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Marathon week of hearings, forums, legislation aims to solve US opioid dilemma

A marathon week of hearings, forums, new legislation and strategies put a fresh spotlight on the massive problem the U.S. is confronting in trying to find solutions to an epidemic of opioid abuse that grew over the past 15 years to become a national crisis of overdoses and death.

The week started with President Donald Trump delivering his strategic plan to stop opioid abuse and reduce the drug supply and demand.

Trump's blueprint was short on details, but members of his administration have been traveling around the nation or holding forums in Washington to obtain feedback on what additional steps are needed.

In Trump's address to the nation, however, he was more focused on taking tough tactics, particularly against drug dealers — including pursuing the death penalty.

In a March 20 memo to U.S. prosecutors, Attorney General Jeff Sessions described the types of crimes where capital punishment should be considered, including certain racketeering activities, the use of a firearm resulting in death during a drug trafficking crime, murder in furtherance of a continuing criminal enterprise and dealing in extremely large quantities of drugs.

Legislation and hearings

In the Senate, a group of Republicans, led by Sens. Lindsey Graham of South Carolina and Tom Cotton of Arkansas, introduced legislation to toughen the penalties for anyone caught trafficking in fentanyl — a drug 100 times more powerful than morphine — and its synthetic analogues.

Sens. Elizabeth Warren, D-Mass., and Shelley Moore Capito, R-W.V., also introduced a bill aimed at ensuring more doctors and patients know about the option to partially fill opioid prescriptions, in which only a few pills at a time are dispensed at the pharmacy.

In the House, members of the Energy and Commerce Committee held three days of hearings examining 25 bills and listening to pleas and feedback from nearly 20 witnesses.

As the sole witness at the first of those sessions, which was convened by the panel's Oversight and Investigations Subcommittee, Robert Patterson, the acting administrator at the Drug Enforcement Administration, or DEA, was put in the hot seat about why his agency failed to stop the flood of opioids into West Virginia — which has the highest opioid death toll in the nation.

Many of those pills were shipped by distributor McKesson Corp. to small-town pharmacies — the numbers of which "shock the conscience," said Rep. Gregg Harper, R-Miss., chairman of the subcommittee.

He noted that the panel's investigation revealed that nearly 21 million opioids were shipped over 10 years to pharmacies in Williamson, W.V., home to only about 3,000 people, while another 9 million pills were distributed over just two years to a single pharmacy in Kermit, W.V, where only about 400 people live.

Between 2007 and 2012, distributors shipped more than 780 million hydrocodone and oxycodone pills to West Virginia, Harper said.

"The numbers we have seen coming out of that state are alarming," declared Rep. Diana DeGette, D-Colo., ranking member on the subcommittee. "What on Earth were people thinking?"

"This needs to stop," she said.

Lack of DEA leadership

Distributors are required to tell the DEA how many controlled substances they ship each month and where those pills go and when suspiciously large orders are being placed by pharmacies, noted Rep. Frank Pallone, D-N.J., Energy and Commerce ranking member.

Yet the DEA failed to track the data thoroughly and use it to stop those shipments, he said.

In trying to defend his agency's actions, Patterson acknowledged he had only been serving in an acting capacity as chief since October 2017.

"I doubt you volunteered for the job," Rep. Joe Barton, R-Texas, remarked, noting that Trump has yet to name a nominee to lead the DEA — a position that has gone unfilled in the midst of the opioid epidemic.

Rep. Michael Burgess, R-Texas, chairman of the Energy and Commerce Health Subcommittee, said that as a practicing physician, he was "always fearful" of the DEA.

"Turns out, they weren't really paying attention," he said March 22 at the second day of the hearing convened by his panel.

Unprecedented response needed

Tackling the opioid epidemic is going to require a multipronged, comprehensive approach, Burgess said on March 21 at the opening of the Health Subcommittee's two-day session.

"The unprecedented plague of opioid addiction and substance-use disorder in our country requires an unprecedented response," added Rep. Greg Walden, R-Ore., chairman of the Energy and Commerce Committee.

The economic burden of prescription opioid misuse to the U.S. is $78.5 billion per year, noted Rep. Gene Green, D-Texas, Health Subcommittee ranking member.

At the hearing, the committee heard from 18 witnesses representing government, industry, providers and patients.

Among those was Scott Gottlieb, commissioner of the U.S. Food and Drug Administration, who called on lawmakers to better clarify his agency's authority to ensure regulators have the power they need to address the crisis.

While the FDA believes it can legally ask a drugmaker to remove its opioid from the U.S. market based purely on the drug's potential for illicit use, Gottlieb said having "carefully constructed authority" would better benefit the agency.

He said the FDA needs the authority to destroy packages of what may be illicit or counterfeit drugs being shipped into the country through the international mail system.

Right now, the agency must establish the intended use of a drug, and if regulators cannot do that, the FDA must simply return the package to the sender, Gottlieb explained.

And often, the FDA will see the same packages come back through the mail system a second or third time — sometimes with investigators seeing their own handwriting on parcels from the first time they were inspected.

"This is a numbers game," Gottlieb said. "They simply overwhelm our system with volume."

Access to treatment and services

On the second of the two-day Health Subcommittee hearing, lawmakers heard from various patient advocates, who urged Congress to ensure that the new funds included in the $1.3 trillion omnibus spending bill intended to address the opioid crisis not only result in more and better overdose-reversal agents and medication-assisted therapy, but that all Americans who need those products have access to them.

They also highlighted the need to ensure that treatment and recovery services are made consistently available for all patients — not just certain populations — including American Indians and Alaska Natives, whose communities have had the highest rates of drug overdose deaths for the past decade.

"Addiction is a lifelong challenge," said recovery advocate Ryan Hampton of Facing Addiction and the National Council on Alcoholism and Drug Dependence.

While Hampton said treatment saved his life, he said the system is failing because it is not spending enough time and money on supporting recovery.

"Treatment is not recovery. Recovery happens when you leave treatment," he emphasized.

Hampton also stressed the need to study long-term recovery, noting that the federal government has the data showing there are 23 million Americans in recovery but "is not spending any time studying us."