  Several speakers highlighted that opioid-related fatalities are now starting to exceed annual deaths due to automobile accidents.  Recently the New York Times calculated all drug overdose deaths ranged from 59,000 to 65,000 annually.  At the turn of this century they were approximately 20,000.  Congressman Tim Murphy (R-PA) talked forcefully about the need for more mental health and drug treatment.  Highlighting the need for both effective drug treatment including therapy along with any medication assistance he also highlighted a shortage in mental health services.  Murphy indicated that the nation eliminated the use of group homes in mental health but never followed up in community-based mental health services.  At one point, he pointed out that if a person has a mental illness they are ten times more likely to be placed in jail than in treatment.

Senator Joe Manchin (D-WV) also discussed the ravages of opioids in his state of West Virginia and the need for more drug treatment.  He talked about legislation he has been working on to open some of the health record confidentiality rules so that there can been better coordination between doctors.  He pointed out that some addictions start or expand through people doctor-shopping to get prescriptions.  Manchin also has legislation that would levy a one cent tax on opioid prescriptions that would yield between one and a half to two billion dollars in drug treatment funds.

The last panel focused on the viewpoint of medical and addiction-treatment professionals and community-based experts on what’s really working on the front lines to address opioid addiction and what can be learned from treating the veteran population.  It included survey results of what medical practitioners and veterans felt was effective.  For all people suffering from opioid addiction, practitioners and other Americans agree on the three most effective responses to help people stop using opioids permanently: medication assisted therapy, behavioral therapy and peer counseling.

The opioid crisis traces its roots to the overuse of prescription opioid medications with people addicted to the legal substance switching to the cheaper street heroin which is now being combined with Fentanyl –including some especially toxic street versions.  The drug can be so toxic that even law enforcement officials or drug sniffing dogs can die from exposure if not handled properly.

The crossover between the increasing drug addiction crisis and child welfare is coming more into public focus with a growing number of publications highlighting the subject.  Many publications are finding dramatic increases in foster care demand.  In some cases these increases are so great that communities, cities and states can’t keep up with the need for placements.  The Washington Post reported this month that Ohio’s foster care system has seen more than 60 percent of their children coming into care due to parental drug abuse.  A recent report from public broadcasting in the Sarasota, Florida area included a quote from a regional child welfare official who said,

“we’ve actually had to have a lot of our children either placed in group homes to keep siblings together or outside of our circuit and then that means you have the case manager driving to pick them up or foster parents driving to meet them and that’s not the environment we want for our children “

A recent article in Governing Magazine quoted an Ohio association official as indicating that in addition to the dramatic increases in foster care placements and the increased demand for foster homes it is also having an impact on their child welfare workforce.  The association estimated that the opioid epidemic, at least in part, is responsible for the 1 in 7 caseworkers in Ohio leaving their positions because of burnout.

The opioid epidemic has also caught the attention of some in Senate and their reluctance to cut or cap Medicaid funding into the future.  The question is when the Congress moves on from health care and returns to look at child welfare will they continue to pursue the same “budget neutral within child welfare services” strategies to address the increasing caseloads.