Over the past couple of years, a groundswell of grief and suffering has forced the issue of opioid abuse onto the political radar—particularly in New Hampshire and Massachusetts, whose U.S. Senators have led the charge for help from the federal government.
The problem has only worsened, but Washington’s attention has waned. There has, after all, been a lot going on to distract attention.
Last week, the region’s Senators tried, on several fronts, to push the topic forward. On Wednesday, that meant newly elected Maggie Hassan of New Hampshire devoting her maiden speech on the Senate floor to the topic.
“The heroin and opioid epidemic continues to be the most pressing public health challenge facing New Hampshire,” Hassan told me, in an interview later in the week. Although last year saw passage of the Comprehensive Addiction and Recovery Act, an increase in funding through the 21st Century Cures Act, and other small pieces of legislation, Hassan says, “I don’t want to see Washington get complacent.”
Hassan says that lawmakers must play both offense and defense on the issue. On the pro-active side, she is co-sponsoring three bills. The Synthetics Trafficking & Overdose Prevention (STOP) Act tries to interrupt the shipping of fentanyl and other synthetic drugs into the country. The Synthetic Abuse and Labeling of Toxic Substances (SALTS) Act would make it easier to prosecute for the sale of synthetic drugs. And the so-called LifeBOAT Act, introduced by Connecticut Senators Richard Blumenthal and Chris Murphy, would establish ongoing funding for substance abuse treatment through a small fee on prescription opioids.
The STOP and SALTS bills both have sponsors from both parties. Republicans from affected states—including Ohio, Iowa, Florida, and Kentucky—agree about the scope of the problem, if not always the proper federal remedies.
That also included President Donald Trump, at least during the election. After hearing repeatedly about the opioid problem while campaigning in New Hampshire, Trump made it a frequent topic in speeches, often specifically citing his desire to help the Granite State out of trouble.
Nevertheless, proposals from Trump and Congressional Republicans have Hassan and others playing defense. “It really doesn’t look like President Trump is living up to his promise to address the opioid epidemic, Hassan says.
Hassan's biggest concerns come in the American Health Care Act (AHCA)—the repeal and replace of the Affordable Care Act (ACA), or ObamaCare—which is scheduled for a House of Representatives vote this Thursday. As currently drafted, it would undo ACA’s Medicaid expansion, and further cap Medicaid spending. Plus, Medicaid coverage would no longer be required for behavioral health and addiction services.
“Health care providers [in New Hampshire] tell me that expanded Medicaid is the most important thing we can do for treatment,” Hassan says. “Medicaid expansion is a true lifeline for people.”
Massachusetts Senator Elizabeth Warren also delivered a blistering floor speech Wednesday, about the effect of AHCA on the opioid crisis. In addition to the Medicaid changes, Warren pointed to the Office of Management and Budget’s estimate that 24 million fewer Americans would have health insurance than under the ACA. “That’s 24 million people who no longer have any access to substance use disorder and prevention services,” Warren said in her speech.
“We already have an opioid treatment gap,” she continued. “Gutting the ACA is like shoving a stick of dynamite in the treatment gap and lighting the fuse.”
Earlier in the week, Warren launched a new project, to survey Massachusetts treatment and recovery service providers. The idea is to identify, and quantify, those opioid addiction “treatment gaps” that could be targeted with more federal funding. (You can see the survey questionnaire here.)
Senator Ed Markey of Massachusetts also took aim at the topic last week. On Thursday, the Senate passed his resolution, co-sponsored by Republican Marco Rubio of Florida, on addressing international trafficking of fentanyl.
That came a day after Markey announced his opposition to Scott Gottlieb, Trump’s nominee to head the Food and Drug Administration (FDA), over opioid issues. Markey is demanding that the FDA take a more aggressive role in keeping prescription opioids from reaching the black market. Reforms he wants include advisory committees for opioid-approval decisions, and removal of Opana ER, which was supposed to be abuse-deterrent but may now be a rising cause of overdoses. Last year, Markey held up a Barack Obama FDA nominee over similar concerns.
Gottlieb, according to Markey, is more likely to allow pharmaceutical companies to push more, and increasingly dangerous, opioids to market. Gottlieb has also expressed skepticism about the FDA’s Risk Evaluation and Mitigations Strategies plans, which Markey believes should be applied to opioid drugs.
And New Hampshire’s other Senator, Jeanne Shaheen, was also hot on the topic last week—as she frequently is. She has been aggressively criticizing Trump for weeks over concerns that his health care coverage plans, as well as cuts in his federal budget proposal, will make it harder to address the crisis.
With health care very much in the news, Shaheen was chosen to deliver the Democrats’ weekly address on Friday. She used the opportunity to say that AHCA “will have especially tragic consequences for New Hampshire and other states fighting the heroin and opioid epidemic.”
Shaheen also registered a small win on the issue, in the midst of all this shouting into the wind.
On Thursday, the United Nations Commission on Narcotic Drugs voted, as Shaheen has urged them to do, to designate fentanyl’s so-called “precursor chemicals” as Table 1 substances for regulation. The hope is that this regulation will limit the flow of fentanyl, a synthetic opioid that has contributed to three-quarters of New Hampshire’s opioid deaths, according to Shaheen.
Warren, by popular vote
Just for fun, I ran a series of Twitter polls, March Madness bracket-style, to determine my followers’ favorite New England members of Congress.
The Final Four were Massachusetts Congressman Joe Kennedy, coming out of the “Southeast” region; Connecticut Senator Chris Murphy from the Southwest; Vermont Senator Bernie Sander representing the North; and Massachusetts Senator Elizabeth Warren of the East.
Regional runners-up were Michael Capuano, Pat Leahy, Jim McGovern, and Seth Moulton.
Warren emerged the winner, followed by Kennedy, Sanders, and Murphy.