Spiraling Abuse

04.29.14

The Heroin Hearing That Wasn’t

Tuesday’s subcommittee hearing on America’s out-of-control opioid epidemic began with hope and ended the same old way—without results. Why the lawmakers and panelists missed the point.

Hope isn’t a word you normally associate with heroin. But at the start of a subcommittee hearing on America’s opioid epidemic on Tuesday, the House of Representatives was teeming with it.

“This is a prestigious panel, an all-star group,” Rep. Michael Burgess (R-TX) gushed of the five people sitting before him. Hailing from the five agencies with leading roles in addressing opiate dependency, Michael Botticelli of the Office of National Drug Control Policy, Dr. Daniel M. Sosin of the Centers for Disease Control and Prevention (CDC), Dr. Nora D. Volkow of the National Institutes of Health (NIH), Dr. H. Westley Clark of the Substance Abuse and Mental Health Services Administration (SAMHSA), and Joseph T. Rannazzisi of the Drug Enforcement Administration had been tapped to identify the policies and programs that have been the most effective in combating prescription drug and heroin abuse in the United States.

“We look forward to your testimony,” he told them.

He wasn’t alone. The families of the roughly 17,000 people who die from opioid overdoses each year, 3,000 of which are from heroin, were likely looking forward to it, too. But with no plans to implement changes for a year, and no real progress made on what exactly those changes need to be, they were in for a disappointment.

The hearing, while useful to get the conversation started, was likely as infuriating for the families as it was for the members of Congress present, many of whom raised their voices in anger at the panel of five. The lawmakers have good reason to be anxious—and angry. The opioid epidemic, which first gained national attention at a similar hearing in the 1990s, has been spiraling out of control for almost three decades.

So “Examining the Growing Problems of Prescription Drug and Heroin Abuse” should have been a hearing with a captive audience apart from those directly affected or those whose job demands they be. It wasn’t. And not one of the congressmen or panelists seemed to capture the larger problem: Opioid addiction and heroin abuse in America are skyrocketing, and the things we’re doing to stop them aren’t working.

As congressman after congressman pummeled him with questions, the stark truth became apparent: He’s doing everything he can, and it’s still not working.

A quick look at the facts: According to the CDC, 50 Americans a day die from prescription painkillers. That number directly correlates with the 300 percent increase in the sale of prescription painkillers since 1999. In 2010, the annual number of prescriptions for painkillers was 76 million; just two years later it had nearly tripled, to 210 million. In 2011, hospitals reported more than 500,000 emergency room visits related to opioids, a three-fold jump since 2004. But it’s not just prescription pain pills sending people to emergency rooms. According to SAMSHA, in 2012, the number of people aged 12 and older who used heroin in the past year more than doubled, bringing the total to 669,000. From 2007 to 2012, the use of heroin in the United States increased 79 percent. Today, experts estimate that at least a half-million people in the country are addicted to heroin.

Those are statistics that Botticelli, one of the five featured panelists on Tuesday, has likely memorized. After citing a few of the numbers in his opening speech, the acting director of the Office of National Drug Control Policy described America’s opioid epidemic as a “matter of great concern” for the Obama administration. Of the five, Botticelli’s opening speech was easily the most powerful. But as congressman after congressman pummeled him with questions, the stark truth became apparent: He’s doing everything he can, and it’s still not working.

In no portion of the hearing was this “hands are tied” feeling more clear than during a discussion between Rep. Peter Welch (D-VT) and Dr. Clark, SAMSHA’s director of substance abuse treatment.

“Can you explain the decision not to increase state programs, then? They need more resources,” Welch asked the five panelists, as if willing any of them to answer. Dr. Clark’s reply, unfortunately for those hoping that real change might come from the hearing, was essentially “no.” “We are working closely with authorities, but we are approaching this from a comprehensive approach, we need to keep in mind that we need multiple strategies,” he said. “Relying on the Affordable Care Act. Using prevention efforts as well as treatment efforts, but—”

“—so no more money?” Welch interrupted, offering a smile that signaled pure exhaustion and defeat. “Money is tight, I get it.”

Other aspects of the hearing, including a thoughtful discussion on the role of doctors in relieving pain by Dr. Volkow, director of the National Institute on Drug Abuse, were informative, but in the end unproductive.

Turning the tide of America’s opioid epidemic, it seems, will take many more resources than the ones on the table Tuesday. Getting them there will take more Americans speaking up, and fewer congressmen talking in circles.