WASHINGTON — Senator Rob Portman, one of Capitol Hill’s leading voices on the opioid epidemic, can count a couple big wins to his name:
The Ohio Republican authored the Comprehensive Addiction and Recovery Act, the first major legislation that addresses the opioid crisis, and he helped secure $1 billion in funding in the 21st Century Cures Act, which President Obama is expected to sign this week. Those bills will help get naloxone in the hands of more first responders.
But there’s still a lot more to be done. A record 52,000 people in the US died last year from drug overdoses, and for the first time, the number of heroin deaths topped the number of gun homicides.
STAT spoke with Portman recently about the crisis. Among other things, he called for cracking down on mail-order imports of synthetic opioids from China and for lifting a cap on the number of beds in drug treatment facilities.
Here are the highlights, edited and condensed for length and clarity.
What should Congress focus on next?
In terms of new things, three things I think are most important. One is reducing some of the barriers we see to treatment right now. There are people who are ready to seek treatment or are overdosing and getting into an emergency room but having no place to go to detox. One of the problems is there’s an exclusion that caps Medicaid reimbursement for any drug treatment facility. You’re capped at 16 beds. People are telling me, ‘Gosh, Rob, if we could have 32 beds or even 20 beds, it would help. We’d be able to get people off the waiting list.’
I think second would be focusing on recovery more. The US Department of Housing and Urban Development, for instance, has some rules with regard to housing we’d like to take a look at it. There’s some great places in Ohio that provide recovery housing that has no medication aspect to it, and they’re doing an incredible job, yet they can’t get HUD funding.
The third area where we can make progress is in trying to keep these synthetic heroins out. One of the new challenges we’ve seen in Ohio is carfentanil and fentanyl. At this point, law enforcement people tell us they’re coming in from overseas, specifically China is the major source, [and] some is from India. It’s very high potency and it comes in packages through the US mail system.
If they send it through UPS or FedEx or any other private carrier, they have to provide information upfront about where it’s from, what’s in it, where’s it going. They don’t have to do that with the US mail system, and that’s one reason the traffickers use the mail system. What we’re saying is let’s simply require the same information.
How tough will it be to implement the new programs?
We’ve got a lot of implementation challenges ahead. We have to ensure we actually get these programs up and going and they’re working properly.
It has a new national prevention program. I want to make sure that’s launched properly. [The bill creates an inter-agency task force to examine pain management and prescribing practices, and it provides funding for community education programs.] Make sure that they are using some of the best and brightest minds from outside government to put together the program.
What can Trump do when he takes office?
There are a couple of people in the transition who are very interested in this. I know that Donald Trump himself heard a lot about this in New Hampshire and Ohio, and I think that’s one reason that he gave a speech. I’ve talked to him about it briefly. He gets it, that we’ve got to do a better job pushing back, both in terms of the supply side and the demand side.
What would you like to see in a new drug czar?
I have made some suggestions, not so much about specific individuals but the kind of person. I think it needs to be somebody who does have an interest and a focus on the demand side, not just the supply side. Sometimes, drug czars are focused more on the eradication. That’s all important, but I think it needs to be somebody who’s got this broad view of it and has a background on the demand side, the treatment, recovery, prevention side.
What will Obamacare repeal mean for the opioid epidemic?
Medicaid, I think in Ohio, will be the bigger issue for us. We have Medicaid coverage now for people who didn’t have it previously that’s being used for mental health and for drug addiction. So as we reform Medicaid, which is part of this effort, the state of Ohio would like more flexibility. I know how Ohio would use more flexibility, which is to provide more coverage for these areas. It’s something to watch.