Murphy Seeks to Amend Opioid Bills In Health Subcommittee Mark-Up

For Immediate Release: April 20, 2016
Contact: Murphy Press 202.225.2301

(Washington, DC) - On Wednesday, the Energy & Commerce Subcommittee on Health convened a markup on 12 bills offered in response to the exploding substance abuse epidemic in the country. In 2015, the Energy and Commerce Committee’s Oversight and Investigations Subcommittee, chaired by Congressman Tim Murphy, convened five hearings on the drug abuse crisis and compiled a series of findings to identify how Congress can best respond. 

Towards that end, Murphy drafted several amendments to the bills being marked up to address the gaps identified in the bills. Based on a dialogue with the Chairman, Murphy withdrew his amendments with the understanding the issues will be worked on before full committee mark-up. 

Read Congressman Murphy's Statement Below:

Thank you Mr. Chairman. We are in the throes of an opioid crisis greater than any previous drug in our nation’s history. Overprescribing of opioids is at the center of the crisis: 4 out of 5 heroin users started their addiction with a prescribed opioid. Yet, this committee will be moving legislation and members will be offering amendment to increase access to opioids with buprenorphine, which is diverted for illegal use at a rate higher than Methadone, Morphine, or Codeine. According to the DEA buprenorphine is the third most confiscated opioid in drug raids by their agents.

As a clinician, I urge the highest caution for this committee on policies that expand the prescription of this highly diverted opioid when we don’t have the infrastructure in place to truly care for the whole patient who has a substance use disorder. I have drafted 10 separate amendments to several of today’s bills designed to address the known gaps in the legislation. These amendments are based on the bipartisan work of the Oversight and Investigations subcommittee over the last two years. I will not be offering my amendments today because I have assurances from Committee leadership that we will be working to address these concerns between subcommittee and full committee.

My drafted amendments address:

• Keeping the buprenorphine prescribing cap at a level where treatment can be provided with the aim of recovery;
• Enhancing the requirements that patient receiving buprenorphine receive evidence based addiction counseling;
• Amending 42 CFR Part 2 so that highly diverted drugs like buprenorphine are included in prescription drug monitoring programs like NASPER;
• Allowing patients to more easily and voluntarily share their substance use treatment records with primary care and physical health providers;
• Studying how pain metrics on patient satisfaction surveys that are tied to payments for hospitals are contributing to increasing rates of overprescribing pain medication, (as revealed in the Journal of American Medical Association it “may paradoxically promote prescribing of opioids and other addictive medications”) ;
• Expanding our understanding of how the Institutions of Mental Disease (IMD) exclusion has decreased access to inpatient and residential treatment for substance use disorders. Thus limiting evidence based treatment option for induvial trying to recover from addiction;
• Ensuring that we are working upstream to prevent an overdose, and a priority to help addicts recover and refrain from using dangerous drugs, instead of simply expanding access to naloxone.

I have a tremendous amount of admiration and respect for the people on this subcommittee and especially Dr. Bucshon. He is a leader in this House on the issue of opioid addiction. But we need more providers who can deliver the wraparound services that make Medication Assisted Therapy (MAT) work. My concern is that we now falsely consider MAT any services provided by a DATA 2000 waivered doctor to a patient with an opioid addiction. MAT must be accompanied with wraparound services and counseling, since that is how that clinical intervention is defined by SAMHSA. CMS, and HHS. An offering of referral isn’t treatment, having staff members sitting in waiting rooms with patients is not psychotherapy. We need more professional to treat patient on the non-pharmaceutical side of the MAT model. We don’t have enough psychologists, mental health professionals and professional substance abuse counselors since a third of all people experiencing mental illnesses and about half of people living with severe mental illnesses have a co-occurring substance use disorder. Right now in Pennsylvania:

• 59% of patients did not have any counseling in the year that buprenorphine was prescribed
• 24% of prescriptions for buprenorphine were not preceded by a physician visit in the prior 30 days
• 10% of patients prescribed buprenorphine had more than 20 buprenorphine 30-day refills per year
• Between 26% - 32% of the buprenorphine claims where for patients who had not been diagnosed with opioid use disorder
• And, among those patients with without an opioid use disorder diagnosis:  
  • Over 90% received no counseling services in the year
  • 78% were not tested even once for illicit drug use
  • Over half (52%) did not have a physician visit in the preceding month 
  • 46% had filled a prescription for benzodiazepines (a class of addictive medications used for sedation, that are commonly abused by opioid addicted individuals)

Many addicts know how to manipulate physicians, families and friends. That is not a criticism or condemnation; it is the reality of addiction, which is often more powerful than a desire to care for their own life or for the love of family. Many will lie to their doctor and family or steal from family and friends because they are not able to do anything other than feed their addiction. I caution this committee that we can’t become enablers and allow ourselves to believe that just because we are doing something, that we are doing the right thing. 

For decades Congress has failed to address the issue of drug abuse, treating it as a crime, rewarding doctors who overprescribe opioids, prohibiting the integration of substance abuse records with physical health records, and looking the other way when facts about the adverse effects of bad policy become clear. We cannot allow that to continue and we need to advance policies that provide a path to full recovery that heals patients, not a dead end road that leaves people addicted opioids and the federal government.

I thank the Chairman and look forward to our continued work together.

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