01/15/20 Jennifer Smith

The Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce held a hearing January 14 entitled “A Public Health Emergency: State Efforts to Curb the Opioid Crisis.” On this edition of Century of Lies we hear from: Jennifer Smith, Secretary of Pennsylvania’s Dept. of Drug and Alcohol Programs; Monica Bharel, MD, MPH, Commissioner of Public Health at the Mass. Dept. of Public Health; Christina Mullins, Commissioner of the Bureau for Behavioral Health at West Virginia’s Department of Health and Human Resources; Kody Kinsley, Deputy Secretary for Behavioral Health and Intellectual and Developmental Disabilities at North Carolina’s Department of Health and Human Services; and Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island Department of Health.

Program: 
Century of Lies
Date: 
Tuesday, January 14, 2020
Guest: 
Jennifer Smith
Organization: 
Drug War Facts
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CENTURY OF LIES

JANUARY 15, 2020

DEAN BECKER: The failure of the Drug War is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization and the end of prohibition. Let us investigate the Century of Lies.

DOUG MCVAY: Hello and welcome to Century of Lies. I am your host, Doug McVay, Editor of www.drugwarfacts.org.

On Tuesday, January 14th, the Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce held a hearing entitled, “A Public Health Emergency: State Efforts to Curb the Opioid Crisis”, the hearing was chaired by Representative Diana DeGette who is a Democrat from Colorado. The next voice you hear will be that of Representative DeGette introducing the witnesses.

CHAIR DEGETTE: I now want to introduce the witnesses for today’s hearings. Jennifer Smith, Secretary of Pennsylvania’s Dept. of Drug and Alcohol Programs; Monica Bharel, MD, MPH, Commissioner of Public Health at the Mass. Dept. of Public Health; Christina Mullins, Commissioner of the Bureau for Behavioral Health at West Virginia’s Department of Health and Human Resources; Kody Kinsley, Deputy Secretary for Behavioral Health and Intellectual and Developmental Disabilities at North Carolina’s Department of Health and Human Services; and Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island Department of Health. I want to thank all of you for appearing in front of the Subcommittee today.

Ms. Smith, I am pleased to recognize you for five minutes.

JENNIFER SMITH: Thank you Chairman, Ranking Member, and Members of the Subcommittee. My name is Jennifer Smith, and I am Secretary for Pennsylvania’s Department of Drug and Alcohol Programs as well as a member of the National Association of State Alcohol and Drug Abuse Directors. Thanks for your interest in how Pennsylvania is using the State Opioid Response Funding to promote prevention, treatment, and recovery efforts.

Acting as the state’s single authority for Substance Use Disorder services, my department coordinates efforts with federal and local entities as well as across state departments. Our ability to orchestrate resources and direct policy during the opioid crisis has been a crucial component in affecting long term change and maximizing resources available to our communities. We are grateful for these federal grant opportunities at a time of hopelessness and despair for families and communities. I can say with certainty that this funding has saved lives.

With a population of 12.8 million, Pennsylvania is the fifth most populace state consisting of 67 counties that range from large urban centers to rural counties. Our state is among those hardest hit by the nation’s prescription opioid and heroin epidemic. In 2014, we lost more than 2,700 Pennsylvanian’s to drug related overdoses, which equates to seven deaths per day. By 2017, that number had tragically doubled to more than 5,400 lives lost or 13 deaths per day.

As statistics rose year over year our primary focus became simple. Keep Pennsylvanian’s alive. That meant infusing naloxone in to communities, implementing warm handoff protocols to transition overdose survivors from emergency departments in to treatment, expanding access to evidence based practices such as Medication Assisted Treatment, and launching a 24/7 Get Help Now Hotline. I am proud to say that in 2018, Pennsylvania reported an 18% decrease in overdose deaths. While it’s not clear whether this promising trend will continue in 2019, it is clear that the more than 230 million dollars in federal funding that the state has received is making a tremendous impact.

We have used these resources and the momentum of the crisis to collaborate, modernize, and innovate using dollars across the full continuum. As far as prevention is concerned we reduced opioid prescribing by 25%, developed prescribing guidelines, incorporated addiction content in to medical school curriculums and established over 800 Prescription Drug Take Back Boxes across the state. With regard to treatment we established a naloxone standing order and distributed over 55,000 free kits, we developed a Warm Handoff model that has been used over 6400 times, expanded treatment capacity through 45 Centers of Excellence and 8 Hub and Spoke Programs, increased our DEA ex-waiver physicians to over 4,000, offered loan repayment, awarded 3 million to expand supports for pregnant women and women with children, and expanded MAT in to our state correctional institutions. In terms of recovery support we awarded 2.1 million to expand Community Recovery Services, developed a website to share recovery stories and spread hope, and awarded grant funds to build Recovery Housing Supports.

In coming months, Pennsylvania will be focused on integrating quality in to our four major goals of reducing stigma, intensifying primary prevention, strengthening the treatment system, and empowering sustained recovery. Without sustainable federal funding the collaboration necessary to accomplish these goals will be greatly diminished. Although we have made significant strides, our work is not done and we need your help.

In terms of funding we need flexibility to address the system, not a substance. We need consistency with funding vehicles and reporting mechanisms where possible such as utilizing the Block Grant, as well as continued use of the Single State Authority as the central coordinating entity, sustainability to allow for the continued relationship fostering, stigma reduction, and integration of services.

Moving an entire system of care is a monumental task. We are working diligently and we have made staggering progress but please don’t give up. The long term success of our programs and communities depends on sustained funding and support. Two other quick considerations would be to address stigma in a more uniform way across the nation through language and action, and to seek ways to address the dire workforce shortage challenges by every state. Thank you again for allowing me to share what Pennsylvania is doing and our suggestions for moving the system forward. I look forward to answering any questions you may have.

CHAIR DEGETTE: Thank you so much. Don’t worry, we don’t intend to give up. Dr. Bharel, you are recognized now for five minutes.

DR. BHAREL: Chair DeGette, Ranking Member Guthrie, and Members of the Subcommittee thank you for the opportunity to speak with you today. In my role as Commissioner of Public Health and as the states Chief Physician, I am dedicated to addressing the opioid epidemic in Massachusetts. I commend Congress and our federal agencies for funding those working tirelessly on the front lines every day. Our data indicates that in Massachusetts our public health centered approach to the opiate epidemic is working. I am heartened to let you know that from 2016 – 2016 our opiate overdose deaths have declined by 4%. We continue to focus on prevention and education, naloxone availability, medication treatment, behavioral health counseling, and sustained recover supports. We have made progress but it is still unacceptable that nearly 2,000 individuals in Massachusetts die from this preventable disease each year. In my clinical practice I cared for people with this disease and I never forget that behind these numbers which we will talk about today are real people, their families, and their communities. Since 2016, we have been awarded approximately 159 million dollars in federal funding specific to Opioid Use Disorder prevention, treatment, and recovery. We have allocated approximately 111 million of those funds. We have used federal funding to support expansion and enhancement of our treatment system through a data driven approach that targets high risk, high need priority populations and disparities with the goal of reducing opiate overdoses and deaths. In 2015, Governor Baker appointed a working group who developed an action plan emphasizing data to identify hotspots and deploy appropriate resources. Additionally, a law referred to as the Public Health Data Warehouse enabled us to link 28 different data sets across state government and establish a public private partnership to maximize the use of data to study this major public health crisis. This was unprecedented in Massachusetts.

Our approach started with data analytics and research allowing us to gain a deep understanding of who was dying where and why so that new investments could be strategic and impactful. Our data led us to quickly focus our efforts on five key populations that we saw were still suffering from overdoses and overdose deaths and those are people released from incarceration, communities of color, people with co-occurring mental health and Substance Use Disorders, people with a history of homelessness, and mothers with Opioid Use Disorder.

Our data showed that the rate of overdose death from mothers with Opioid Use Disorder was more than 300 times higher than mothers without it. In response one of the programs we set up was Mom’s Do Care, which is currently 100% federally funded. This innovative approach built a seamless, integrated continuum of care for pregnant and parenting women with Substance Use Disorder. It provides access to medications, prenatal and post-natal care, maternity and pediatric care, behavioral health counseling, and peer to peer recovery supports, and so much more. With federal funds we are also supporting and expanding our Prescription Drug Monitoring Program, allowing all Massachusetts prescribers enhanced access to this vital system.

While we have had many successes, we do see opportunities for federal assistance so that we can continue to make progress. This includes funding that is flexible. When funding requirements restrict us to addressing only opiates states are limited in our flexibility to address the changing landscape of Substance Use Disorder. Flexibility would enable to address other substances connected to this epidemic such as cocaine and methamphetamines. Additionally, there are currently federal barriers to Medication Assisted Treatment such as methadone and buprenorphine and these barriers should be removed. This would allow Medication Assisted Treatment to be regulated more similarly to other chronic disease treatments and available in traditional healthcare settings to increase access and reduce stigma.

In conclusion, we are grateful to Congress for the commitment to address this opiate epidemic. Much of our progress can be attributed to federal funding we receive and I encourage Congress to continue these critical funding efforts. This crisis did not build overnight and it will take time to reverse. Addiction is not a choice, it is a disease and with the continued support of our federal partners we will build a solution to tackle this epidemic in Massachusetts and in this country. Thank you.

CHAIR DEGETTE: Thank you so much. Ms. Mullins you are recognized now for five minutes.

CHRISTINA MULLINS: Thank you. Chairwoman DeGette, Ranking Members, and Members of the Subcommittee. My name is Christina Mullins, and I am the Commissioner for Behavioral Health within the West Virginia Department of Health and Human Resources. I also serve as a member of the National Association of State Alcohol and Drug Abuse Directors. First I want to thank you for your commitment to address this crisis. Without the resources provided by this committee West Virginia would be in a considerably worse position. I also want to thank you for the opportunity to discuss the importance of the initiatives in West Virginia to address the opioid crisis and the impact of funding made available through this committee to promote prevention, treatment, and recovery for Substance Use Disorder.

It is no secret that West Virginia has been Ground Zero of the opioid crisis with the highest overdose rate in the nation. There are award winning documentaries and Pulitzer Prize winning stories that describe what happened to our state and I am sure these efforts have played a significant role in bringing much needed resources to West Virginia. Today I would like to tell you a different story.

With your help West Virginia has reduced overdose deaths for the first time in over ten years. Both opioid prescriptions and opioid doses have decreased by about 50% while naloxone prescribing has increased by 208%. Additionally, we have distributed over 10,000 of naloxone to local health departments. Treatment capacity has been transformed. The number of people that can prescribe buprenorphine has more than doubled from 243 to 584 since 2017. We have increased the number of residential treatment beds from 197 to 740 and our records indicate that those beds are about 85% full at all times. Nearly all birthing facilities have access to integrated Substance Use Disorder treatment in their community. This extraordinary increase in infrastructure and capacity is the result of the significant financial investment of federal, state, and Drug Settlement Funds. West Virginia leveraged federal investments to increase outpatient treatment capacity, increase the number and quality of its workforce, distribute lifesaving naloxone, and conduct rigorous provider education on opioid prescribing, increased evidence-based prevention programs and quick response teams to follow up on individuals who experience non-fatal overdoses. In addition to these efforts the state also increased its infrastructure for surveillance and data analysis and this work drives all of our programmatic decision making. The state complimented the work of its federal projects by using Settlement Funds and general revenue to undertake the development of construction projects that expanded the availability of residential treatment including facilities that specialize in pregnant and post-partum women. The scope of this problem required a historic financial investment to adequately respond to this crisis. (UNINTELLIGIBLE) allowed West Virginia to balance the need for immediate interventions and services with a long-term need to address the systemic issues that serve as an ongoing challenge to the state’s opioid response. While significant progress has been made certain barriers and challenges remain. West Virginia continues to experience substantial workforce shortages, gaps in training related to psycho-stimulants and polysubstance abuse, a lack of capacity to serve children impacted by this crisis. In addition, a key concern when utilizing time and limited grant dollars, is sustainability of efforts in thinking about a bigger, longer term investment if these endeavors are to have a continuing impact in increasing treatment availability and reducing overdose death. The predictable and sustained provision of resources is key to allow states and providers to plan and rely on future year commitments. It can be tough to successfully plan and operate programs if providers are not confident resources will be available beyond a one year commitment. It would be difficult to believe that West Virginia could have accomplished so much without the support of this committee. These funds have allowed West Virginia to have the resources that it needed to respond to this crisis and resulted in a decrease of overdose deaths and transformed our system of care. Our overdose deaths are down at this point by 10% according to our records. The financial resources are crucial to our continuing success and maintaining momentum. Ongoing funding for state alcohol and drug agencies to coordinate substance use prevention treatment recovery services at the state level will ensure continued progress. While barriers remain, West Virginia is better poised to address future challenges and continue its forward progress.

In summary, West Virginia wishes to say thank you to this committee, Sansa, and CDC. Thank you for the support, the resources, and for allowing us to share what is happening and what is working in West Virginia.

DOUG MCVAY: You are listening to Century of Lies. I am your host, Doug McVay. We are listening to a congressional hearing held Tuesday, January 14th on state efforts regarding illegal opioids and other drugs. The witnesses you just heard were Jennifer Smith, Secretary of Pennsylvania’s Dept. of Drug and Alcohol Programs; Monica Bharel, MD, MPH, Commissioner of Public Health at the Mass. Dept. of Public Health; Christina Mullins, Commissioner of the Bureau for Behavioral Health at West Virginia’s Department of Health and Human Resources

Now let’s hear from the final two witnesses: Kody Kinsley, Deputy Secretary for Behavioral Health and Intellectual and Developmental Disabilities at North Carolina’s Department of Health and Human Services; and Dr. Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island Department of Health.

CHAIR DEGETTE: Now Mr. Kinsley I would like to recognize you for five minutes.

KODY KINSLEY: Good morning. Thank you, Chair DeGette, Ranking Member Guthrie, and the Honorable Members of the Subcommittee for this opportunity to testify on North Carolina’s response to the opioid epidemic.

On behalf of the 10.4 North Carolinian’s approximately 426,000 of whom misuse prescription or illicit opioids. I wanted to express my deepest gratitude for your support of funding that has helped us turn the tide on the epidemic. This investment has saved lives, transformed communities, and it has made the down payment on breaking the cycle of addiction, trauma, and poverty in our state.

I am also grateful to the committed staff of numerous federal agencies that have worked quickly to support a concerted strategy working across interconnected systems of healthcare, housing, employment, and justice. North Carolina was hit hard by the crisis. In 2016, 1,407 North Carolinian’s died of an unintended opioid overdose. For each death there were six overdose hospitalizations. We were one of the top eight states for fentanyl overdose deaths. Since the start of the epidemic nearly 100,000 workers have been kept out of the workforce because of opioid misuse alone. Today close to half of the children in North Carolina’s foster care system have parental substance use as a factor in their out of home placement. The human cost and the loss to communities and families is immeasurable. The scale of the problem underpins our magnitude for accomplishment. Our states comprehensive response, the North Caroline Opioid Action Plan, is organized in to three pillars and they are prevention, harm reduction, and connections to care. These pillars encompass numerous strategies all made possible because of federal funding such as: cutting the supply of inappropriate opioid prescriptions; making access to life saving naloxone ubiquitous; supporting Syringe Exchange Programs; making addiction medicine a core of medical education; partnering with county and local communities; launching interventions at the start of treatment; starting treatment at the time of overdose reversal; and blending together broader efforts that support recovery including housing and employment and address the root cause of Substance Use Disorder.

With these efforts, North Carolina saw the first decline in deaths in five years with a decrease of 9% between 2017 and 2018. We have also seen a 24% decline in opioid prescribing and a 20% increase in the number of uninsured individuals receiving treatment. One million North Carolinian’s do not have health insurance and half of the opioid overdose visits to the emergency room are uninsured. Therefore, our highest priority has been expanding evidence-based treatment to those without insurance. We have focused on Medication Assisted Treatment as the gold standard of care providing treatment to an additional 12,000 people. Our success is clear but with your help there is much more we can do. We could stretch grant dollars further if doctors were no longer required to obtain a separate DEA waiver to prescribe buprenorphine for addiction. There is no additional waiver requirement to prescribe the exact same medication when it is being prescribed for other conditions. We should strengthen our focus on justice involved populations. A recent study found that prisoners leaving North Carolina prisons were 40 times more likely to die of an opioid overdose than the general population. We are grateful to have recently received a 6.5 million dollar grant from the Department of Justice to create Pre-Arrest Diversion Programs and expand jail based treatment in our state but with 56 prisons and 96 jails, we have a long way to go. Most significant of all would be giving us more time. Sustaining funding over longer windows of time or permanently would allow states to ready systems for the next wave of the epidemic. That wave is already cresting as we are starting to see rising rates of overdose deaths from methamphetamine and benzodiazepine. Before major federal funding for this epidemic became available, 12,000 people in North Carolina had already died. Meanwhile, North Carolina’s share of the Substance Abuse and Treatment Block Grant had not changed in recent years what North Carolina was one of the fastest growing populations in the country, growing 9% between 2010 and 2018. Growing the block grant at pace with population and inflationary costs in an updated allocation formula would allow states to make better use of short term funding, prevent the next epidemic, and save lives.

Most of all safeguarding Medicare Expansion and the Affordable Care Act is critical to our long term success in fighting the opioid epidemic. States with higher rates of insurance coverage have a more sustainable way of providing treatment and are able to prioritize their federal block grant dollars and opioid response grants on system investments. This is why we are working hard every day to expand Medicaid in North Carolina.

In closing, I want to applaud the flexibility of much of the federal funding we have received which has allowed each state to respond to its own pressing needs. Our strategies are working but our eyes are on the horizon. We appreciate your leadership and I welcome your questions.

CHAIR DEGETTE: Thank you. Dr. Alexander Scott you are now recognized for five minutes for your opening statement.

DR. SCOTT: Thank you. Chairwoman DeGette, Ranking Member Guthrie, and Distinguished Members of the Committee thank you for inviting me to join you today to discuss Rhode Island’s efforts to address the opioid overdose epidemic. Collaboration between states, federal agencies, and federal leaders such as yourselves is critical to our shared goals of preventing overdoses and saving lives. This issue has taken a staggering toll on my state. Since I became the Director of the Rhode Island Department of Health in 2015, an overdose death has occurred in every city in town in Rhode Island. During this time more Rhode Islanders have lost their lives to drug overdoses than to car crashes, firearms, and fires combined. Almost immediately after coming in to office in 2015, Governor Gina Raimondo formed an Overdose Prevention and Intervention Task Force to develop a centralized strategic data driven, comprehensive plan to prevent overdoses. The taskforce includes stakeholders and experts in various fields including public health, law enforcement, behavioral health, community based support services, education, veteran’s affairs, and recovery. As a co-chair of this task force, I have helped steer our efforts in to our four focus areas: prevention, treatment, recovery, and rescue or reversal. We have changed the culture of prescribing in Rhode Island and have dramatically reduced our prescribing numbers. We now have a vast statewide treatment network in place. We have cultivated a group of certified peer recovery specialists who walk side by side with people in recovery. We have put thousands of naloxone kits on to the streets. Most importantly, we have started to give people hope and we are focusing at the community level. We have learned that regardless of your race or ethnicity, regardless of your zip code, income, or insurance status every door for every person should make treatment and recovery services available. We believe that addiction is a disease and recovery is possible. One prime example is the story of Jonathan Goyer from East Providence, Rhode Island. Jonathan became dependent on opioids at 16 years of age. At 25, after more than 30 tries and after reaching depths that many of us could not fathom he was finally able to find, sustain, and maintain a life in long-term recovery. He is now thriving as an expert advisor to Governor Raimondo’s task force and he leads our states Recovery Friendly Workplace Program. When you talk to Jonathan about his journey he says the opposite of addiction is not sobriety. The opposite of addiction is connection. This is true for every community. We are trying to make the connection and the sense of community that brought Jonathan and so many others back from the brink a part of every overdose prevention effort we put in place in Rhode Island. We have had some success. After the number of drug overdose deaths increased each year in Rhode Island for the better part of a decade, that number decreased by 6.5% between 2016 and 2018. However, significant challenges remain. Fentanyl related overdose deaths continue to increase and the opioid conversation must be considered within the larger context of an addiction epidemic that has alcoholism, tobacco use, cocaine use, and other substances. We can broaden the scope even further to talk about the health implications of social and emotional isolation and the need to address the root causes of these challenges in our communities. All of this requires us to look beyond what many believe to be our traditional focus areas in public health. We need to look at the socioeconomic and environmental determinates of health which determine roughly 80% of what makes you healthy and what makes me healthy. These are factors like access to quality education, access to fresh fruits and vegetables, and reliable transportation. We need to ensure that all children grow up in homes and go to schools where they feel safe, supported, and loved. We need to ensure that people have the houses that are healthy, safe, and affordable, and to ensure that people have jobs that offer fair pay. This is a part of our response. The efforts and the progress that I have outlined today would not have been possible without the tremendous contributions of Congress and the federal agencies you fund. I thank you for that sincerely and I look forward to partnering with you to address what lies ahead on behalf of Rhode Island and on behalf of the Association of State and Territorial Health Officials where I serve as Immediate Past President. Thank you.

DOUG MCVAY: You have just heard part of a congressional hearing held Tuesday, January 14th on state efforts regarding illegal opioids and other drugs. The witnesses you just heard were Kody Kinsley, Deputy Secretary for Behavioral Health and Intellectual and Developmental Disabilities at North Carolina’s Department of Health and Human Services; and Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island Department of Health.

That is it for this week. I want to thank you for joining us.

You have been listening to Century of Lies. I am your host, Doug McVay, Editor of www.drugwarfacts.org. The Drug Truth Network has a Facebook page, please give it a like. Drug War Facts is also on Facebook, give its page a like and share it with friends. Remember, knowledge is power! Follow me on Twitter, I am @DougMcVay and of course also @drugpolicyfacts. We will be back in a week with 30 more minutes of news and information about drug policy reform and the failed war on drugs. For now, this is Doug McVay saying so long.

For the Drug Truth Network this is Doug McVay asking you to examine our policy of drug prohibition, the Century of Lies. Drug Truth Network programs are archived at the James A. Baker, III Institute for Public Policy.