The abuse of and addiction to opioids is a serious and challenging public health problem. Deaths from drug overdose have risen steadily over the past two decades and have become the leading cause of injury death in the United States. In Virginia, there were over 1,400 deaths from drug overdose in 2016 - up 38% over 2015.
Fighting the opioid epidemic in Virginia's Fifth District and across the country will be best achieved by advocating for evidenced-based policies and programs that address prevention, harm reduction, and treatment. Practically all of the steps outlined below would be enhanced by the Administration declaring the opioid epidemic a national crisis, which would release critical funding from FEMA's Disaster Relief Fund.
Taking steps to prevent the spread of addiction
Educate the public
Although the public has become increasingly aware of the danger of opioids in recent years, more needs to be done to ensure that everyone from our children to our retirees know that opioids now kill more people in Virginia than car accidents or gun violence. Ensuring the dangers of opioids are universally known will help prevent future pain patients from unwittingly developing an addiction.
We must support the work of local educators who are incorporating opioid education into their health curriculum and encourage physicians prescribing opioids to provide information to the patient on the risks of addiction and the need for safe disposal of leftover medication.
Promote universal, real-time use of Prescription Drug Monitoring Programs (PDMPs)
All 50 states currently utilize some form of PDMP. These programs are most effective when data is readily accessible, records are updated within 24 hours of medication being dispensed, and physicians are required to check the system before prescribing controlled substances.
Congress should promote the sharing of data across state lines so that doctors in one state can know if a patient has already been prescribed opioids in another.
Limit opioid prescriptions
Addiction often begins with the short-term treatment of pain. Center for Disease Control and Prevention (CDC) guidelines on prescribing opioids state that opioids should not be considered a routine therapy for chronic pain, should be prescribed in the lowest effective dosage, and that “Three days or less will often be sufficient; more than seven days will rarely be needed.” Opioid prescriptions should be limited to seven days except for treating cancer and hospice patients, and in other rare cases deemed necessary by a physician.
Support law enforcement efforts to reduce illicit supply
Law enforcement should be given the tools and support they need to prosecute pill mills, heroin and fentanyl trafficking, and all those who seek to profit from other people’s misery. Through making it clear that it does not pay to pump these poisons into our community, we can help address the supply side of the opioid epidemic.
Increase access to effective, non-opioid pain management
In order for opioids to truly become the last resort for pain management, Medicare, Medicaid, Veterans Administration (VA), and private insurance must offer coverage for alternative methods such as massage, physical therapy, and mental health treatment.
Marijuana, which can be used to manage acute pain and reduce the need for dangerous opioids, should be reclassified from the Drug Enforcement Agency’s list of Schedule I drugs to its list of Schedule III drugs. Once properly regulated, a portion of tax revenue from medical marijuana should be directed towards opioid addiction treatment programs.
Further research into the development of non-opioid pain management treatment must be fully funded through the National Institute of Health (NIH) and VA.
Acting to reduce the short-term risk to those currently struggling with addiction
Expand needle exchanges
Needle exchanges are important public health programs that reduce the transmission of HIV/AIDS and hepatitis C and provide an opportunity to raise awareness about treatment options. By supporting their work, we can ensure that risks are minimized to the greatest extent possible for those struggling with addiction in both our urban and rural communities.
Improve naloxone access
Naloxone is a vital tool in the fight to prevent opioid deaths. It is not a long-term solution for addiction, but has nevertheless saved countless lives in our communities. We must take steps to offset the strain that increasing costs of naloxone are placing on local budgets, as well as ensure that the drug is available for administration to all at risk of dying of an overdose. Furthermore, we must work to ensure that those who are administered naloxone and survive an overdose are connected with treatment resources
Ensuring that effective treatment options are available to all those who seek them
Improve access to mental health treatment
There is a lack of mental health services available to those seeking treatment for opioid addiction, particularly in our rural communities. In the near term, this can be addressed by eliminating the Medicaid Institutions for Mental Diseases (IMD) exclusion, which prohibits the use of federal funds for covering mental health care in residential facilities with more than 16 beds.
In the long term, we must also invest in professional training so that more counselors will be available to provide treatment.
Increase availability of Medication Assisted Treatment (MAT)
Lack of access to MAT is an example of how it’s oftentimes easier to get high than it is to get help. When coupled with appropriate mental healthcare, MAT can be an incredibly powerful tool for allowing addicts to regain a sense of normalcy. A 2015 study found that only 10% of patients treated with buprenorphine qualified as having an opioid dependency three-and-a-half years after treatment, yet only 35% of those receiving treatment in 2015 received some sort of medication.
Steps must be taken to scale back some of the regulations regarding MAT and ensure that there are no unnecessary administrative or financial barriers for patients to receive this potentially life-changing treatment.
Expand drug courts to every federal judicial district
We will never work our way out of the opioid epidemic by locking up addicts. Drug courts provide a viable alternative to the traditional criminal justice system that helps ensure those struggling with addiction receive the treatment they need.
As of 2015, only 27 of our 93 federal district courts operate drug courts. I will fully support efforts to ensure that every American in need has access to a drug court.