Letter to Alex Azar, Secretary of Health and Human Serivces - Lawmakers raise concerns over the pandemic's effect on the nation's opioid crisis

Letter

Dear Secretary Azar:
As the coronavirus disease of 2019 (COVID-19) pandemic continues to devastate the
country, Congress and the Energy and Commerce Committee are focused on fighting this
unprecedented public health crisis. With over 160,000 American lives lost, we must continue to
work to ensure the federal government, states, local communities, and health care providers have
the tools they need to respond effectively to this pandemic.
While we continue to combat the COVID-19 crisis, we cannot lose sight of another: the
ongoing substance use disorder (SUD) and overdose crisis that our country has been battling for
decades. Since 1999, over 750,000 Americans have died from drug overdoses,1
representing the
worst drug crisis in American history, and we are concerned that overdose deaths are increasing
while attention is focused on COVID-19.2
In 2018, the number of fatal drug overdoses decreased for the first time in over two
decades, but last year, overdose deaths increased to an all-time high.3
According to the National Center for Health Statistics, the reported number of drug overdose deaths occurring in the U.S.
increased by 4.6 percent between 2018 and 2019, from 67,850 to 70,980.4

Now, recently reported increases in overdose deaths during the COVID-19 pandemic
threaten to exacerbate these trends.5
According to the Washington Post, data indicates that,
compared to the year before, suspected overdoses nationwide increased 18 percent in March, 29
percent in April, and 42 percent in May.6
The New York Times recently reported that "[i]n New
Jersey, where drug-related deaths had leveled off, overdose deaths in the first half of 2020 were
17 percent higher than in 2019. In Colorado, they were up by 30 percent through March."7

Similarly, Kentucky experienced an estimated "25 percent increase in overdose deaths between
January and March while other state data shows a rise in emergency department visits and
[emergency medical service (EMS)] calls connected to overdoses increasing between March and
June," while West Virginia experienced approximately 50 percent more EMS calls related to
overdoses in May as compared to earlier in the year.
8
Recent reports indicate that the COVID-19 pandemic is exacerbating the overdose crisis,
as more Americans are isolated, suffering from depression and economic hardship, and hesitant
or unable to seek treatment.9
Dr. Nora Volkow, Director of the National Institute on Drug Abuse
(NIDA) at the National Institutes of Health (NIH), recently stated, "[t]he concerns we have are
related to the big challenges people are facing right now with [COVID-19]: isolation and
uncertainty resulting in very high levels of stress."10
In addition, during a discussion between
NIH Director Dr. Francis Collins and NIDA Director Dr. Nora Volkow on how the COVID-19
pandemic may be escalating the opioid crisis, Dr. Volkow noted that one of the first things they
have heard from the communities and the families afflicted by addiction is "that the support
systems that were there to actually help them achieve recovery are no longer present. At the same time, access to some of the treatment programs has become much harder to get by and that
actually includes emergency departments."
11

Further complicating matters are reports that some SUD treatment centers have closed,
12
and the COVID-19 pandemic has "put on hold a billion-dollar research program focused on new
forms of addiction treatment, as part of a broader freeze on non-[COVID-19] work at the
National Institutes of Health."13
The Congress and this Committee have a long history of oversight and legislation
focused on the nation's SUD crisis, including providing billions of dollars for states and local
communities to increase SUD services. Key examples of this Committee's oversight work
include extensive bipartisan oversight and investigations into the origins of the opioid epidemic,
the rise of fentanyl in the U.S., patient brokering and the SUD treatment industry, and the
distribution and manufacturing of opioids.
In addition to robust oversight, this Committee championed and passed numerous bills
that became law. The Comprehensive Addiction and Recovery Act (CARA) was signed into law
by President Obama on July 22, 2016, and addresses the full continuum of care from prevention
to recovery support.14
Provisions spearheaded by the Committee and included in CARA
included addressing prevention and education; treatment and recovery; addiction and treatment
services; and incentives for state comprehensive initiatives to address prescription opioid abuse,
among other things. CARA also authorized over $181 million to respond to the opioid
epidemic.15

This Committee also spearheaded the 21st Century Cures Act (CURES), which President
Obama signed into law on December 13, 2016.16
While the law is broader than combatting the
opioid crisis, CURES designated $1 billion in grants for states over two years to fight the opioid
epidemic. The Committee also passed the Substance Use-Disorder Prevention that Promotes
Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which President Trump signed into law on October 24, 2018.17
The SUPPORT Act reauthorized opioid-specific
grant funding and expanded access to SUD treatment and resources, increased opioid abuse and
overdose prevention training, improved care coordination to enhance the quality of SUD care,
and contained provisions to strengthen the U.S. Food and Drug Administration's and law
enforcement's ability to combat illicit opioids.
Now, as the rising use of stimulants such as cocaine and methamphetamine threaten to
become the "fourth wave" of the SUD crisis, we must remain vigilant.
We wrote to you in January about increasing stimulant use in the U.S.,
18 and we
appreciate the briefing provided to the Committee on those issues. We now request that you
provide Committee staff an updated briefing on the latest trends in substance use and overdoses,
how those trends are affected by the COVID-19 pandemic, and what more the federal
government needs to do to address this growing crisis.
The world's public health experts, governments, and industries are focused on the
COVID-19 pandemic -- and that work continues, but we must not become complacent about
other threats that our country faces, nor allow the progress we have made to become undone.
Thank you for your assistance. If you have any questions about this request, please
contact Kevin McAloon of the Majority staff at (202) 225-2927 or Alan Slobodin of the Minority
staff at (202) 225-3641.

Source