At a congressional field hearing on opioids held Tuesday in Baltimore, Republicans, Democrats and health care officials agreed about the scope of the problem, but there appeared to be little agreement about who should do what.
The House Oversight and Government Reform Committee came to Baltimore, where opioids have been a particular scourge, at the behest of Rep. Elijah E. Cummings, its ranking Democrat.
Cummings said heroin and other opioids have become a national “emergency,” noting that during the first two hours of the hearing an estimated half-dozen people around the country lost a parent, sibling or child to an overdose.
Other U.S. lawmakers, as well as Maryland Gov. Larry Hogan and Baltimore Mayor Catherine Pugh who attended the hearing at Johns Hopkins Hospital, called it a “crisis.”
Drug overdoses killed some 64,000 people last year, according to the U.S. Centers for Disease Control and Prevention, a 20 percent increase from the year before. Data shows that opioids led the increase, with much attributed to heroin and the strong synthetic opioid fentanyl and the even stronger carfentanil.
With little progress at stopping the epidemic, which has been tied to overprescribing of addictive painkillers, among other factors, President Donald Trump formed the Commission on Combating Drug Addiction and the Opioid Crisis. The panel, led by New Jersey Gov. Chris Christie, issued a report over the summer and a final version Nov. 1.
This was the first time the oversight committee was able to question Christie about its dozens of recommendations and next steps. Christie said the president would oversee the effort, as well as Cabinet secretaries and, on the front lines, state leaders.
“Who is in charge of implementing recommendations across government?” asked Rep. Jamie Raskin, a Maryland Democrat and oversight committee member. “How do we make sure they get into practice?”
After Raskin questioned the president’s level of attention to the effort, Christie said, “The 535 of you know about this problem, you know people dying in your districts, what are you going to do?”
He boiled the opioid commission’s report down to three fronts the legislators could promote in conjunction with home state political, public health and law enforcement leadership:
The first, Christie said, was “nipping fentanyl and carfentenil in the bud.”
That involves a far tougher federal stand with China, where much of the drug and its analogs are made in illegal labs and shipped to the United States. Congress could pass legislation to require better screening of U.S. Postal Service shipments that deliver drugs.
It also involves education and enforcement at the local level, through, for example, prescription drug monitoring programs that aim to curtail so-called doctor shopping for dugs.
Second was education of the medical community about the dangers of opioids, Christie said. It can take as little as three days to become addicted to opioids if someone is predisposed, he said, so doctors should be aware and scale back prescriptions for the painkillers. Doctors also should be informed about alternatives to treat pain, he said.
The third focus should be on providing more treatment, Christie said. The federal government is already allowing states to use Medicaid funds to treat more people for addiction on an inpatient basis. Maryland was among the first to get permission to use the health program for low-income residents, who make up a disproportionate number of those with addictions. Christie also called for greater use of medication-assisted treatment, which is the use of buprenorphine and other replacement drugs to ween users from opioids.
The commission report did not call for new funding, but instead recommended providing block grants from sources already available.
Money for new and existing programs drew the most pushback from Democrats on the panel, who were otherwise largely supportive of Christie’s report. Cummings also said federal authorities needed to intervene to bring down the ballooning cost of naloxone, the overdose reversal drug that most first responders and many lay people now keep on hand.
Baltimore Health Commissioner Dr. Leana Wen, who testified after Christie, has said she’s been rationing naloxone, a cornerstone of the city’s immediate response to the opioid epidemic. But in her testimony she said the health care system was generally failing those with addictions by not funding enough treatment on demand and stigmatizing drug use rather than treating it like a chronic medical condition.
Baltimore reported 694 overdose deaths last year, more than twice the 318 homicides. Another 393 died in the first half of 2017, up 29 percent compared to the same period last year, according to figures from the state Department of Health. The bulk of the deaths were attributed to opioids, specifically heroin and fentanyl.
Wen said solving the complex problem means having the will to commit resources, much as the federal government does when there is a natural disaster like a hurricane.
“The opioid epidemic can be solved if we commit a similar level of resources with urgency, compassion and action,” she said. “I urge Congress to put the full weight of the federal government to stem the tide of this epidemic, and to join those of us on the front lines to commit the necessary resources to save lives and reclaim our communities.”