Shaquita Ogletree

Last Wednesday, April 11, the Senate HELP Committee held a hearing on additional legislation to deal with opioids. The legislation, The Opioid Crisis Response Act of 2018, has been called by some a second version of the 2016 Comprehensive Addiction and Recovery Act (CARA). The Committee released a discussion draft.

The focus of the hearing was to discuss the draft legislation. Witnesses included: Jennifer Donahue, Child Abuse Investigator Coordinator of the Delaware Office of the Child Advocate, Robert Morrison, Executive Director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), and Jessica Hulsey Nickel, President & CEO for Addiction Policy Forum.

Ms. Donahue is responsible for reviewing and monitoring child fatalities, child maltreatment and is responsible for Plans of Safe Care, and other grants provided to the state programs. She discussed how Delaware is developing draft Plans of Safe Care. There is a need for additional funding to support implementation and monitoring of Plans of Safe Care including access to Medicated Assisted Treatment (MAT). In 2015 there were 294 notifications to the child welfare agency, and in 2017 that number jumped to approximately 450 with 78% of the cases involving infants exposed to substances or opioids in Delaware.

Donahue also discussed the Delaware Child Abuse and Neglect Panel (CAN Panel). They reviewed cases between 2010-2014 and found that there were 17 policy failures related to infants with prenatal substance exposure. Aiden’s Law, named after an infant who died in 2015 after suffering from abuse and neglect from his heroin-addicted parents, aims to prevent child fatalities and improve state’s policies. Ms. Donahue called on the need for more guidance and additional funding to implement Plans of Safe Care and strengthening the state’s child welfare workforce because the child welfare system is underfunded and overburdened.

Senator Robert Casey (D-PA) highlighted the additional $60 million to CAPTA to implement Plans of Safe Care and is proposing a more permanent program. He inquired about the role of multi-disciplinary teams in implementing Plans of Safe Care. Ms. Donahue thought the team could assist various stakeholders such as family, clinical social worker, caseworker, substance abuse treatment counselor and others because it is not the responsibility of one agency but many. The implementation and monitoring of the Plans of Safe Care have been a challenge stated Ms. Donahue due to lack of funding and training.

In response to a question from Senator Patty Murray (D-WA), Ms. Donahue highlighted the need for mental health services in school for children, especially those who experience trauma. Senator Pat. Roberts (R-KS) asked about the effectiveness of telemedicine in schools as a solution to improve access to treatment and if there were other services to treat patients with substance abuse. Jessica Nickel, Addiction and Policy Forum, praised the effectiveness of telemedicine to prescribe medicated assisted treatment, counseling and behavioral support. Senator Lisa Murkowski (R-AK) stated that mental health and substance abuse and treatment in schools could break multigenerational trauma, but in Alaska the lack of access to therapeutic services is unavailable. In Alaska, providers offer services in schools, but it is challenging to fund mental health professionals.

Ms. Nickel spoke about both of her parent’s struggles with heroin addiction that took their lives. Highlighting the need to remember her parents and other victims of addiction, such a remembrance resulted in her efforts in the formation of her organization to advocate for a comprehensive response to additions. Senator Susan Collins (D-ME) inquired if peer to peer recovery models were instrumental and sustainable and Ms. Nickel highlighted what we have learned from peer support from the fields of mental health and veterans services. She spoke about how peer support specialist can support individuals in crisis.

Senator Johnny Isakson (R-GA) also shared the tragedy of losing his grandson in 2016 and that you never know who or how individuals become exposed or addicted. He recommended that providing education, awareness, and talking with children is critically important along with making sure that drug abuse is not stigmatizing. Senator Doug Jones (D-AL) raised the issue around the workforce and employment and its interaction with substance use disorders. Ms. Nickel emphasized that the pathway to recovery is employment and support from employers. Addicted individuals need access to employee assistance program to help with their addiction.

Robert Morrison, representing state substance use agencies, offered a series of recommendations. He encouraged Senators to provide legislation that will ensure that state alcohol and drug agencies are involved in the funding and programs in an effort to promote coordination and avoid creating parallel, duplicative, or bifurcated systems of care. He also urged members to ensure consistent, predictable and sustained funding and resources to avoid a financial cliff and to continue to work to address the opioid crisis but also elevate efforts to address all substance use disorders, including those linked to alcohol and other substances.

Sen. Murkowski (R-AK) said that in Alaska the addiction is alcohol and that heroin is declining but methamphetamine is skyrocketing. Mr. Morrison underlined the need for flexibility for states to target their own unique needs. Senator Elizabeth Warren (D-MA) discussed how the misuse of unused medication serves as a source of drugs and that partially filling opioid prescriptions may be a viable solution. According to Mr. Morrison, SAMSHA data revealed that use of drugs not prescribed to individuals comes from friends and families.

Ms. Donahue raised another concern, she commented on women avoiding pre-natal care out of fear and the stigma—the fear of losing your child and the stigma of addiction. She recommended a non-punitive public health approach.

At the end of the hearing, Chairman Alexander (R-TN) informed that the committee will convene on Tuesday, April 24, 2018 at 10 AM.