AAOS September 31, 2017
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Trump Addresses Opioid Crisis, Congress Talks Other Efforts

On Thursday, October 26, President Trump addressed the nationwide dramatic increases in opioid use in the ongoing and evolving crisis, declaring the opioid epidemic a public health emergency. The declaration, which lasts for a duration of 90 days, allows for increased access to telemedicine for residents in rural areas, a problem that many members on the House Energy and Commerce Committee have highlighted in the past.

“Nobody has seen anything like what is going on now. As Americans, we cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction,” said President Trump in his address.

The previous day, Chairman Greg Walden of the Committee on Energy and Commerce convened a hearing to provide a status update and review implementation of the provisions in the Comprehensive Addiction and Recovery Act (CARA) and the initiatives funded by the Opioid State Targeted Response (STR) grants, authorized in the 21st Century Cures Act. The hearing also reviewed other federal efforts to address the opioid crisis, additional steps Congress can take to augment those efforts, and address new and emerging issues in the fight against opioid abuse.

Chairman Walden pointed to multiple bipartisan investigations related to the opioid epidemic this year from the Subcommittee on Oversight and Investigations, such as the “pill dumping” investigation and the investigation of “patient brokers” who are serving as intermediaries and profiting from recruiting patients seeking addiction treatment. He, along with Ranking Member Frank Pallone, stressed the importance of cooperation from the Drug Enforcement Administration (DEA) in providing information for these investigations.

“We all want to end this scourge,” Walden said.  “We have a duty to our constituents and the American people to combat the epidemic from all angles -- everyone has a stake in this fight.”

Ranking Member Pallone expressed concern for the absence of a representative from the Centers for Medicare & Medicaid Services (CMS). He emphasized the importance of increased funding for substance abuse initiatives, and he cautioned against congressional support for the Senate’s recently approved 2018 budget blueprint.

Dr. Scott Gottlieb, MD, began his testimony by pointing to three new FDA steps in expanding access to treatment:

  • FDA issuance of guidance for product developers in order to promote the development of new addiction treatments
  • FDA promotion of more widespread use of existing safe and effective FDA-approved therapies to help combat addiction
  • FDA participation in efforts to break the stigma associated with medications used for addiction treatment, taking a more active role in speaking about the proper use of the drugs

Following Dr. Gottlieb’s testimony, Dr. McCance-Katz discussed the Substance Abuse and Mental Health Services Administration’s (SAMHSA) State Targeted Response to the Opioid Crisis Grants program created by the 21st Century Cures Act. She stated that the program is increasing access to treatment, and she pointed to SAMHSA regulation of opioid treatment programs. She pointed to the recent SAMHSA allocation of grants through CARA and their role in providing resources to treatment providers. 

Dr. Anne Schuchat, MD, highlighted the CDC’s Overdose Prevention in States (OPIS) in her testimony, which provides resources and scientific support to 45 states and Washington, D.C., as well as the CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program, the third program under OPIS, which improves the timeliness of reporting fatal and non-fatal opioid overdoses. Dr. Schuchat also stressed the importance of cooperation across sectors, such as initiatives with law enforcement agencies in order to strengthen collaboration on the federal level. In terms of consumer education, she discussed the CDC’s Rx Awareness communications campaign to increase awareness about the risks of prescription opioids.

Dr. Nora Volkow, MD, explained that NIH is exploring ways to promote new and innovative medications and technologies to treat opioid addiction and improve overdose prevention and reversal interventions, as well as safe, effective, non-addictive strategies to manage pain. She highlighted the NIH public-private partnership that developed an intranasal naloxone product to reverse opioid overdose, and she reiterated NIH’s commitment in preventing health consequences for infants born with NAS. In terms of pain management, Dr. Volkow pointed to NIH’s Federal Pain Research Strategy, which coordinates the federal research agenda on pain and focuses on prevention of acute and chronic pain, management of acute pain, transition from acute to chronic pain, and understanding the disparities that influence pain and pain management.

Finally, Mr. Neil Doherty began his testimony by raising concern for exploited loopholes in the analogue provisions of the Controlled Substance Act and their aid to foreign-based fentanyl manufacturers and domestic distributors. He pointed to the transport of heroin from Mexico across the southwest border through established distribution networks for profit. Additionally, Mr. Doherty discussed DEA and Chinese collaboration in countering the threat from fentanyl class substances and reiterated DEA’s commitment to continued collaboration with China in the future.

For more information, access Chairman Walden’s press release and President Trump’s White House press release.