Testifying before a U.S. House Energy and Commerce subcommittee, experts said Tuesday that more flexibility and stability in funding is necessary to battle the next phase in the war against opioid addiction.
During the Oversight and Investigations subcommittee hearing entitled, “A Public Health Emergency: State Efforts to Curb the Opioid Crisis,” health and addiction experts from five states expressed concerns that the focus of state efforts must now turn to prevention, requiring them to use federal funds in different ways, and requiring more sustainable funding from the federal government.
U.S. Rep. Diana DeGette (D-CO), subcommittee chair, said the crisis is moving into a new stage and Congress must be aware of how the funds they’ve allocated towards the crisis are being used, and if they are effective.
“This crisis has continued to evolve, and the challenges that we face have continued to evolve along with it, DeGette said. She explained that the first wave of the crisis began in the 1990s with the over-prescribing of pain medication, followed by a second wave that began in 2010 with increased deaths due to heroin overdoses. A third wave was marked by the rise of synthetic opioids such as fentanyl.
“Now, unfortunately, it looks like a ‘fourth wave’ of the crisis may have already arrived, DeGette said. “The opioid epidemic has fueled a huge increase in methamphetamine use. In 2018, there were more than twice as many deaths involving meth as 2015, and meth is increasingly turning up in overdose deaths and drug busts across the country.”
Jennifer Smith, secretary of the Pennsylvania Department of Drug and Alcohol Programs, said that as the primary drugs found in overdose deaths changes, states need to have more flexibility in how they spend federal money in order to address those changes.
“We need the flexibility to address the system, not the substance,” Smith said. “The long-term success of our programs and communities depends on sustained support.”
In Pennsylvania, opioid overdose deaths rose between 2014 and 2017 from 2,700 to 5,400, or about 13 per day. But between 2017 and 2018, the state saw an 18 percent decrease in overdose deaths, largely due to innovative strategies taken at the state level, she said.
Increased awareness, access, and distribution of naloxone, a medication used to reverse the effects of opioid overdose, such as NARCAN nasal spray, was cited as one key initiative that saw results.
Pennsylvania distributed nearly 13,000 naloxone kits free of charge directly to Pennsylvania residents over three days in December 2018 and September 2019, Smith noted in her written testimony.
“Funding used toward public messaging and awareness of naloxone availability in Pennsylvania communities – throughout our standing order prescription, as well as naloxone availability through Centralized Coordinating Entities for first responders – likely also contributed significantly to this reduction in deaths,” she said.
The state also included addiction content in medical school curriculums, installed 800 prescription drug take-back boxes across the state and instituted a “warm hand-off” program that transferred patients who had survived an overdose to treatment facilities. The state also worked to expand its support of pregnant women with addiction issues, to increase the number of physicians in the state and to expand medical addiction treatments into its corrections facilities.
But as the drugs causing overdose deaths change, the state’s need flexibility in order to move quickly and effectively, she said.
“Now we’re seeing more polysubstance abuse,” she said. “It’s challenging to appropriately tie the care to opioids while some of the people we’re treating may not identify opioids as their primary substance.”
In West Virginia, the No. 1 state for opioid overdose deaths in the country, federal funding has helped that state see a reduction in the number of opioid overdose deaths for the first time in over 10 years.
Christina Mullins, West Virginia’s Commissioner for the Bureau of Behavioral Health in the Department of Health and Human Resources, said the state has reduced its opioid prescriptions and opioid overdoses by half.
“Our Naloxone prescriptions have increased by 208 percent,” she said. “Additionally, we have distributed over 10,000 doses of Naloxone to health departments. Treatment capacity has been transformed … through an increase in the number of residential treatment beds from 197 to 740 and those beds are 85 percent full about all of the time.”
But now, as the state turns to look at data to find the root cause of the opioid epidemic in that state, funding the state can count on is crucial for things like construction projects for treatment facilities, and addressing the workforce shortage issue.
Almost all of the panelists cited workforce shortages as an obstacle to helping more of their states’ residents struggling with addiction issues.
“We do not have enough people to deliver the key treatments that are needed across the state,” Mullins said.
U.S. Rep. Bob Latta (R-OH) said Congress needed to continue to fund the battle against the opioid epidemic, utilizing a centralized information system to let states know what funding is available. Latta’s legislation, the Indexing Narcotics, Fentanyl and Opioids (INFO) Act was signed into law in 2018 as part of H.R. 6, the SUPPORT Act.
“Last Congress, I authored the INFO Act in order to create a one-stop-shop dashboard to help states learn about the various substance use disorder funding opportunities available across the federal government so they can better serve the people in their communities who are struggling with substance abuse,” Rep. Latta said. “A record amount of resources are being made available to prevent addiction, provide treatment and combat this crisis, but we need to ensure that communities… can access these funds.”
The next phase for the states, the panel said, was to use federal funding to determine the root causes of opioid addictions through data-driven analysis.
“We need funding that lasts for extended time and with flexibility to deal with the coming wave of methamphetamine,” said Kody Kinsley, deputy secretary of Behavioral Health and Intellectual and Developmental Disabilities for the North Carolina Department of Health and Human Services. “Our strategies are working but our eyes are on the horizon.”