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Fentanyl driving US overdose deaths; lawmakers urge HIV crisis-like action

The opioid epidemic is getting worse, with illicitly manufactured fentanyl — a drug 100 times more powerful than morphine — and its synthetic analogues now driving the rate of overdose deaths to an all-time high, U.S. health officials reported.

The rise in deaths was also attributed to illicit fentanyl being mixed with counterfeit opioid and benzodiazepine pills, heroin and cocaine.

Drug overdoses resulted in 632,331 deaths from 1999 to 2016 in the U.S., with 351,630 of those from opioids, according to a new in-depth analysis by the Centers for Disease Control and Prevention, or CDC.

In 2016 alone, 63,632 Americans died of a drug overdose — a 21.5% increase from a year earlier — with 42,249, or 66.4%, of those involving opioids, the CDC said in its Morbidity and Mortality Weekly Report.

Opioid-related drug overdose deaths jumped by 27.9% from a year earlier.

The analysis also showed that the epidemic is spreading geographically and increasing across all demographic groups — men and women, teens to older adults, and all races and ethnicities.

The largest increase in opioid overdose deaths, however, was in men age 25-44.

"No area of the United States is exempt from this epidemic — we all know a friend, family member, or loved one devastated by opioids," CDC Principal Deputy Director Anne Schuchat said in a statement.

New Hampshire, West Virginia and Massachusetts had the highest death rates from synthetic opioids.

There also was a large spike in cocaine-related overdose deaths — climbing 52.4%.

Overdose deaths from psychostimulants increased in 2016 by 33.3%, while those from heroin were up by 19.5%.

An official from the Drug Enforcement Administration had warned lawmakers during a Feb. 28 hearing about the proliferation of those drugs in the U.S.

The CDC also found that overdose deaths from prescription opioids grew by 10.6% from a year earlier.

HIV crisis-like attention needed

The report came on the same day that two Democratic lawmakers called on their colleagues on Capitol Hill to address the opioid crisis like Congress finally did for the HIV/AIDS epidemic when it passed the Ryan White Comprehensive AIDS Resources Emergency Act in 1990.

Sen. Elizabeth Warren, D-Mass., and Rep. Elijah Cummings, D-Md., in a March 29 op-ed in USA Today insisted Congress had "only nibbled around the edges" of the opioid epidemic so far.

They said they plan to introduce legislation modeled after the Ryan White Act. They said the bill also would make it easier to hold the corporate executives at companies that fuel the epidemic more accountable for their actions.

Several other bills also have been introduced in recent weeks, including another one by Warren, who co-authored legislation with West Virginia Republican Shelley Moore Capito to ensure that 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.

Sen. Lamar Alexander, R-Tenn., also unveiled a bill that would require certain opioid-makers to package their pills in limited quantities, known as blister packs.

In addition, a bipartisan group of senators proposed legislation to impose a three-day limit on initial opioid prescriptions for acute pain and expand a 2016 law — the Comprehensive Addiction and Recovery Act, or CARA. The CARA 2.0 bill would let states waive the 100-patient-per-physician limit on using medication-assisted therapies, or MATs, such as buprenorphine, to treat opioid addiction. It also would permanently allow physician assistants and nurse practitioners to prescribe MATs under the direction of a qualified doctor.

Tough action

A group of Republicans, led by Sens. Lindsey Graham of South Carolina and Tom Cotton of Arkansas, introduced legislation aimed at toughening the penalties for anyone caught trafficking in fentanyl and its synthetic analogues.

That bill came after President Donald Trump called for the death penalty for certain drug dealers as part of his overall strategic plan to address the opioid crisis.

The House has been considering a series of bills as well, with the Energy and Commerce Health Subcommittee set to hold its third and final hearing April 11 ahead of finalizing a legislative package for the chamber to consider before its Memorial Day break at the end of May.

Other steps

In its fiscal 2018 spending package, Congress allotted nearly $4 billion in new funds to address the crisis, with $500 million of that going to the National Institutes of Health. The agency has been waiting for the funds for nearly a year to start up a public-private partnership aimed at accelerating the development of nonaddictive alternatives to opioids and better overdose-reversal agents.

The industry has been reluctant to partner until the Congress assured the funds.

To get a better handle on the opioid crisis, Health and Human Services Secretary Alex Azar appointed Brett Giroir to be a senior adviser for mental health and opioid policy to coordinate the agency's efforts across the administration to fight the epidemic.

Giroir already serves as the assistant secretary for health.

Trump and the White House are hoping to bring more attention to the epidemic by displaying the National Safety Council's memorial to the victims of the opioid crisis at the Ellipse in Washington.

The National Park Service will keep the memorial on display at the Ellipse, which is near the White House, until April 18.