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#SubHealth Reviews Additional Prevention and Public Health Solutions to Combat the Opioid Crisis


Subcommittee Wraps Up Two-Day Hearing Examining 25 Bipartisan Bills

WASHINGTON, DC – The Health Subcommittee, chaired by Rep. Michael C. Burgess, M.D. (R-TX), today held the second part of a two-day hearing examining 25 bipartisan prevention and public health solutions to help combat the opioid crisis.

Yesterday, #SubHealth heard from two panels of witnesses – one composed of federal officials and a second panel tailored to bills under the Food and Drug Administration’s (FDA) jurisdiction and other research, development, and prevention initiatives.

Today, the subcommittee heard from two more panels of witnesses, this time focused largely on recovery and treatment efforts.

#SubHealth focused on the following bills today:

NOTE: Some bills have not received formal titles and instead are denoted by working descriptions.

As the subcommittee looked to additional bills for consideration today, much of the discussion regarded a bill that seeks to modernize substance use disorder (SUD) treatment records (often called “Part 2”).

Rep. Markwayne Mullin (R-OK) questions the witnesses about his bill, H.R. 3545.

H.R. 3545, the Overdose Prevention and Patient Safety Act (AINS), authored by Reps. Markwayne Mullin (R-OK) and Earl Blumenauer (D-OR), will permit SUD records to be shared in accordance with Health Insurance Portability and Accountability Act (HIPAA) for the purposes of treatment. The bill would also increase the penalties in the event of disclosure, add breach notification requirements, and provide discrimination prohibitions to protect people seeking and receiving SUD treatment.

  • Rep. Mullin posed a number of questions to Dr. Kenneth Martz, Special Projects Consultant, Gaudenzia, who expressed concerns about patients’ privacy relating to the bill. After a series of yes or no questions, Rep. Mullin concluded, “This is about patients. It’s not about opinion or maybes. It already is illegal and under this legislation, it stays illegal.”
  • Rep. Larry Bucshon (R-IN) questioned Dr. Eric Strain, Director of the Center for Substance Abuse Treatment and Research, Johns Hopkins University School of Medicine, citing some of the patients’ privacy concerns voiced by Dr. Martz, asking if the current framework included the necessary safeguards. Dr. Strain responded, “Absolutely. My understanding of it is that there are safeguards within the Mullin amendment that does prevent those sorts of concerns.”

H.R. 5009, Jessie’s Law, authored by Reps. Tim Walberg (R-MI) and Debbie Dingell (D-MI), will ensure medical professionals have access to a consenting patient’s complete health history when making treatment decisions by requiring the Department of Health and Human Services (HHS) to develop and disseminate best practices regarding the prominent display of SUD history in patient records of patients who have previously provided this information to a health care provider.

  • After Rep. Walberg told the story of Jessie Grubb, a young woman in recovery who tragically overdosed after being prescribed opioids for a sports-related injury, Dr. Strain  responded to a question about the value of Jessie’s Law and Rep. Mullin’s H.R. 3545, saying, “I think that both illustrate that as a physician, I teach my residents and interns ‘when in doubt, get more data.’ And that is something that we’re in a situation now where we may not know about how to get more data. …I think that bringing together stakeholders who can look at how could something like this not happen in a medical record again is a worthwhile thing to do.”

H.R. 5176, the Preventing Overdoses While in Emergency Rooms (POWER) Act, authored by #SubEnvironment Vice Chairman David McKinley (R-WV) and Michael Doyle (D-PA), will provide resources for hospitals to develop protocols on discharging patients who have presented with an opioid overdose. These protocols would address the provision of naloxone upon discharge, connection with peer-support specialists, and the referral to treatment and other services that best fit the patient’s needs.

  • Dr. Mark Rosenberg, Chairman of Emergency Medicine and Chief Innovation Officer, St. Joseph’s Healthcare System, on behalf of the American College of Emergency Physicians, spoke in support of the bill, telling the subcommittee, “One of the key elements of H.R. 5176, and frankly any successful ED-initiated [Emergency Department] MAT [medication-assisted treatment] program, is the requirement that the health care site have agreements in place with a sufficient number of community providers to ensure a ‘warm hand-off’ from the ED can be established. Initiating MAT in the ED can be the critical difference between a patient with a SUD following through on their addiction treatment or not, but just as important is ensuring sufficient access to and continuation of services in the outpatient setting.”

Witnesses from the first panel listen to a member’s questions.

H.R. __, the Eliminating Opioid-Related Infectious Diseases Act, authored by #SubCommTech Vice Chairman Leonard Lance (R-NJ) and Rep. Joe Kennedy (D-MA), will authorize the CDC to undertake an injection drug use-associated infection elimination initiative and work with states to improve education, surveillance and treatment of injection drug-use associated infections, like human immunodeficiency virus (HIV) and hepatitis.

  • Dr. Michael Kilkenny, Physician Director, Cabell-Huntington Health Department of West Virginia, spoke in support of the measure, describing it as “…a necessary step in reducing the rate of infectious disease outbreaks and would provide CDC with an additional $40 million a year for surveillance activities, helping local health departments to prevent an outbreak before it occurs.” He also noted that in addition to West Virginia leading the nation in overdose deaths, they also have leading rates of Hepatitis B and C, and Neonatal Abstinence Syndrome. He described the situation as “forming for us an epidemic of epidemics.”

H.R. 5329, the Poison Center Network Enhancement Act of 2018, authored by Reps. Susan Brooks (R-IN) and Eliot Engel, will reauthorize the important network of centers within the National Poison Data System that offer free, confidential, expert medical advice 24 hours a day, seven days a week.  Oftentimes these programs serve as the primary resource for poisoning information and help reduce Emergency Room visits.

  • Dr. William Banner, Board President, American Association of Poison Control Centers, noted the hearing fell during National Poison Prevention Week and testified in support of the measure, saying, “The legislation before the subcommittee today, the Poison Center Network Enhancement Act of 2018, would reauthorize the Poison Center Program for an additional five years, through FY 2024. The 55 poison centers throughout the country, including the centers that serve your constituents, receive approximately 15 percent of their funding through this program. This federal support is vital to the existence of the national poison center system. In addition, this bill clarifies that poison centers can be called upon to assist with public health emergencies, responses, and preparedness; requests that enhanced communications capabilities like texting be established; and request that the FCC work with HHS to ensure that calls to our 1-800 numbers are properly routed.”

H.R. 5140, Tribal Addiction and Recovery Act of 2018 (TARA), authored by Rep. Markwayne Mullin (R-OK) would make Indian tribes eligible to be direct grantees of State Targeted Response to the Opioid Crisis Grants to fight the opioid epidemic in Indian Country, reflecting the government-to-government relationship between Indian tribes and the United States. Tribes would receive their own $25 million allocation that they could apply directly to the federal government, instead of having to go through their states.

  • Ms. Stacy Bohlen, CEO, National Indian Health Board, detailed how many Tribal communities have had difficulty accessing opioid prevention and treatment resources and stressed that a “Failure to include Tribal Nations when seeking solutions to the opioid epidemic will result in major gaps in the ability of the United States to eradicate opioid addiction I this country.” Ms. Bohlen also spoke support of H.R. 5140 saying, it is “a critical piece of legislation that will be an important first-step in getting funding to Tribal communities.”
  • Ms. Bohlen also highlighted the $1 billion in new grants included in the omnibus, which passed the House earlier this afternoon, to be dispatched to the states and Indian tribes.

Mr. Hampton answers a member’s question.

H.R. 4684, the Ensuring Access to Quality Sober Living Act, authored by Reps. Judy Chu (D-CA), Mimi Walters (R-CA), Raul Ruiz (D-CA), and Gus Bilirakis (R-FL) will authorize SAMHSA to develop, publish, and disseminate best practices for operating recovery housing that promotes a safe environment for sustained recovery from SUD.

  • Mr. Ryan Hampton, a recovery advocate with Facing Addiction, shared his story. It began in a familiar way – by receiving painkillers after an injury while hiking. Facing the subcommittee, Mr. Hampton explained he spent 10 years battling his heroin addiction that transpired, and has been sober for more than three years. After finally getting into a treatment center, Mr. Hampton said, “I needed help re-entering everyday life. I needed a long-term, safe, sober living situation that facilitated my recovery. I didn’t need much to stay sober, but the things I needed were absolutely not negotiable. I needed housing, medical care, and a supportive peer network, and a low barrier to access those things. I needed help, acceptance, and a path out of my addiction.”
  • Mr. Hampton also told the story of his friend, Tyler, who died of a heroin overdose while staying in a sober home, which did not have naloxone on site. “H.R. 4684 is important. It’s life or death,” pleaded Mr. Hampton, who encouraged national standards for sober homes.

H.R. 5197, the Alternatives to Opioids (ALTO) in the Emergency Department Act, authored by Reps. Bill Pascrell, Jr. (D-NJ) and David McKinley, will establish a demonstration program to test alternative pain management protocols to limit the use of opioids in hospital emergency departments.

  • Dr. Rosenberg spoke about the implementation of the ALTO program at St. Joseph’s University Medical Center in Paterson, New Jersey, saying, “I am proud to say that after two years of implementation at St. Joseph’s – the ALTO program has witnessed tremendous success. Six months before the program was launched, physicians at St. Joseph’s Emergency Department wrote over 4,000 prescriptions for opioids. One year later, with the use of ALTO protocols, that number decreased by 46 percent. Two years later, we’ve seen an 82 percent reduction in opioid prescriptions. …And even more importantly, the ALTO program can save lives. This is why H.R. 5197 and the $10 million per year for three years it provides can help expand access to this evidence-based program to other Emergency Departments across the country.”

H.R. 3692, the Addiction Treatment Access Improvement Act, authored by Rep. Paul Tonko (D-NY), will expand access to medication-assisted treatment (MAT) by allowing clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists to prescribe buprenorphine and permanently authorize non-physician providers to prescribe buprenorphine. The bill would also codify regulations that increased the cap on the number of patients a physician can treat under a waiver with buprenorphine to 275 patients.

  • Ms. Alexis Horan, Vice President of Government Relations, Clean Slate Centers, highlighted a treatment center in Anderson, Indiana, which currently has a waiting list of 60 patients. Speaking to their challenges under current law, Ms. Horan testified, “Some of those patients are traveling to our next closest center, over an hour away in Indianapolis, which is less than ideal for patients who are seeking to work and support their families as they receive treatment. The current buprenorphine prescription limit dictates our treatment capacity rather than the talent and resources of our health professionals within our treatment center. …Were this bill the law today, we would not have a patient waitlist at Anderson and we would see a meaningful increase in the number of patients that could be served by other qualified providers throughout the United States.”

Ms. Alexis Horan answers a member’s question.

H.R. 5102, the Substance Use Disorder Workforce Loan Repayment Act of 2018, authored by Reps. Katherine Clark (D-MA) and Hal Rogers (R-KY), will create a loan repayment program for SUD treatment providers. Specifically, the bill will offer student loan repayment of up to $250,000 for participants who agree to work as a SUD treatment professional in areas most in need of their services. The program will be available to a wide range of direct care providers, including physicians, registered nurses, social workers, and other behavioral health professionals.  

  • Ms. Horan spoke in support of H.R. 5102 saying, “This funding, bolstered by the Opioid State Targeted Response Grants authorized in the 21st Century Cures Act, is a significant investment in building the addiction treatment workforce and in addressing the nation’s opioid epidemic more generally. Not only will this legislation incentivize newly-minted providers to explore careers that involved treating substance use disorders, the bill will also help stabilize the workforce by meting out the payments over a six-year period, which should counter attrition that is all too common in the field.”

H.R. __, Fentanyl Testing, authored by Rep. Ann Kuster (D-NH), will provide grants to federal, state, and local agencies for the establishment or operation of public health laboratories to detect fentanyl, its analogs, and other synthetic opioids.

  • Dr. Kilkenny supported Rep. Kuster’s bill, detailing this issue in his state, “Another challenge in my community is the rise in the use of powerful synthetic opioids such as fentanyl and carfentanil, which has exacerbated the epidemic because of the potency of these drugs.” Mr. Kilkenny also said the bill “recognizes this threat and would assist public heath laboratories to their efforts to detect fentanyl and other synthetic opioids.”

Rep. Buddy Carter thanking today’s witnesses, particularly those in recovery, for testifying today.

H.R. __, Peer Support Specialists Workforce Grants, authored by Reps. Ben Ray Lujan (D-NM), and Bill Johnson (R-OH) would increase the funding for the Comprehensive Addiction and Recovery Act’s Building Communities of Recovery Program and authorize HHS to award grants to peer support specialist organizations for the development and expansion of recovery services.

  • Ms. Carlene Deal-Smith, Peer Support Specialist, Presbyterian Medical Services, shared her experience with addition and her path out of it, saying, “I am a Native American Woman of the Navajo Tribe, Master Weaver, and also a recovering alcoholic. I have struggled with my addiction for 20 years and I am 17 years sober. This would not be possible if it weren’t for the places I have worked. I have worked with Substance Abuse Programs for 25 years… My past gives me a better understanding of how to approach the specific needs of this population.”
  • In pledging her support of the legislation, Ms. Deal-Smith said, “In my opinion, increased funding for Peer Support is essential to help overcome barriers that prevent addicted individuals from accessing peer support services as well as those in recovery from obtaining peer support status.”

For a recap of yesterday’s portion of the two-day hearing, click here.

For more information on today’s hearing, including a background memo, witness testimony, and archived webcast, click here.