Jul 17, 2019

Critical opioid funding is running out

Photo: Spencer Platt/Getty Images

The opioid crisis seems to finally be slowing down, but some treatment centers say that fragile progress could slip away if Congress doesn't step in to renew a critical funding stream that's quickly running dry.

The big picture: Congress and the Trump administration signed off in 2017 on a $3.3 billion grant program to helped bolster access to treatment. But that money is beginning to run out, The New York Times' Abby Goodnough reports.

  • The problem is especially serious in states that haven't expanded Medicaid. The program offers coverage for addiction treatment that non-expansion states have to make up for with their grant funding.
  • North Carolina and Kansas both exhausted portions of their funding months ahead of schedule and Missouri is on a similar trajectory, per NYT.
  • Some treatment centers are cutting back on certain services to stretch their money further.

What they're saying: "When we first heard the money was coming, I remember thinking, 'Wow, that's a lot,'" Nora Bock, who helps run treatment programs for Missouri's state government, told the Times. "Now it's like, 'Oh my God, it's nowhere near enough.'"

What's next: Sen. Rob Portman of Ohio told NYT he's concerned that because the rate of overdose deaths nationwide is beginning to level off, Congress could get distracted and turn to other priorities, letting another round of funding wither.

My thought bubble: I'd be less concerned about this next round of funding falling through than the one after that, or the one after that.

  • The number of overdose deaths is still staggering, and there are a lot of people in Congress (including Portman) who are still laser-focused on this epidemic.
  • But addiction treatment and recovery can be a long — sometimes lifelong — process.
  • Even if Congress comes through this time, the fear alone is a reminder that all one-time funding streams eventually run out, putting treatment programs and other long-term supports further in jeopardy every time the acute crisis gets a little better.

Go deeper: There are more opioid overdoses in the suburbs than ever

Go deeper

U.S. drug overdose deaths fell last year

Note: 2018 data is provisional; Data: Centers for Disease Control; Chart: Axios Visuals

Fewer Americans died from drug overdoses last year than the year before. It's the first time that number has gone down in almost 30 years.

Yes, but: This progress is both fragile and modest. Overdose deaths fell by about 5% last year, according to provisional data from the federal government. But overdose deaths rose by roughly 316% between 1999 and 2017. There's still a long way to go, and more than 68,000 Americans still died of overdoses last year.

Go deeperArrowJul 18, 2019

The Future of Pain Management

Sen. Jeanne Shaheen discusses the opioid crisis on the Axios stage. Photo: Chuck Kennedy for Axios

The big picture: Thursday morning, Axios' Health Care Editor Sam Baker hosted a 4-part conversation on the future of pain management including policy changes, investment in new research and expanded access to non-opioid choices.

Representative David B. McKinley, West Virginia

Rep. David B. McKinley (R-Wv.) discussed the impact of opioid addiction on his constituents and his frustration that the pharmaceutical industry was not being held accountable for their role in the unfolding crisis.

  • On drug makers: "When you have 200-300 pills per person for a person living in Mingo, WV, come on...They had to have known that was an excessive amount."
  • On the slow pace of legislative progress: "The frustration I have is 7 months into the 116th Congress under Pelosi, we've only had one hearing (about the opioid crisis)."

Drawing direct comparisons to European countries, he highlighted their significantly lower opioid-related overdose rates and willingness to use non-opioid courses of pain management.

  • On the need for sustained commitment: "We can't just throw money at [the opioid crisis] and expect it to go away."
Senator Jeanne Shaheen, New Hampshire

Sen. Jeanne Shaheen (D-Nh.) agreed with Rep. McKinley on the need for holding the pharmaceutical industry accountable, and the interconnections between opioid addiction and other substances.

  • On the need for a flexible approach: "What we've got to do is refocus Congress on the fact that we have not overcome this epidemic...It's evolved in a way where our approach needs to change. Our programs have to be flexible enough to address the other problems [with other substances] we're seeing."
  • On the stigma around addiction: "This is not a moral failing...this is a physical condition and we need to treat it that way."

She underscored the importance of the Affordable Care Act in maintaining current treatment programs.

  • "If [the ACA] goes away, there's no affordable alternative to treatment."
Dr. Marian Sherman, Director of Clinical Operations, Acute Pain Service Faculty, George Washington University Hospital

Anesthesiologist and Director of Clinical Operations of Acute Pain Service Faculty at George Washington University Hospital, Dr. Marian Sherman unpacked the role of opioids in a medical setting and focused on the dangers of using it as a monotherapy.

  • On layering other types of medications: "We're using different types of medications to target different types of pain...We begin with acetaminophen and drugs like Ibuprofen and Motrin before thinking about layering on opioids."
  • On the importance of short-course therapies: "We need to educate surgeons and other prescription writers to ensure that patients are only on a short course of opioids...Opioids as a monotherapy is not a good choice medically and clinically."
Admiral Brett Giroir, Health and Senior Adviser, Opioid Policy, U.S. Department of Health and Human Services

Admiral Brett Giroir, Health and Senior Adviser on Opioid Policy at the U.S. Department of Health and Human Services, focused on the evolution of the opioid crisis and the progress being made thus far.

On the relationship between opioid addiction and fentanyl: "Prescription opioid deaths are down...and we're starting to get control over fentanyl overdoses as well. If we can treat opioid use, then we can impact the fentanyl crisis."

On making the system work for everyone: "We need to transition to a sustainable framework of care...[An important component of that] is to understand how to better reimburse people for treatment."

On the social determinants of health: "We have to deal with the underlying issues that make us all prone to this...Prescribing opioids is not an ideal solution, but we have to deal with people who have chronic, unremitting pain to deal with their quality of life."

Thank you Voices for Non-Opioid Choices for sponsoring this event.

Keep ReadingArrowJul 19, 2019

Drug overdose deaths spike in urban America

Reproduced from NCHS; Chart: Axios Visuals

For years, death rates from drug overdoses surged in rural America. But now, overdose death rates are rising faster in cities, according to a newly released data analysis from the Centers for Disease Control.

What's happening: The opioid crisis has devastated many rural areas while heroin deaths are climbing in urban centers.

Go deeperArrowAug 7, 2019