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.”
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Source: MedicalNewsToday.com
