By Kyle Simon
Congress is finally talking about our nation’s prescription drug abuse and heroin epidemic. Last month, Senate Majority Leader Mitch McConnell (R-Ky.) and Sen. Ed Markey (D-Mass.) requested an official report from the surgeon general on prescription opioid abuse and heroin use. Later this summer, the Department of Health and Human Services (HHS) will bring together officials from across the country to discuss responses to the crisis.
The Centers for Disease Control and Prevention (CDC) report that, in 2013, 16,235 Americans died of opioid-related overdoses, and heroin deaths reached 8,257, for a total of 24,492 lives lost. The CDC has warned that the epidemic could lead to more severe outbreaks of HIV and hepatitis C nationally, much like the one in a southeastern Indiana community of 4,200, in which 158 people have tested positive for HIV and 122 individuals have been diagnosed with hepatitis C.
The problem is clear. So are the solutions.
Since 2009, dozens of not-for-profit health and safety organizations have come together each year to identify prevention, intervention, and treatment strategies to reduce opioid abuse, heroin use and their consequences. More than 30 not-for-profit health and safety groups have vetted and endorsed the 2015 National Prescription Drug Abuse Prevention Strategy.
States at the forefront of reducing prescription drug abuse have taken aggressive action and are seeing results. In Florida, for example, where the legislature enacted strong pill mill laws and prosecutors have cracked down on the physicians who operate them, opioid analgesic-related overdose deaths are down 17 percent.
As we successfully reduce the supply of prescription medications available for abuse, naturally, we must address demand. Among the most obvious and best ways of reducing the demand for substances of abuse is to ensure people with addiction get the treatment they need. This is where the federal government must do more.
Sen. Sherrod Brown (D-Ohio) got it right last year when he stated, “We’ve got a problem when it’s easier for Americans to get heroin than it is for them to get help to break their addiction.”
A federal law enacted before this epidemic took hold prevents physicians from treating more than 100 patients at a time with buprenorphine, an FDA-approved medication for opioid-use disorders. The patient limit established by the Drug Addiction Treatment Act of 2000 (DATA 2000) was intended to prevent diversion and abuse of the medication.
Now, the demand for treatment exceeds capacity, with half of the physicians authorized to provide buprenorphine-assisted treatment forced to relegate patients in need to waitlists. At best, those patients fuel the demand for diverted buprenorphine on the black market — precisely what DATA 2000 attempted to prevent. At worst, they never reach the top of the waitlist.
The Obama administration has had its chance to act, and it has declined to do so. In July 2014, HHS received a petition for rule-making to increase the patient limit for physicians who hold certifications in addiction medicine, and to exclude from the limit women who are pregnant or nursing – an attempt to stem the tide of neonatal abstinence syndrome. Other practical proposals exclude from the limit patients who pose a low risk of diversion or abuse, such as individuals who get implants or injections, are on a low dose of buprenorphine, or have succeeded for two years or more in uninterrupted recovery.
HHS never responded to the petitioners.
In the absence of meaningful executive leadership, Congress must now step in. Carefully expanding access to medication-assisted treatment for opioid-use disorders can reduce overdoses, HIV, hepatitis C and deaths. Enough talk already. It is time for federal action.
Published in The Hill on July 1, 2015.