WASHINGTON – During a U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee hearing on “The Federal Response to the Opioid Crisis” on Thursday, U.S. Senator Chris Murphy (D-Conn.) questioned Director Debra Houry, M.D., MPH of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention, Commissioner Scott Gottlieb, M.D. of the Food and Drug Administration, and Director Francis Collins, M.D., Ph.D. of the National Institutes of Health about ways the federal government can help stem the opioid epidemic. Murphy received feedback on reasons why the opioid epidemic continues to worsen, and about methods to keep people off of a pathway to addiction. Click here to view video of Murphy’s remarks.

“As you’ve all noted, the [opioid] epidemic continues to get worse. Drugs are not the only way to manage pain and yet insurance companies seem to drive payment towards prescriptions rather than to other methods that, maybe in the short term, are more expensive, but in the long term, may keep you off of these dangerous drugs,” said Murphy. “What does the data tell us about how we’re doing on the over-prescription of medications, and why is this heading in the wrong direction if we’re finally getting a handle on pain meds? What are the additional avenues we need to do to help give doctors and potentially insurance companies some different ways to manage pain other than the drug?” 

According to Connecticut Chief Medical Examiner Dr. James Gill, there have been 539 accidental drug overdose deaths in Connecticut over the first half of the year. The figures include 322 deaths involving fentanyl. If this rate continues, Connecticut will see a projected 1078 overdose deaths in 2017, up from the 917 deaths last year and nearly triple the 357 deaths five years ago. 

Dr. Elinore McCance-Katz, the first-ever U.S. Department of Health and Human Services Assistant Secretary for Mental Health and Substance Use, was also at the HELP hearing. The position was created under reforms championed by Murphy and U.S. Senator Bill Cassidy (R-La.) as part of their Mental Health Reform Act. 

Full text of Murphy’s remarks is below:

MURPHY: Thank you all for being here. Let me just note that Dr. McCance-Katz is our first Assistant Secretary for Mental Health and Substance Abuse. This committee, in a bipartisan way last year, passed the Mental Health Reform Act which eventually ended up part of the 21st Century Cures Act, which created the position and we were all very excited to support Dr. McCance-Katz for that position. It’s kind of wild that we did not have someone at HHS for all those years who was focused at the top level of leadership on these questions of mental health and leadership, so we’re very glad you’re here.

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MURPHY: I’ll maybe pose this question to Dr. Gottlieb and Dr. Houry – to talk a little bit about what the data tells us with respect to the progress we’re making on prescription patterns. So for years, pain medication scripts were going up, and up, and up. And from what I’ve seen, the last few years tell us that we’ve finally bent the curve downward.

SAMHSA has a document out that suggests that maybe the actual number of pills that are being prescribed may not be heading in the right direction as fast, but overall the number of prescriptions are going down, and yet as you’ve all noted, the epidemic continues to get worse. So I think a lot of us have hung our hat on this idea that if you get ahold of the over-prescription, that you will make a big impact ultimately on the number of overdoses and addictions, but that doesn’t seem to be the case. 

So what does the data tell us about how we’re doing on the over-prescription of medications, and why is this heading in the wrong direction if we’re finally getting a handle on pain meds? 

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MURPHY: Dr. Collins, what are the additional avenues for research on pain management? Drugs are not the only way to manage pain and yet insurance companies seem to drive payment towards prescriptions rather than to other methods that maybe in the short term, are more expensive, but in the long term, may keep you off of these dangerous drugs. What are the additional avenues we need to do to help give doctors and potentially insurance companies some different ways to manage pain other than the drug? 

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MURPHY: And I would just very quickly note I think that is in part because of the problem you identified, which is insurance reimbursement. Insurers are not willing to reimburse either for the scope of services or for the amount necessary to bring providers in. And it speaks to the way that risk allocation simply does not work for this population because if you don’t keep someone off of this pathway to addiction, you may not as the insurer actually bear the responsibility because the cost to the individual is so catastrophic that they are likely going to come off your insurance plan because they end up in jail, or they end up homeless, or they end up out of work.

So we’ve got to have a conversation about how you structure risk allocation here to promote insurers to pay for the stuff that actually keeps you off of that pain medication pathway.

Thank you, Mr. Chairman.

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