House Members Divided on Response to Opioid Crisis
Republicans stress border issues, Democrats talk treatment $$
https://www.medpagetoday.com/psychiatry/opioids/79782
WASHINGTON — A House Oversight Committee hearing on the opioid crisis revealed a partisan split over its main drivers and how best to address them.
A Republican member identified drug supply and border security as the main problem. “One party wants more money, more money, and more money,” said Rep. James Comer (R-Ky.) at Thursday’s hearing held by the House Oversight & Reform Committee.
“Until we cut off the flow of illegal drugs coming across the border … we’re still going to have a drug problem,” he continued. “If we’re serious about stopping the flow of illegal drugs in the U.S., we’re going to have to get serious in this Congress about securing the border.”
In addition, he said, “the business model to treat pain has been wrong. Doctors … for whatever reason, overprescribed opioids for the treatment of pain. We’ve come a long way in educating our medical providers on the perils of opioids … but there are also a lot of people in America that have legitimate pain, and there are people that deserve and have the right to treat their pain.”
Rep. Eleanor Holmes Norton (D-D.C.) had a different take. “At first glance, the president’s budget appears to put a priority on public health priorities, but at a second look, the president has very inconsistent policies here; he’s gutting the programs critical to the objective of confronting the opioid epidemic. I say that because so many caught in the opioid epidemic depend on Medicaid — 4 in 10 adults [are] struggling with this addiction … I’m trying to find the real deal on the resources that are committed to this program.”
The Office of National Drug Control Policy (ONDCP), the White House office tasked with developing a strategy to combat the opioid crisis, has made some progress, but still has a ways to go, said witness Triana McNeil, acting director for homeland security and justice at the Government Accountability Office (GAO).
She said ONDCP’s strategy omitted key requirements, “including a performance system to track [results].”
Recently, the drug control office has provided the GAO with some of the materials it has requested for oversight purposes, McNeil said, noting that her office will be issuing a report on the agency’s progress. However, she replied in response to questions from Rep. Jackie Speier (D-Calif.), “there are two things [that] we’ve been asking for from [the] ONDCP for us to continue make progress — one, the budget guidance they used, and two, the National Security Council Strategic Framework for reducing the availability of illicit drugs. We asked for [those] in December and still haven’t received [them].”
Medication-assisted treatment, especially buprenorphine, came up several times during the hearing. Karyl Rattay, MD, director of public health for the state of Delaware, “strongly urged” lawmakers to pass legislation to modify the “3-day rule.” This rule limits a non-waivered emergency room physician to administering — but not prescribing — buprenorphine one day at a time for relieving acute withdrawal symptoms in overdose patients awaiting admission into treatment.
“The Association of State and Territorial Health Officials is deeply concerned that the requirements of the 3-day rule are preventing providers from appropriately managing withdrawal and we are missing opportunities to successfully engage [and get] people into treatment,” she said. “I implore the committee to address this immediately.”
Rep. Ro Khanna (D-Calif.) noted that in France, which had an opioid epidemic in the 1980’s and 1990’s, the government eliminated a waiver requirement — similar to the one now enforced in the U.S. — limiting the number of patients that primary care physicians could treat with medication for substance use disorders, “and opioid overdoses dropped 80% after they did that.”
ONDCP director James Carroll, who also testified at the hearing, responded that “buprenorphine is very effective, but not without its own dangers, and we do need to make certain that the people prescribing it are properly trained,” he said. “The original cap … was 100 [patients], and the Secretary of Health and Human Services engaged in rulemaking and moved it up to 275 [patients]. But I think you’re right and one of our goals is to make sure buprenorphine is more available.”
Rep. Pete Welch (D-Vt.) asked about increasing the use of peer coaches to help patients with opioid use disorder get through recovery. Carroll agreed they were important. “They really do help — they can reach out and say, ‘I’ll hold your hand and get you through this,'” Carroll said.
Carroll particularly praised a project that uses a “quick response team” that visits opioid-addicted patients on their second day of treatment; it consists of a law enforcement officer — someone not in uniform, who is there to take away any illicit drugs with no questions asked — plus a public health official, a member of a faith-based community, and a peer counselor.
“This type of quick response team, it works,” said Carroll.
Rep. Carolyn Maloney (D-N.Y.) asked about ways to increase the use of non-pharmaceutical alternatives to opioids. “One thing I’ve heard from doctors is that the incentive is to give pain medication,” she said, adding that she was pleased that patient satisfaction surveys have dropped questions about whether physicians have completely relieved their patients’ pain. “Instead of asking [patients] to rate whether the doctor took away all their pain, you could ask the doctor, ‘Did you try every other alternative form of pain relief before you moved to an opioid?'”
“I think you should take opioids totally off the market, unless it’s [for] hospice [patients], because [they’re] harmful to people,” Maloney added. “Most people [get] addicted by the doctor giving them these pills.”
Rattay noted that changing physician prescribing habits “is a tough nut to crack,” in part because the system is set up to favor drugs over other types of therapy. “Insurance is much better at reimbursing for pharmaceuticals, including opioids. We’re now working on massage and acupuncture and requiring reimbursements for those.”
Filed under: General Problems
This is where its going people!!!!Notice not 1 long term medically ill person in physical pain from their medical condition was invited,,Heck not even a acute physical pain person was there to represent the LAWFUL RIGHT, for effective physical Pain relief from a medical condition,,why was no-one there or invited who has a physically painful medical condition,,,, its corrupted ,,Cruel inhumanetreatment is against the law,,,WTH is wrong w/these people????!!!!Again why do they think they have the right to decide who forcible suffers in physical pain from ANY medical condition??No-wonder why my question concerning exactly that has been censorred EVERYWHERE
IN AMERICA!!!!!Combing addiction with the medically ill has always tortured the medically ill,,r they really that inhumanely stupid??Agreed a simple waiver on our informed consent form would of stopped all of this..Say,something like,,”I am aware of the possible low risk of addiction ,however as a adult i formally dismiss my doctors of any legal,medical recourse should i choose as a ADULT to abuse,divert or become addicted to any medicine my doctor prescribed.. .This type of patient/doctor informed consent legal statement/law would of allowed and prevented any $$$$$$$$ making scheme of kolodny,addiction psychaitry DEA,,OR LAW ENFORCEMENT!!!!!WHY WASN;T THAT EVER THOUGHT OF OR CONSCIDERED???Since when is some police,dea,,,my doctor?Since when is some senatore my doctor,,,they don’t have the legal authority to practice medicine.Furthermore none of them are recognizing International treaty laws,which America has signed and ratified that opiates are a essential medicine when used for physical pain from physically painful medical conditions!!!!!MARYW
.aloney has No Clue what he’s talking about! In 2017 are very own CDC published that less than 2% of all legally prescribed hopefully patients ever abused the drugs and less than .02% ever became addicted to the drugs because of prescription! This always has a continues to be caused mainly by the illicit pills and street drugs, basically all illegal drugs. Our own government admitted this many times now, but ignorant people that just want to run their mouth don’t acknowledge it. We need to allow actual chronic pain patients to get relief from the pain that they are suffering because this has become inhumane Torture to our own citizens and a lot of them are veterans! I don’t understand how our own government can be so ignorant and naive about this situation. I’m sure part of it is because a lot of them are benefiting off of the importation of the legal street drugs. This has been known improving for the past 60+ years. Obviously those people in our government and government agencies are not willing to do the right thing but the rest of them should be willing to, but are just too ignorant to know him better.