White House Focuses on MAT, Punishment for Dealers at Opioid Summit

A week after sending his son for his sophomore year at the University of Colorado last fall, former Fox News anchor Eric Bolling was enjoying dinner out with his wife when he got shocking news. His daughter was on the phone, hysterically crying. Something made Bolling ask about his son, “Is he still alive?” No, there was a detective in his son’s apartment.

Bolling and his wife were completely blindsided that their 19-year-old son had died of an opioid overdose. “We never saw it coming,” Bolling said. He has since been overwhelmed by the outpouring from people whose lives have been similarly ruined by opioids.

So began the first White House Opioid Summit last month. The Trump administration declared the opioid epidemic a national health emergency last fall and signed a budget deal in February that earmarked $6 billion to confront it. However, the administration has faced criticism for its wan response to date as the number of deaths from opioid overdoses continues to climb. From July 2016 to July 2017, there were nearly 45,000 deaths from opioid overdose, an 18 percent increase over the same period a year earlier

The summit brought together President Trump and members of his cabinet, including the secretaries of the departments of Veterans Affairs (VA), Health and Human Services (HHS), Housing and Urban Development (HUD), and Justice. They presented overviews of federal initiatives to combat the opioid epidemic. Also among the speakers were members of the public and others whose lives have been impacted by the crisis.

“The administration is going to be rolling out policy over the next three weeks, and it will be very, very strong,” Trump said. The answer to the crisis is strength and toughness against drug pushers and dealers, including possible use of the death penalty, he said.

The Justice Department filed a statement of interest in a slew of lawsuits against drug companies brought by cities, counties, and medical institutions seeking reimbursement for costs related to the opioid crisis. The suits claim that the drug companies used “false, deceptive, or unfair” practices when marketing prescription opioids. Attorney General Jeff Sessions said the federal government would seek repayment, since it, too, has borne substantial costs.

Jim Carroll, the director of the Office of National Drug Control Policy, a position known as the “drug czar,” made his first public appearance at the summit after having been appointed the week before. Carroll had previously served as White House deputy chief of staff.

For his part, HHS Secretary Alex Azar said he is encouraging more states to apply for the department’s streamlined waiver process announced last fall that allows a state’s Medicaid program to cover adult inpatient substance use treatment in psychiatric and substance use treatment facilities with more than 16 beds. Such treatment is currently prohibited under the Medicaid Institutions for Mental Diseases (IMD) exclusion, a rule that APA has long opposed. Azar said he “berated” state governors at a recent National Governor’s Association meeting that only five states had applied for the waiver so far. “I told them we’re eager to work with them, we have a streamlined process for considering them, and I want more.”

Azar called it “unacceptable” that only one-third of U.S. treatment facilities offer medication-assisted treatment (MAT). “There are many approaches to addiction treatment. We know this one works, though, and one-third is not enough.” He said HHS must use part of its opioid funding to build up MAT offerings. The Food and Drug Administration will be issuing two guidances aimed at expanding the availability of MAT and accelerating access to it, he said. One will be aimed at assisting the development of long-acting depot formulations, like the monthly buprenorphine injection approved last fall. The other guidance is intended to create new ways of assessing MAT effectiveness by using alternative endpoints, aside from achieving complete abstinence, such as reduction in “cravings.”

The United States makes up just 5 percent of the world’s population but consumes 90 percent of prescription opioids. To help reduce use of these drugs, HHS held a “code-a-thon” with software developers to create apps to monitor risky opioid prescribing by physicians and help them monitor their prescribing volume to see whether they are outside the norm. HHS is also issuing $500 million in targeted response grants to state governments to cover opioid abuse prevention and treatment as well as recovery supports, including MAT, he said. HHS also anticipates launching a mass multimedia campaign aimed at educating the public about the dangers of opioid addiction.

HUD Secretary Ben Carson said 76,000 people, or about 25 percent of those HUD serves, reported substance use problems last year. Its new EnVision Center initiative will focus on improving access to community health and wellness services, including services for substance use disorder. The pilot program will create 10 centers across the country near public housing developments.

“It is important to note that the scourge of opioids in America is not simply a crisis of health; it’s also a crisis of hope,” Carson said. EnVision will also promote long-term economic, educational, and employment opportunities, all of which bring hope, Carson said.

VA Secretary David Shulkin reported that his department, which runs the largest health system in the country, has invested more than $300 million in preventing and treating opioid addiction, achieving a 41 percent reduction in opioid use at its facilities. He attributed the drop to a 90 percent reduction in the past six years in new opioid prescriptions, which was brought about by encouraging its prescribers to seek alternatives to opioids. They might still be writing prescriptions but for a non-opioid, he pointed out.

Two months ago, the VA became the first U.S. health system to publish online its opioid prescription rates, which range from 20 percent of all prescriptions written at its Rosenburg, Ore., medical center to 3 percent at its Cleveland, Ohio, center. One goal of the program was to encourage other health care systems to follow the VA’s lead, said Shulkin.

Daniel A. Goonan, a fire chief in Manchester, N. H., said he noticed city personnel were handling 75 opioid overdoses a month, up from 20 a month. Thus, he created the Safe Station program, opening all its fire stations 24 hours a day to anyone who needs help because of opioid use. Its personnel offer “nonjudgmental” help. He has since noted a 30 percent reduction in overdose deaths. “We know we’re saving lives every day” the program is in operation, Goonan said. ■