Senate Finance on Examining the Opioid Epidemic
On February 23, 2016 the Senate Finance Committee held a hearing to examine the opioid epidemic in the United States. In his opening statements, Senate Finance Committee Chairman Orrin Hatch (R-UT) shared the therapeutic results that can benefit patients who use opioid analgesics for pain management. However, he also highlighted the growing problem of opioid abuse, which has negatively affected many families, children, and communities. Each day, approximately 7,000 people go to the emergency room for complications related to opioid abuse with a death related to opioid abuse occurring every 30 minutes. According to Hatch, “Put simply, opioid abuse has become an epidemic and a significant public health problem.”
A bipartisan bill developed by Senators Pat Toomey (R-PA) and Rob Portman (R-OH), in conjunction with Senators Tim Kaine (D-VA) and Sherrod Brown (D-OH) was discussed as a step in the right direction in stemming the tide of opioid abuse. The objective of this bill – the Stopping Medication Abuse and Protecting Seniors Act of 2015, S. 1913 – is to enable drug plans under Medicare Part D to help patients select a physician that would be solely responsible for prescribing opioid analgesics to the patient. The patient would also receive assistance in selecting one pharmacy that would dispense the prescribed opioid prescription. As a result, it is hoped that patients would receive better care, and because they are seeing only one prescriber and one pharmacy, that this would significantly reduce the amount of cases of opioid abuse. This kind of “lock-in” program is currently in place for Medicaid and the bill’s sponsors argued that S. 1913 would expand the positive outcomes of that initiative to Medicare.
The three witnesses that were in attendance included Allan Coukell, Nancy Young, MD, and David Hart. Coukell, Senior Director of Pew Charitable Trusts, shared that a policy change was necessary to combat the opioid epidemic. His suggestion to the committee was that the Patients Review and Restriction Program (PRR) would help to prevent the issue of doctor shopping, which is prevalent amongst at-risk beneficiaries. Dr. Young, the Director of Children and Family Futures, focused on the timeliness of treatment to patients suffering from opioid addiction and its impact on child welfare. According to child welfare professionals, the misuse of opioids has had some of the worst effects on the child welfare system, and there is a drastic rise in the amount of infants coming into protective custody as a result. As an attorney with the Oregon Department of Justice, Hart’s testimony focused on the effects of marketing and promotion of opioids, as well as the approach that Oregon has taken to fight the opioid epidemic. In his testimony, Hart spoke of a settlement that was reached with Purdue Pharma as a result of their misrepresentation of OxyContin’s risk for causing addiction. Hart also shed light on the fact that OxyContin is mostly prescribed by mid-level providers, and he suggested that more training should be implemented on prescribing guidelines.
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During the hearing, both Senators Michael Bennet (D-CO) and Robert Menendez (D-NJ) expressed their concerns for the lack of expert witnesses on the treatment options available for patients with opioid addiction. A significant point addressed in this hearing was also the rising levels of heroin use as a cheaper alternative to patients suffering from prescription opioid addiction. Senator Wyden ended the hearing with a sense of optimism that the bipartisan bill would help to sway the “prescription pendulum” in the right direction for physicians, health care providers, and ultimately patients.
“As one listens to the current debate on opioids, there is a sense that policymakers will have to choose between two solutions,” Wyden stated. “One approach is tough enforcement, which means cracking down on pill mills, fraudsters bilking Medicare and Medicaid with unneeded prescriptions, and unscrupulous abusers doctor-shopping for their next bottle of pills. Others want to focus on more social services. My own view on what’s needed is a better approach that includes three things: more prevention, better treatment, and tougher enforcement. True success will require all three to work in tandem.”