Last Thursday the Senate HELP Committee focused on the topic of spreading opioid addiction and what current Administration leaders and departments were doing about it. One of the starkest statistics (from the CDC) is that for every opioid related overdose death, there are another 60 addicts out there.
The witnesses were Food and Drug Administration (FDA) Commissioner Scott Gottlieb, National Institutes of Health (NIH) Director Francis Collins, Assistant Secretary for Mental Health Elinore McCance-Katz, and the Centers for Disease Control and Prevention (CDC) Director Brenda Fitzgerald.
The hearing was well attended, with many Senators discussing what they were seeing in their own states. Chairman Lamar Alexander (R-TN) pointed out in his opening remarks that Tennessee has an opioid prescription rate of 1,100 prescriptions per 1,000 people. He also talked about the 1,631 people who died of overdoses last year and the 1,000 babies who were born addicted. Ranking Member Patty Murray (D-WA) also discussed babies and the increasing number being born addicted in Washington State.
Senator Murray, joined by several other Democrats, also highlighted what the impact on access to substance abuse treatment would be if the ACA were repealed. Later Senator Bill Cassidy (R-LA) defended his block grant/per capita cap proposal, arguing that his bill would provide more money to states that had not expanded their Medicaid and that it would give states more flexibility to address these substance abuse problems.
Many Committee members raised questions and offered comments regarding a lack of access to drug treatment services. Senator Lisa Murkowski (R-AK) raised questions about some of her remote Alaska areas, the use of telemedicine, and how best to address the drug treatment needs of some homeless populations in her state. Senator Maggie Hassan (D-NH) asked that SAMSHA have a better distribution formula for the emergency CARA ACT funds approved by Congress for FY 2017 and FY 2018. She pointed out that New Hampshire received only $3 million of the $500 million funds despite having the highest per capital drug related death rates. Senator Todd Young (R-IN) focused attention on the impact of heroin use and its injection method of delivery and how that is contributing to the number of Indianans with HIV and hepatitis C—both of which can be spread through intravenous drugs. Other senators highlighted the number of drug overdoses and fatalities.
Senator Susan Collins (R-ME) bemoaned a new Portland Press Herald headline (Portland, Falmouth officials deliver bleak report on opioid crisis: ‘It’s getting worse’ ) that stated the opioid crisis was worsening in that city. According to the newspaper report and Senator Collins, in 2016, 376 drug-induced deaths were reported statewide, representing a 38-percent increase over the deaths reported in 2015. In line with the sentiments expressed by several senators, that Maine forum discussed the vital role of treatment. A local police official took aim at Attorney General Jeff Sessions’ recent comments:
“Create and foster a culture that is hostile to drug use.’ This is the leader of law enforcement. … Police Lt. John Kilbride went on to say, He’s so far off-base. He doesn’t get it that it is a disease of the brain that can capture an 18-year-old who took oxycodone when he had his wisdom teeth out and he’s dead three years later, two years later. If our attorney general doesn’t get it, who does at the federal level?”
Senator Al Franken (D-MN), like many Senators, asked for attention in specific areas. Franken focused on the need to better address the issue in Indian Country, urging the agency heads to engage tribal leaders and to pay special focus to Neonatal Abstinence Syndrome (NAS).
Senator Tim Kaine (D-VA) wondered if, like the 1961 challenge of John F. Kennedy to land a man on the moon within the decade, we could challenge ourselves with a goal of being addiction-free by 2030. Dr. Collins from the NIH said we did need to be bold in our thinking and did not dismiss the suggestion.
Many questions and responses focused on how we can better prevent usage. The responses and the strategies included better or alternate pain management, including speeding up the development of less addictive pain killers. Other senators want greater research and better implementation of effective practices. Others focused on greater interdiction though the mail and internet, which is becoming an important and open source for drugs including the deadly Fentanyl, which is being combined with heroin and other opioids.
There seemed to be overall agreement that drug addiction and substance abuse was in fact a disease. That opinion may signal progress, since the approach to addiction during the 1980s predominately involved incarcerating addicts, including pregnant women.