March 05, 2019

Credit: WBAL-11, Lisa Robinson

Those with a substance use disorder have a hard time getting treatment without insurance, which they can’t get without ID that often requires a lost birth certificate.

Even if they can access treatment, they sometimes can’t focus on their recovery if they don’t have a place to live, are hungry or suffer other mental and chronic health conditions.

Some may have disappointed themselves by failing at treatment before, but they can’t stop craving heroin that they suspect is laced with the far more powerful, and often deadly, fentanyl. No one may have provided them with the overdose treatment naloxone.

These are some of the interlocking issues related to the nation’s opioid epidemic that a group of freshmen congressmen, led by Maryland Democratic Rep. David Trone, sought to understand as they toured the Johns Hopkins University’s research and treatment facilities on Tuesday.

“The most important reason I ran for Congress is to make a change in America on the opioid catastrophe,” Trone said after joining other members from Maryland, Pennsylvania and Texas in touring the facilities around Baltimore that included physicians’ offices focused on behavioral and medical health and the emergency room at Johns Hopkins Bayview Medical Center.

“This is the No. 1 issue facing the country,” he said. “There are 72,000 that die a year, 192 every day. …This is all about giving hope to people.”

Trone, who lost a family member to an overdose, announced the creation last month of the Freshmen Working Group on Addiction, a bipartisan group of 40 lawmakers who would study the problems and craft a package of legislation to tackle the years-long epidemic that shows no signs of slowing.

The lawmakers, along with staff from other congressional offices, said legislation could tackle pieces of the problem, such as ensuring more widespread availability of naloxone, enhancing public education campaigns about the dangers of fentanyl and boosting efforts to keep drugs from coming to the country from illicit Chinese labs.

Congress already has taken some steps to address the epidemic in recent years. States will have access to $1 billion in grant funding and there is a new law aimed at stopping drugs in the mail, for example. Many states expanded their Medicaid programs with federal dollars under the Affordable Care Act, and the health coverage for low-income residents now funds a disproportionate level of addiction treatment.

But Trone wanted the freshmen to bring “fresh eyes” to the opioid problem. He and Rep. Susan Wild, a Pennsylvania Democrat, and Rep. Dan Crenshaw, a Texas Republican, had the chance to asked questions of doctors and nurses, researchers, peer counselors and those with substance use issues.

They said they could build on the “best practices” from Hopkins to share with hospitals in other states. That would include the wrap-around services, such as links to housing and other social services, which gets at related issues that can hamper treatment.

They also got a rundown of the issues and data from researchers at the Hopkins Bloomberg School of Public Health, who suggested various changes the lawmakers could pursue.

“The problem is absolutely horrible and it’s reducing life expectancy,” said Dr. Joshua Sharfstein, vice dean for public health practice and community engagement in the school of public health. “It helps to understand that this is a chronic illness of the brain.”

Sharfstein moderated a panel of Hopkins researchers who pitched changes in federal policy to boost access to medications found effective in treating addiction. They proposed upgrading opioid labeling to reduce unsafe use and continuing the decrease in prescribing opioid-based pain relievers that are considered a major link to substance abuse.

Others suggested better tracking of treatment after nonfatal overdoses, which Sharfstein said is a major risk factor for another overdose, as well as timely and accurate fatal overdose data from medical examiners.

They suggested mandating comprehensive addiction treatment in employer-sponsored insurance, since many people with substance use disorders are working. They also called for the Justice Department not to interfere with states that wish to host safe injection sites, which have been rebranded as overdose prevention sites because of better public acceptance.

The group said more needs to be done to reduce stigma, so people don’t feel shame in seeking treatment.

Like any other chronic health conditions, a substance use disorder is a complicated issue that requires different avenues to address for those afflicted, they said.

“This is a disease,” said Dr. Caleb Alexander, a Hopkins professor of epidemiology. “No one chooses to have it.”