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November 01, 2017

Senate HELP Committee Holds Hearing on Opioid Response

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The Senate Committee on Health, Education Labor and Pensions (HELP) convened a hearing in early October to examine the federal response to the opioid crisis. Senators heard testimony from top officials representing the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Food and Drug Administration (FDA), regarding the opioid-related efforts underway at each agency.

In opening remarks, HELP Chairman Lamar Alexander highlighted the committee’s past efforts to stem the national crisis, including the 2016 passage of the Comprehensive Addiction Recovery Act (CARA) and the 21st Century Cures Act. He discussed the way each law has led to the issuance of millions of dollars in grant funding in 2017 to states, health providers, and community organizations engaged in prevention, treatment, and recovery projects, and invited the agency leaders to further elaborate on how the Trump Administration intends to move forward on implementation.

In her remarks, Ranking Member Patty Murray outlined the questions she hoped would be answered by each agency and expressed concerns regarding the Trump Administration’s overall response to the opioid crisis. She characterized the Administration’s actions as a “hindrance to our efforts” and cited proposed budget cuts for prevention efforts around substance use disorder and mental health programs at SAMHSA and the “undermining of the value of medication-assisted treatment in effectively managing opioid use disorders.”

Four agencies offered testimony – each under HHS – by the following experts:

  • Dr. Elinore F. McCance-Katz, Assistant Secretary for Mental Health and Substance Use at SAMHSA;
  • Dr. Debra Houry, Director of the CDC’s National Center for Injury Prevention and Control;
  • Dr. Francis Collins, Director of the NIH; and
  • Dr. Scott Gottlieb, Commissioner of the FDA.

Committee Discussion

Senator Chris Murphy highlighted that Dr. Katz is the first Assistant Secretary for Mental Health and Substance Use at SAMHSA, a new position created under the 21st Century Cures Act. She detailed for the committee the many activities SAMHSA is overseeing to implement the CARA and 21st Century Cures Act, including administering a wide range of grant streams aimed at mental health interventions and the proliferation of medication assisted treatment. She emphasized to the lawmakers the importance of greater integration of mental health and substance abuse treatment into primary care, and better training among a wide range of providers, noting the co-occurring health issues that can be addressed from an integrated approach.

Senator Michael Bennet asked about the federal policy that incarcerated individuals lose access to their Medicaid coverage after transitioning out of prison. Dr. Katz agreed that when former inmates are transitioning back into society, it is a critical time for them to have access to the treatment and support services they need, but said it is a policy set by Congress and the federal government.

Through her testimony, Dr. Houry described how the CDC is focused on the critical effort to prevent addiction in the first place, by funding state efforts in Prescription Drug Monitoring Programs (PDMP) and other data-driven prevention programs. She also highlighted the importance of CDC’s public health surveillance work, which she said helped scientists make the initial connection between the opioid crisis and prescription drugs. “Public health data helps us all understand the crisis,” she said. She said the CDC has access to county-level data and has been able to pinpoint outbreaks in certain cases.

Senator Bill Cassidy questioned why agencies aren’t better able to pinpoint the physicians/facilities engaged in inappropriate prescribing, when each is linked to tracking systems and identifications registered with the Drug Enforcement Agency (DEA). Dr. Houry noted that while money from the 21st Century Cures Act is allowing greater collection of data in this regard, each state has their own PDMP system, and tracking and investigations are driven at the state level, making it difficult.

Senator Elizabeth Warren mentioned that in the last budget process, a modest increase in funding for the CDC was approved, and questioned what the agency was able to do with the money. Dr. Houry said that CDC expanded surveillance system programs from twelve to thirty-two states, granted funding to coroners and medical examiners for the first time to provide enhanced capacity for toxicological screenings, and helped twenty-two more states to adopt CDC communications campaigns on prevention.

Dr. Collins highlighted NIH’s research addiction, chronic pain, and on medication assisted treatment (MAT), and said the agency continues its commitment to identifying which individuals succeed on which treatments, what the best methods of delivery are. He also discussed how NIH is collaborating with industry to advance the development of non-addictive pain medications, as well as new forms of MAT.

Dr. Gottlieb commended the work of the FDA prior to his arrival, and said that since he has joined the organization he has sought to focus the agency’s opioid response on three areas:

1) reducing the incidence of addiction by limiting overall exposure of the public to immediate release prescription opioids;

2) spurring new product innovation to both render current products less susceptible to abuse, and to create new non-addictive alternatives; and

3) bringing a broader array of medical therapies to help treat addiction and transition people to sobriety.

He said steps the agency is taking to implement these changes include: extending risk management programs to include provider education requirements and upcoming guidance to industry on product development.

Chairman Alexander indicated that the hearing was the first in a series that the Committee will hold on the nation’s battle with opioids, and a second hearing next month will cover state and local perspectives on the efforts happening on the ground. The HELP Committee also met on Tuesday, October 17th, to examine the costs of prescription drugs.

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