WASHINGTON — Public health and criminal justice experts and a clinician directly impacted by the opioid crisis shared examples of interventions they believe are helping to drive down the epidemic during a hearing of the Senate Health, Education, Labor, and Pensions (HELP) Committee on Thursday.
Increasing prescriber education, enhancing prescription drug monitoring programs (PDMPs), providing incarcerated individuals access to treatment, and preventing low-level offenders from being jailed in the first place are effective strategies for combating the opioid crisis, they said.
Omar Abubaker, DMD, PhD, of Virginia Commonwealth University in Richmond, shared his personal connection to opioid addiction: his 21-year-old son Adam died from an overdose in 2014 after becoming addicted following a Vicodin prescription for a minor shoulder injury.
“My pain is magnified because my profession shares some of that burden,” he said.
Abubaker told the committee that the entire educational system needs to change so that dentists, doctors, and nurses will begin to see addiction for the brain disease that it is.
“What we’re trained is really write the prescription and … walk away from the patient,” he said.
This lack of education, he believes, is one reason for the crisis.
In his written testimony, he urged the committee to enact federal mandates requiring education on opioid prescribing, pain management, and addiction.
Sen. Al Franken (D-Minn.) agreed: “I firmly believe all physicians need this training … Our nation’s clinicians need to know when they see someone who has an addiction problem, and I don’t think they get that training.”
Another panelist spoke of Rhode Island’s comprehensive response to the opioid epidemic, which is widely viewed as a national model. Rebecca Boss, director of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, described the state’s comprehensive program that promotes prevention, rescue, treatment, and recovery for individuals with substance use disorders or the potential to develop such issues.
Gov. Gina Raimondo (D-R.I.) created The Governor’s Overdose Prevention and Intervention Task Force, which Boss co-chaired. It developed a strategic plan, the cornerstone of which was access to treatment.
The $2 million in state funding for programs in fiscal years 2017 and 2018 has allowed Rhode Island to adopt an approach of “every door being the right door.” For example, anyone entering the corrections systems is screened for opioid use disorders and, when appropriate, started on medication assisted therapy, or continued on such therapies, Boss said.
Currently, 300 inmates receive access to medication assisted treatment each month, she noted.
The state’s Anchor MORE program lets recovery coaches reach out to addicted individuals on the the streets and to inmates in the corrections system prior to their release. Boss touted a 75% success rate in connecting former inmates to care in the community.
A similar program, AnchorED, connects overdose survivors with coaches. The state recently developed a pilot program with special authorization allowing these survivors to consent to being reached after they’ve left the hospital, which is showing some preliminary success, she said.
Boss is optimistic about the 10% reduction in overdose deaths for 2017 — a statistic expected to be formally announced this week. However, “the battle is far from over and we need to press on,” she said.
Boss thanked Congress for passing the 21st Century Cures Act, which included $1 billion for prevention, treatment, and recovery from substance use disorders. She also acknowledged that measures in the Comprehensive Addiction Recovery Act, such as changes to waiver requirements for prescribing substance use disorder treatment, are one reason the state now has twenty new, mid-level practitioners to help to manage this population.
John Tilley, JD, Secretary of the Justice and Public Safety Cabinet for Kentucky, also thanked Congress for state grants provided in the “Cures Act,” which allowed pilot programs such as one that provides inmates with naltrexone 30 days before release, on the day of release, and in the community setting.
Finally, Andrea Magermans, managing director of the Wisconsin Prescription Drug Monitoring Program, spoke of the success her state had in integrating PDMPs with the electronic health record.
The Wisconsin e-PDMP — the “e” stands for enhanced — allows “one-click access” to a patient’s prescription history, including warnings about high levels of opioid use and concomitant benzodiazepine prescribing. The systems also tracks patients who travel long distances to obtain prescriptions.
In addition, prescribers can use the tool to evaluate their own prescribing patterns compared with peers in their specialty, and their supervisors can monitor the e-PDMPs to find outliers.
Data from the e-PDMPs is also collected by the Wisconsin State Controlled Substances Board, where staff can determine whether to refer a prescriber to a state licensing board for disciplinary action.
Several of the committee members, mainly Democrats, pressed witnesses about the issue of opioid funding.
While President Trump declared the opioid epidemic a “public health emergency,” he has yet to send Congress a supplemental funding request.
All of the witnesses agreed that additional funding would be needed to help quell the opioid epidemic.
Asked about the impact of a potential $1 trillion cut to Medicaid if the Republican tax reform bill passes, most of the witnesses agreed their programs would be negatively affected.
Tilley wavered, arguing that access to Medicaid does not necessarily mean better outcomes.
But, “if we don’t have money to do the things we do today, there will be some changes,” he said.
Boss was unequivocal: “I think all of our efforts are disintegrated,” she said. “Our access to treatment is foundational and Medicaid supports access to treatment.”