On the same day that the FDA issued black box warning to all immediate release opioids, the House Committee on Oversight and Government Reform held a hearing entitled “America’s Heroin and Opioid Abuse Epidemic.” The hearing focused on the alarming increase in abuse of illegal opioids, i.e., heroin and fentanyl, as well as controlled prescription opioids like hydrocodone and oxycodone.
According to the Centers for Disease Control and Prevention (CDC), the rate of overdose deaths involving opioids increased by 200% from 2000 to 2014. Additionally, in 2014, sixty-one percent of drug overdose deaths involved some form of opioid, and on average, seventy-eight Americans die daily from overdoses of heroin or painkillers. Congress has held several hearings over the past few months on the topic, and adding to their concern, researchers have found that prescription opioid abuse serves as a gateway of sorts to heroin use and the National Institute on Drug Abuse shows an increasing number of high school students and young adults using OxyContin.
Congressional members in attendance at the hearing heard from five witnesses from various organizations and government agencies: The Honorable Michael Botticelli, the Director of the Office of National Drug Control Policy; Mr. Lou Milione, the Deputy Assistant Administrator for Diversion Control at the Drug Enforcement Administration; Ms. Kana Enomoto, the Acting Administrator for Substance Abuse and Mental Health Services Administration; Leana S. Wen, MD, MSC., FAAEM, the Health Commissioner at the Baltimore city Health Department; and The Honorable Teresa Jacobs, the Mayor of Orange County, Florida.
Discussion
Rehab Can’t Be the Only Solution
Republican John Mica, got quite vocal at the hearing, when he stated that rehabilitation is not enough when it comes to dealing with heroin and opioid addiction. As he stated, “treatment is at the end of the process. They’ve already been addicted.” Mica called for immediate action, “we haven’t killed this many people in multiple-year wars as we’re killing in one year. We are going to lose half a million people in a decade at this rate. Every family has been affected by it, and now it’s just a slaughter out of control.”
Emergency Fund
Representative Carolyn Maloney was one of several Congressional members present who were perturbed that a $600 million emergency fund has been passed in the Senate as part of the Comprehensive Addiction and Recovery Act, but the House has not picked up a companion bill. In her mind, and in the mind of others, what good is the emergency fund if it has not been funded? Representative Maloney urged colleagues on both sides of the aisle to work on passing a companion bill funding the $600 million before going home for recess.
Safe Prescribing
Dr. Wen was asked several times what she felt caused the epidemic and what can be done in the future to stop the epidemic from spreading any further. Dr. Wen believes that part of the problem is the cultural idea that there is a pill to resolve every pain and that there is one pill or combination of pills that will patients to be completely pain free. She believes that before we can truly evaluate and halt the epidemic, it is important to get away from that idea, and instead, move toward an idea that appropriate treatment should be the goal.
Dr. Wen also stated that she believes that the CDC guidelines released recently are helpful, but that more concrete guidelines would be helpful, including specifics on: monitoring and regulating the price of naloxone, require co-prescriptions for naloxone to every individual receiving opioid medications, require a “black box warning” on opioids and benzodiazepines, and remove barriers that currently exist to prescribing Buprenorphine.
Other Topics
Another topic touched upon was brought up by Mayor Jacobs, who reminded Congressional members that the country galvanized around the tobacco industry years ago, which had a huge impact and helped to reduce tobacco use and deaths related to tobacco. She suggested that something similar be done with opioids, and perhaps if Americans came together and work on a campaign to create and increase awareness for painkiller, heroin, and opioid addictions, there could be a huge impact.
Congressman Ken Buck mentioned the idea that many young people, including teenagers, are actually getting the drugs from their parent’s drug cabinets. He encouraged the FDA and other governmental agencies to look into doing something similar to opioid bottles as is done to aspirin bottles, and creating tamper resistant bottles. The DEA also agreed that would be something to look into.
Takeaways
Currently, primary and secondary prevention programs are in place to decrease the use of potential gateway drugs in youth and others who are vulnerable to heroin use. In 2015, $400 million was appropriated to address the opioid epidemic – an increase of $100 million; however, to date, none of the money has been spent.
On Tuesday afternoon, following the hearing, the Food and Drug Administration (FDA) announced new guidelines, which call for prescription labels to warn that opioids can cause a dangerous central nervous system reaction if they interact with antidepressants and migraine medications, along with other warnings.