AAOS October 17, 2017
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Eric Hargan Serving as HHS Acting Secretary

Senate Talks Opioid Epidemic with Administration Officials

MACRA Episode-Based Cost Measures Field Testing

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House of Representatives Legislative Activities

Senate Legislative Activities
Senate Talks Opioid Epidemic with Administration Officials

On Thursday, October 5, Senator Lamar Alexander, Chairman of the Senate Committee on Health, Education, Labor, and Pensions, convened a hearing to examine how well the federal government has responded to the mounting opioid epidemic. Committee members discussed legislation that addresses prevention and treatment of the opioid crisis, including the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act (CARA), both of which include provisions intended to reduce the impact of opioid use disorders.

Chairman Alexander pointed to a study in March, which revealed that 1/5 patients who were prescribed an initial 10-day supply of opioids were found to still be using opioids a year later. He stressed the importance of a bipartisan approach to the crisis, as well as the need for public-private partnerships and state integration of drug monitor programs. Ranking Member Patty Murray raised concern for budget cuts proposed by the current administration, as well as the treatment of addiction as a criminal justice issue. In her opening statement, she warned against complacency with existing legislation alone, saying that “as we work to build upon our work in CARA and Cures, it’s absolutely critical that we put investments into ensuring these policies have the impact that families and communities need.”

Dr. Elinore McCance-Katz, Ph.D., Assistant Secretary for Mental Health and Substance Use, began her testimony by pointing to the continued increases in overdose deaths since 2013, and she stressed the Trump administration’s commitment to the opioid health crisis. She highlighted five Health and Human Services (HHS) strategies to guide the response to the crisis:

  • Improving access to treatment and recovery services
  • Promoting use of overdose-reversing drugs
  • Strengthening our understanding of the epidemic through better public health surveillance
  • Providing support for cutting edge research on pain and addiction
  • Advancing better practices for pain management

In terms of the Substance Abuse and Mental Health Services Administration (SAMHSA) implementation of the 21st Century Cures Act and CARA, Dr. McCance-Katz discussed the State Targeted Response to the Opioid Crisis Grant Awards program created by the 21st Century Cures Act. She said the program is increasing access to treatment, reducing unmet treatment need, and reducing opioid-related deaths. She also pointed to SAMHSA regulation of opioid treatment programs, as well as the CARA provision that allows nurse practitioners and physician assistants to prescribe Buprenorphine. Dr. McCance-Katz closed her statement by emphasizing the increased availability and use of Naloxone through SAMHSA grants, as well as data from the National Highway Traffic Safety Administration (NHSTA) used to track trends in opioid use.

Dr. Debra Houry, MPH, stressed the Centers for Disease Control and Prevention (CDC) mission of using a comprehensive approach as outlined in the HHS strategy to end the epidemic. She discussed the CDC’s work with state health departments in instituting best practices, improving prescribing practices, improving prescription drug monitoring programs (PDMPs), and evaluating policies. Additionally, she emphasized the importance of tracking non-fatal opioid overdoses in order to have a better understanding of the changing epidemic and respond accordingly. In regards to patients and families, Dr. Houry pointed to the CDC’s RX Awareness communications campaign to raise awareness about the risks of prescription opioids.

Dr. Francis Collins, Ph.D., Director of the National Institutes of Health (NIH), pointed to increasing relapse rates, stressing that more options besides opioid antagonist drugs are needed to end the epidemic. He stated that more detailed data on medication success rate is needed in conjunction with individual patient data, such as dosage, time, etc. He pointed to the expense of Naloxone injection kits and expressed support for the NIH development of a nasal spray for more straightforward application.

Dr. Scott Gottlieb, Commissioner at the Food and Drug Administration (FDA) expressed focus for three domains of activity:

  • Reduction of the rate of new addiction, as well as reduction of overall exposure to opioid drugs
  • New product innovation to render current opioid products less prone to abuse or replaced entirely by non-addictive pain treatments and/or medical devices
  • Development of better medical therapy to help those addicted transition to lives of sobriety

Finally, Dr. Gottlieb highlighted the FDA’s participation in the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership to address issues of trials needed for approval. He also stressed the importance of access to effective medically assisted therapy for the treatment of addiction.

For more information, access Chairman Alexander’s press release and Ranking Member Murray’s press release on the hearing.