WASHINGTON — North Carolina and other states need sustained, flexible federal funding to support programs working to reduce deaths and addiction from opioids and other drugs, state health officials told Congress today.
Public health officials asked lawmakers for continued commitment to Medicaid and programs that help states address drug addiction problems. A panel of the U.S. House Energy and Commerce Committee held a hearing on the issue.
“Moving an entire system of care is a monumental task. We’re working diligently and we’ve made staggering progress, but please don’t give up,” Jennifer Smith, secretary for the Pennsylvania Department of Drug and Alcohol Programs, told lawmakers. “It depends on sustained funding and support.”
States, particularly North Carolina, have been trying to respond to a growing problem of addiction and overdose to opioids and other drugs. From 1999 to 2017, nearly 400,000 people across the United States died from opioid overdoses, according to the Centers for Disease Control and Prevention.
Federal lawmakers passed a collection of bipartisan bills in 2018 aimed at fighting the crisis. The legislation provided states billions of dollars in federal funding to assist with response, treatment and recovery.
State public health officials from Pennsylvania, Massachusetts, Rhode Island and West Virginia also credited Medicaid expansion in their states for giving them the ability to pay to treat many of those who face addiction.
Rep. Diane DeGette (D-Colo.), who chaired the hearing, said states are now facing a “fourth wave” of the opioid crisis: a large increase in methamphetamine use.
“In 2018, there were more than twice as many deaths involving meth as 2015, and meth is increasingly turning up in overdose deaths and drug busts across the country,” DeGette said.
“Given the complexity of the epidemic and its ability to evolve, states, federal government agencies and Congress must remain vigilant.”
“This is not a crisis that we can resolve overnight, and it requires ongoing federal and state attention,” said Energy and Commerce Committee Chairman Frank Pallone (D-N.J.). “States are on the front lines of this national emergency, providing much of the support for those in need. They are our eyes and ears on what is occurring on the ground, and that’s why this hearing is so important.”
Over the past two decades, North Carolina has had 12,000 deaths due to opioid overdose, according to the North Carolina Department of Health and Human Services (DHHS). In 2016, North Carolina was in the top eight states for fentanyl overdose deaths alone.
“North Carolina was hard hit by the opioid crisis. The consequences have been large, and far reaching,” said Kody Kinsley, a DHHS deputy secretary.
In 2016, 1,407 people died in North Carolina due to unintended overdoses. For each death, there were six more hospitalizations, Kinsley said. But in 2018, North Carolina saw its first decline in deaths in five years.
“The most significant thing you can do would be to give us more time. Sustaining funding over longer windows of time or permanently would allow states to be ready for the next wave of the epidemic,” Kinsley said.
Kinsley asked for lawmakers to increase the substance abuse and treatment block grants, which have stayed constant for North Carolina even though the population is growing.
Kinsley said an even bigger boost would be for North Carolina lawmakers to expand Medicaid. More than half of the people who come to North Carolina hospitals with an overdose are uninsured, so much of the extra federal funding for opioids in North Carolina goes directly to their treatment. North Carolina provided treatment to 12,000 uninsured persons with the federal programs.
But that also means that money is not available to start new programs like other states that rely on Medicaid to treat their patients, like Pennsylvania and Rhode Island.
“At present, more than two-thirds of our federal opioid response grants are just going for treatment and expanding care for those that are uninsured,” Kinsley said. “So we do not have those dollars available to expand workforce and treatment.”
In Pennsylvania, more than 2,700 people died in 2014 from overdose, according to the Pennsylvania Department of Drug and Alcohol Programs. That number doubled in 2017 to 5,400 deaths. In 2018 the state saw an improvement, an 18 percent decrease in overdose deaths.
“As the statistics rose year over year, our primary focus became simple, to keep Pennsylvanians alive,” said Smith.
She credits the improvement to expanded access to medication-assisted treatment and efforts to transition people treated in the emergency room for overdose to more comprehensive addiction treatment.
Pennsylvania was also able to distribute nearly 13,000 kits with naloxone — an opioid overdose rescue drug — free of charge in 2018 and again in 2019, thanks to a combination of state and federal funding.
“While it is not clear whether the promising trend will continue in 2019, it is clear that the more than $230 million in federal funding the state has received is making a tremendous impact,” Smith said.
Smith said the next challenge for the state is to do more to try to prevent drug use and overdose in the first place.
“Our primary focus was keeping people alive. Now that we have started to get a handle on that, we can spend some time and energy looking upstream, at how we can improve our prevention efforts,” Smith told the panel.
“There is one glaring problem that has been highlighted by a few of my colleagues, and that is the lack of continuity of care and resources in the states that have not expanded Medicaid,” said Rep. Kathy Castor (D-Fla.).
Castor and other Florida Democrats sent a letter to state lawmakers this week asking them to expand Medicaid in Florida — which they say could bring in billions of dollars of federal support to the state over the next five years.
“You are not doing right by our citizens,” said Castor.
Republicans press opioid manufacturers for answers
Top Republicans on the committee also re-opened an investigation this week into the role three major drug manufacturers have played in the opioid crisis.
Reps. Greg Walden (R-Ore.), Morgan Griffith (R-Va.), and Brett Guthrie (R-Ky.) sent letters to the opioid manufacturers yesterday to try to get more information on what the companies knew about the sales and dangers of their medication.
“We write today to reactivate the investigation started on August 2, 2018, that examined potential breakdowns in the controlled substances supply chain, which may have contributed to the nation’s opioid epidemic, and the role of certain opioid manufacturers in such potential breakdowns,” the lawmakers wrote in the letter.
The lawmakers sent letters to Insys Therapeutics, Mallinckrodt Pharmaceuticals and Purdue Pharma.
They asked Phoenix-based Insys for more information about an alleged kickback scheme designed to boost sales of a fentanyl spray. The letter to Mallinckrodt requests more information about their efforts to monitor sales for suspicious orders.
Lawmakers asked Purdue Pharma about the company’s marketing of OxyContin after the FDA determined in 2001 that the addictive painkiller should not be used long-term.
Meanwhile, lawsuits on the issue are piling up. This week, Walgreen, CVS, Walmart and Rite Aid filed their own lawsuits against physicians in two Ohio counties for excessive prescriptions of opioids. The two counties previously sued the major national drugstore chains for their distribution of the drugs.
Allison Winter is a reporter for the Washington, D.C. bureau of The Newsroom network, of which Policy Watch is a member.