Upton: We can’t arrest our way out of opioid epidemic
Nearly every 12 minutes, someone dies of a drug overdose in the U.S. Addiction to drugs like Vicodin, OxyContin, and Percocet often progresses to heroin abuse, and the trend of growing deaths and injuries is cause for alarm. Republicans and Democrats on the House Energy and Commerce Committee are trying to do something about it.
The Centers for Disease Control and Prevention reports that nationally, nearly 260 million opioid prescriptions were written in 2012. According to the director of the National Institute on Drug Abuse, Americans consume 80 percent of the world’s prescription opioids, despite constituting just 4.6 percent of its population. Our country is in the midst of an opioid epidemic.
The committee’s investigation over the last year has included hearings with over two dozen witnesses. Between hearings and meetings with experts, stakeholders, individuals in recovery, and family members of opioid abuse victims, we have identified a number of problems with the way opioid addiction is addressed and ways to take action.
Federal policies toward opioid addiction have often overemphasized a law enforcement approach at the expense of public health. It is clear that this is a public health crisis and our strategy needs to reflect the complex dynamic between public health and criminal activity. We cannot arrest our way out of this epidemic.
Opioid addiction is a chronic disease of the brain and can be treated. Unfortunately, only 10 percent of the 23 million people suffering from alcohol and drug addiction get any form of treatment. Of those who do get treatment, only 10 to 20 percent are getting evidence-based treatments shown to be effective.
The committee found that programs and services provided by addiction treatment centers frequently use acute individual treatment models in response to the chronic health problem of opioid addiction. Some patients with opioid addiction may need treatment for months or a few years, while others may need treatment for a lifetime. Furthermore, the availability of behavioral counseling may be inadequate, if not absent altogether.
In March, the Department of Health and Human Services announced its roadmap to combat opioid abuse, proposing improvements to opioid prescribing practices, expanded use and distribution of overdose reversal drugs, and expansion of medication-assisted treatment. More recently, the administration announced new efforts, several mirroring recommendations witnesses provided to our committee. These are important steps, but there is more we can do.
We should develop guidelines for the use of medications, including opioids, in the treatment of chronic pain. Changing doctor prescribing behavior requires giving doctors information and tangible incentives to prescribe more judiciously, and guard that neither pain nor addiction is undertreated. At the same time, we must empower opioid-addicted individuals to choose from the full range of proven pharmacological treatments, including crucial behavioral and psychosocial therapies.
We should reform regulations governing the privacy of patient substance-use records to address the challenges that health providers face when communicating among themselves and treating patients. We can also incentivize increased practitioner use and otherwise enhance state prescription drug monitoring programs. This would decrease doctor shopping and improve data sharing by state agencies, treatment programs, and other health care providers to avoid inappropriate prescribing and decrease the risk of overdoses.
Perhaps most importantly, we must shift the paradigm of substance use treatment to a long-term view, similar to other chronic diseases such as diabetes and cancer. The committee has begun to consider a number of bipartisan bills crafted around these solutions.
U.S. Rep. Fred Upton, R-St. Joseph, is chairman of the House Energy and Commerce Committee.