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December 12, 2017

Senate Appropriations Committee Takes on the Opioid Epidemic

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On December 5, 2017, the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies held a hearing to discuss the opioid epidemic and the possible role that Congress could play in the prevention, treatment, and recovery.

Senator Roy Blunt, the Subcommittee Chairman, opened the hearing by discussing the fact that overdose related deaths outnumber the deaths at the peak of the AIDS/HIV epidemic. Overdose deaths have also overtaken automobile accident fatalities to become the number one cause of accidental death in the United States. Senator Blunt also spoke about the three proposals he believes the Subcommittee needs to focus on moving forward. Those three proposals are: (1) understanding the best options for treating an opioid use disorder, including recognizing that behavioral health issues should be treated like any other physical health ailment; (2) stemming the number of individuals who become addicted in the first place, including improving surveillance to better understand where the problems are and where they are the most severe; and (3) developing new pain treatments as adequate alternatives to opioids.

Senator Patrick Leahy, the Senate Appropriations Committee Ranking Member, also mentioned the high rate of opioid-related deaths and heavily criticized the Trump Administration for not budgeting more money to fight the epidemic, noting that the president’s declaration of a public health emergency was “all talk and no action.”

Subcommittee Ranking Member Senator Patty Murray also criticized the Trump Administration and its response to the epidemic. She did suggest a solution, however, urging Congress to focus on restricting synthetic fentanyl — a main driving force in the opioid epidemic today.

Witnesses present at the hearing were: Francis Collins, Ph.D., Director at the National Health Institute; Patrick Kennedy, former Congressman and current member of the President’s Commission on Combatting Drug Addiction and the Opioid Crisis; Elinore McCance-Katz, Ph.D., Assistant Secretary for Mental Health and Substance Use at Substance Abuse and Mental Health Services Administration (SAMHSA); and Debra Houry, Ph.D., Director of the National Center for Injury Prevention and Control in the Centers for Disease Control and Prevention (CDC).

As with most Congressional discussions, funding played a prominent role in the hearing. Mr. Kennedy expressed concern about the lack of funding to fight the crisis. He had previously called for the Federal government to provide $10 billion a year for a decade to fight the epidemic. He stated that this number was the minimum amount that should be provided and cited that when the AIDS epidemic was at its height, Federal spending was “$24 billion of today’s dollar.” Senator Shelley Capito also voiced concerns that there are not enough resources available for states that have the most need.

Senator Leahy opined that the best way to treat individuals with opioid addiction it to prevent addiction, questioning what steps the NIH has taken to treat chronic pain without using opioids. Dr. Francis Collins, the Director at the National Health Institute, stated that there are two things to take into consideration when avoiding addiction: (1) understand the transition from acute to chronic pain, as opioids work well for acute pain when the patient is exposed to the drug for only a short amount of time; and (2) the longer the patient is prescribed to the opioid, the more likely they will transition to addiction.

Education was also discussed, with Senator Capito wondering how closely prescriptions were being tracked by the CDC and questioned why those numbers were not flagged earlier. Dr. Houry responded that the CDC has been tracking numbers for a few years and they are now sending officials to communities that have exceptionally high prescription rates to educate prescribers about over-prescribing. In that vein, Senator Dick Durbin questioned whether doctors are paying attention to CDC prescribing guidelines. Dr. Houry noted that the CDC is being more rigorous with training for physicians and nurse practitioners while they are still in school. Further, for those who are no longer in school, the CDC has started online courses that outline safe prescribing practices.

Overall, throughout the hearing, members of the Subcommittee showed bipartisan support for promoting the development of effective, non-addictive pain medications.

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