Tip Sheets

Behind Washington’s promises to tackle opioid abuse

By Alicia Ault

• White House leadership

• HHS: putting policy into action

• Congress points the finger

• Beyond Washington: Issues to consider

• Some ideas for covering the story

• Further reading

In any election year, you can bet that politicians will pay a lot of attention to voters’ concerns. The stakes are even higher in a presidential election year, which is one reason why – after years of relative silence on a rapidly growing opioid epidemic – Congress and the Obama administration have recently started rolling out a variety of solutions.

In a November 2015 Kaiser Family Foundation poll tracking issues important to voters, half of the respondents said heroin and opioid abuse should be a top priority for their governor and legislature. Almost 60 percent said they knew someone who had abused a prescription painkiller, had been addicted or died from an overdose. By February, 30 percent of voters polled by Kaiser said they were closely following  President Barack Obama’s proposal to increase funds for heroin and prescription painkiller addiction, part of his 2016 budget request.

The abuse of opioids like hydrocodone and oxycodone has fueled parallel and growing use of another opioid, heroin. Misuse of prescription opioids has been on the radar screen at least since Purdue Pharma introduced OxyContin — a high-potency version of oxycodone — in 1996, and it has grown astronomically since 2000, when the company won Food and Drug Administration (FDA) approval to sell a 160 milligram tablet (16 times the original 10 mg dose).

The U.S. has experienced a quadrupling of written opioid prescriptions and a quadrupling of overdose deaths from prescription opioids, according to the Centers for Disease Control and Prevention (CDC). From 1999 to 2014, more than 165,000 Americans died from prescription opioid overdose. The CDC data showed 2014 was a record-setting year: for drug overdose deaths, for heroin overdose deaths, and for prescription opioid deaths. Now, an estimated 16,000 people a year die from a prescription opioid overdose, it found.

Nearly half of those who report using heroin also are addicted to prescription opioids, says the CDC. Heroin overdose deaths quadrupled from 2002 to 2013. That year, 8,200 people died from a heroin overdose.

Those are attention-getting numbers. But are politicians serious about tackling America’s addiction problem?

White House leadership

At a summit on heroin and opioid abuse in March 2016, Obama said politicians hadn’t cared about the problem until recently because it was seen as only affecting the poor and minorities. Not so anymore. “One of the things that’s changed in this opioids debate is a recognition that this reaches everybody,” he said.

But even the White House had been mostly focusing its drug policy efforts on law enforcement and reducing marijuana use in America’s youth. Prescription drug abuse was only highlighted for the first time in the 2011 White House Office of National Drug Control Policy annual strategy. It has been a focus every year since. But it wasn’t until October 2015 when the president visited West Virginia to meet with families affected by opioid abuse that it appeared to become a priority. Obama announced an effort to support more prescriber training, push more warning ads and study barriers to access to addiction-fighting medications.

The president’s 2016 budget included a $1.1 billion request to expand access to opioid addiction treatment. At the summit in March, Obama also unleashed a torrent of proposals and funding to address addiction. He also announced a new White House Domestic Policy Council task force to determine best practices for mental health and substance use disorder treatment by Oct. 31.

HHS: Putting policy into action

HHS is the main cabinet department charged with addressing the health aspects of opioid use and misuse, through the CDC, the FDA, the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Administration (SAMHSA), among other agencies.

  • In March, HHS issued a rule making it possible for physicians who are qualified to treat opioid abuse to prescribe the maintenance medication buprenorphine to 200 patients, instead of the previous limit of 100.  

  • SAMHSA said it would make $11 million available to states to buy naloxone, a treatment reversing opioid overdose.

  • The CDC recently issued a guideline on use of opioids in chronic pain for primary care physicians. The guideline development process was fraught with political bickering among physician organizations, advocacy groups, and pain patients. It’s not clear whether the voluntary guideline will be taken to heart by doctors.

  • The FDA, which some in Congress view as being partly responsible for the opioid epidemic, in February said it would revisit opioid labelling, how it approves the drugs, and whether the risk outweighed the benefits for many conditions that opioids are used for currently. The agency added new, broader and more severe warnings to opioids in March, and will be taking a closer look at opioid use in children at an advisory committee meeting in September.

Congress points the finger

Several senators from states struggling with addiction — most notably Joe Manchin (R-W.Va.), Edward Markey (D-Mass.), and Bernie Sanders (I-Vt.) — tried earlier this year to block a floor vote on Obama’s nominee to head FDA, Robert Califf.  It failed, but they brought attention to the opioid issue. Soon after, the FDA issued its opioid review policy.

Congress also came to attention. Two House members from New Hampshire formed the Bipartisan Task Force to Combat the Heroin Epidemic in November 2015, which has held periodic meetings with experts. In the current 2015-16 congressional session, almost 50 bills pertaining to opioids were introduced, compared to 16 in 2014 and 7 in 2013. House Speaker Paul Ryan (R-Wisc.) has said the House is making the opioid epidemic a priority, and House Majority Leader Kevin McCarthy (R-Calif.) said the chamber will bring several bills to the floor for a vote in May after a dozen bills passed a key committee in April. Another bill, the Protecting Our Infants Act of 2015, called for HHS to examine the issue of babies being born addicted to opioids and was passed in November.

In the Republican-led Senate, the Comprehensive Addiction and Recovery Act passed March 10. It would authorize grants to fund medication-assisted treatment for addicts and direct HHS to create an inter-agency task force to develop best practices for pain management and prescribing pain medication. Although the House has not taken up the legislation, its companion bill has more than 100 co-sponsors, the majority Democrats.

Beyond Washington: Issues to consider

  • What is the impact in your city or state of new funding for medication-assisted treatment for prescription opioid and heroin addicts?

  • Will allowing doctors to treat more patients with medication — like buprenorphine — lead to greater abuse or diversion of that opioid substitute? Will it help more addicts?

  • Will the Republican-controlled Congress appropriate the $1.1 billion for prescription opioid and heroin treatment sought by President Obama, given that it is an election year, and that there is a short legislative calendar? What if they don’t approve the money?

  • Is there any legislation that addresses opioid abuse that stands a chance of passage in 2016? Are your Members of Congress involved, and what are they advocating?

  • What is the impact of the availability of additional naloxone in your area, and what state or local laws guide its availability? Has its availability helped reduce overdose deaths?

  • How are state and local governments stepping up to address opioid abuse in the absence of federal action?

  • Who is on the Domestic Policy Council task force on mental health and substance abuse, where will they be meeting, and what can they accomplish by October? Will their recommendations influence the medical profession?

  • What are the presidential candidates promising on opioid addiction?

Some ideas for covering the story

Though opioid and heroin addiction have been local stories for decades, now may be time to convey to readers that substance use is on the national stage and what that might mean for them, especially in an election year.

Local reporters wanting to get a sense of what’s happening on Capitol Hill can, as a start, take a look at the work being done by the committees with jurisdiction over health issues. In the House, they are: Energy and Commerce; Ways and Means; and Oversight and Government Reform. In the Senate, they are Finance; Health, Education, Pensions and Labor; and Judiciary.  Staffers are eager to promote their bosses’ interests, so you are likely to find a welcome reception. Check committee websites for upcoming hearings on opioid-related topics and for “mark-ups”, which are committee votes on legislative proposals. Most committees now have live webcasts of hearings and mark-ups. Congress.gov is a searchable database of legislation that displays the text, co-sponsors, and House and Senate actions.

The CDC is a starting point for federally-collected statistics and scientific background. For more about administration policy, start with the press contacts at the Office of the HHS Secretary. It’s helpful to have a narrow topic and very specific questions. Reporters rarely get to interview administration officials, but the department often will point you in the right direction for background. AHCJ has been working with HHS to make it more responsive to reporters’ requests, including granting wider access to officials.

Further reading

Alicia Ault is a Washington and New Orleans-based freelance writer who has been covering health for 27 years. She has written about health policy, science and medicine for the Washington Post, the New York Times, and Reuters, among others. She is a contributing writer for Medscape Medical News. You can follow her on Twitter @aliciaault