House Committee Holds Hearing on Combating the Opioid Crisis
The House Energy and Commerce Committee convened a hearing to review the federal government’s response to the opioid epidemic on Wednesday. Lawmakers sought a status update on the implementation of the Comprehensive Addiction and Recovery Act (CARA), the 21st Century Cures Act, and various grant initiatives and heard from the heads of the top agency leads within the Department of Health and Human Services. The hearing reflected a bipartisan consensus that more resources are needed to tackle a disease that claims the lives of 91 Americans every day.
INCREASING MEDICATION-ASSISTED TREATMENT
During opening statements, Dr. Nora Volkov, Director of the National Institutes on Drug Abuse (NIDA) explained that medication-assisted treatment, a highly effective treatment for opioid addiction, is vastly underutilized across the country. To expand access to medication-assisted treatment, the committee oversaw the passage of two major initiatives —the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act (Cures) last year.
Dr. Elinore McCance-Katz, Assistant Secretary at the Substance Abuse and Mental Health Services Administration (SAMHSA), updated committee members on both laws, saying the states have received their first round of CARA and Cures grant funding for MAT and that the agency will begin collecting performance data later this year. SAMHSA has also started processing waivers to allow nurse practitioners and physician assistants to prescribe buprenorphine in accordance with the requirements of CARA.
Dr. Scott Gottlieb, head of the Food and Drug Administration (FDA), emphasized that all three FDA-approved medications of opioid addiction (methadone, buprenorphine, and naltrexone) should be made available to patients so they can select the treatment option best suited to their needs. Dr. Gottlieb announced that the FDA would take a more active role in challenging the negative assumptions associated with treating addiction with medications by speaking more often about their appropriate and effective use. Dr. Gottlieb clarified, “We should not consider people who hold jobs, reengage with their families and regain control over their lives through treatment that uses medications to be addicted.”
EXPANDING COMMUNITY-BASED ADDICTION SERVICES
Multiple committee members wanted to know what types of interventions beyond MAT would help reverse the tide of opioid addiction. Dr. McCance-Katz pointed to SAMHSA’s efforts to reduce opioid overdose death through naloxone and expanded access to long-term recovery supports through the Building Communities of Recovery program. She also shared her experiences from Rhode Island, where individuals with lived addiction experience go to emergency rooms and encourage individuals who have recently overdosed to seek treatment. Representative Doris Matsui (D-CA) asked the panel how the Certified Community Behavioral Health Clinics (CCBHCs) demonstration would affect the nation’s opioid response. Dr. McCance-Katz explained that in 8 selected states, CCBHCs are in the process of bringing together the elements of mental health and substance use treatment so that people with co-occurring conditions can receive treatment in one location.
REDUCING OPIOID DIVERSION
According to Dr. Anne Schuchat of the Centers for Disease Control and Prevention (CDC), increasing safe prescribing practices for prescription painkillers is key to preventing the non-medical use of opioids. To implement safe prescribing practices, the CDC created safe prescribing guidelines for doctors and other prescribers and continues to help states enhance their Prescription Drug Monitoring Programs (PDMPs). Law enforcement efforts on opioid trafficking are now responding to the rise of fentanyl and other synthetic opioids. Neil Doherty from the Diversion Control Division at the Drug Enforcement Agency (DEA) explained that these drugs have a higher potency than heroin and often make it to U.S. from China through mail carriers. All panelists agreed that the development of non-addictive pain remedies would be crucial to reducing the demand for opioids.