Biden drug policy director pledges to close treatment gaps
Fatal overdoses up during pandemic
WASHINGTON — The Biden administration is moving to usher significant federal resources to close drug treatment gaps and make medications more accessible to everyone, the top White House drug policy official told House lawmakers Wednesday as they considered 11 bills to address a worsening drug abuse health crisis exacerbated by the COVID-19 pandemic.
Regina M. LaBelle, acting director of the White House Office of National Drug Control Policy, acknowledged long-standing racial inequities, bureaucratic red tape and the pandemic’s hardships have all contributed to a 29% spike in fatal overdoses in the 12-month period ending last September, according to preliminary data from the Centers for Disease Control and Prevention also released Wednesday.
At the same time, Ms. LaBelle told lawmakers that one key federal tool to stem the recent spike in overdose deaths — keeping fentanyl on the list of most tightly regulated controlled substances — would expire on May 6 if Congress does not approve an extension.
Fentanyl, a powerful synthetic opioid that has flooded hard-hit U.S. cities like Pittsburgh from China and Mexico, was temporarily added to the list of controlled substances in 2018. Ms. LaBelle said her office was working with justice, health and drug enforcement officials to study a Government Accountability Office report released this month that assesses the impact.
Law enforcement officials believe the fentanyl scheduling has helped, the GAO reported, but drug researchers and civil rights advocates expressed concerns that it has led to harsh sentencing and delayed studies.
“We understand the urgency” of addressing fentanyl, Ms. LaBelle said. “It’s not going to happen before May 6, but we’re going to work as quickly as possible.”
A spokesman said the White House Office of National Drug Control Policy takes the deadline seriously “and will work with Congress to seek a clean extension to prevent this important tool from lapsing while we address legitimate concerns related to mandatory minimums and researcher access to these substances.”
The attention on the troubling surge in drug abuse — outlined in the annual White House drug policy plan submitted to Congress on April 1 — comes as a flood of federal resources pours out of Washington.
The American Rescue Plan, approved by Congress and signed by President Joe Biden last month, included $1.5 billion in block grants for substance abuse services, and tens of millions for other programs that improve addiction care. That came on top of $1.65 billion allocated in December’s COVID-19 relief bill, of which Pennsylvania was awarded $55 million last month.
The Pennsylvania Department of Drug and Alcohol Services has made up to $2.7 million in grant money available to community groups that help people who are in recovery from substance use disorder. The money can be used to provide services like GED assistance, recovery coaching and substance-free social activities, the state said.
And last week, Mr. Biden’s proposed budget to Congress included $10.7 billion for addiction programs, a 57% increase from the 2021 enacted funding levels.
Wednesday’s hearing, titled “An Epidemic Within a Pandemic: Understanding Substance Use and Misuse in America,” was called as lawmakers on the House Energy and Commerce Committee consider further legislation.
The 11 bills on the agenda would, among other things, aim to train more health providers in addiction treatment; expand Medicaid to close health care coverage gaps for those leaving prison; crack down on methamphetamine; reauthorize state opioid grants; and speed up research approvals on controlled substances.
One bill would permanently schedule fentanyl as a controlled substance.
Democrats and Republicans have expressed bipartisan alarm at the opioid epidemic and tended to work together on legislation.
“This number of deaths says to me that we’re not making progress, and we have to change that,” said Rep. Anna Eshoo, D-Calif., who chairs the panel’s health subcommittee.
Lawmakers pressed Ms. LaBelle to remove barriers for health care providers to treat substance abuse disorders with buprenorphine, a popular and effective medication, and expand access to methadone.
Physicians and other practitioners currently must complete additional training and get federal approval to prescribe buprenorphine, and methadone is now mostly limited to brick-and-mortar facilities.
Rep. John Joyce, R-Blair, said his home county has seen an 80% increase in overdose deaths, and the local coroner “can rattle off these statistics in a breath.” Mr. Joyce asked Ms. LaBelle why the Biden administration had rescinded the Trump administration’s last-minute move in January to lift the buprenorphine training requirements.
Ms. LaBelle answered that policy is being reviewed to ensure it “can withstand any kind of legal challenge to it” and provided no timeline. She said the office was planning to publish new rules on mobile methadone clinics that deliver the medication by van.
A second panel of public health experts, including a University of Pittsburgh professor, highlighted racial inequities in substance abuse treatment that go back decades — long before the opioid epidemic arrived in predominantly white areas of the country.
In her testimony, J. Deanna Wilson, an assistant professor of medicine and pediatrics at the University of Pittsburgh School of Medicine, told lawmakers that overdose deaths have disproportionately hit racial and ethnic minorities because of entrenched policy missteps.
Dr. Wilson, a pediatrician and internist who currently treats patients ages 13 to 74 with substance use disorders at UPMC and UPMC Children’s Hospital of Pittsburgh, recalled a seven-year stint in Baltimore where she treated Black patients for heroin addiction.
“My patients would comment on the irony of addiction now being seen as a disease requiring medical treatment when they lived in communities devastated by the war on drugs and mass incarceration — the treatment strategies they had been offered,” Dr. Wilson testified. “These policies devastated families, communities and entire neighborhoods.”
Today, for every 35 white patients with opioid abuse disorder who receive a buprenorphine prescription, only one racial or ethnic minority patient will receive one, Dr. Wilson stated.
Dr. Wilson told Ms. Eshoo, the chairwoman, that while highly effective treatment options are available, “we are not getting the medical therapies to the patients and communities that need them.”
Ms. LaBelle’s testimony cited a recent study that found Black people entered addiction treatment, on average, four to five years later than white people. She said Wednesday the White House was working with the Health and Human Services Department to identify lasting solutions.
“We want to do more than just a program that sounds good or looks nice,” Ms. LaBelle said. “We want to put in programs and policies that make a difference, once and for all, on this issue.”