Lack of Medication-Assisted Treatment Impeding Opioid Response in West Virginia, Nurse Tells Congress

This July 23, 2018 file photo shows packets of buprenorphine, a drug which controls heroin and opioid cravings, in Greenfield, Mass.

This July 23, 2018 file photo shows packets of buprenorphine, a drug which controls heroin and opioid cravings, in Greenfield, Mass. Elise Amendola/AP Photo

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Medical experts offered their assessment of the federal government’s approach to combating the opioid crisis before the House Oversight and Reform Committee.

Huge gaps in access to medication-assisted treatment and the failure of federal funding to materialize in communities overrun by opioids are hampering efforts to stem the crisis in West Virginia, a nursing director told a congressional committee on Wednesday.

Testifying before the House Oversight and Reform Committee, Angela Gray described the obstacles that continue to prevent West Virginians from receiving opioid addiction and recovery care. The nursing director for the Berkeley-Morgan County Board of Health told lawmakers that despite federal efforts to appropriate funding for state and local opioid treatment, there are still significant barriers preventing people in the state from receiving care.

“My state is hemorrhaging and without long-term funding and commitment and planning, we will continue to bleed,” Gray said. “We need infrastructure support.”

An estimated 130 Americans die every day from opioid-involved overdoses, according to the Centers for Disease Control and Prevention, and West Virginia ranks highest for overdose death rates in the country.

The federal government has appropriated billions of dollars for opioid-related matters in recent years, funding law enforcement efforts meant to crack down on the trafficking of fentanyl, heroin and carfentanil, a synthetic opioid; distribution of the opioid-overdose reversal drug naloxone; and state and local grants to expand access to medication assisted treatment (MAT) drugs.  

But Gray told lawmakers that recent appropriations, specifically the U.S. Department of Health and Human Services administered State Opioid Response grants, have not yet trickled down to the county-level clinics where she works.

“To this date, none of the SOR money has hit the community level. I have not seen one penny,” Gray said.

HHS awarded West Virginia $14.6 million in SOR funding this year.

While the SUPPORT for Patients and Communities Act, signed into law by President Trump in 2018, requires Medicaid to cover medication-assisted treatment, Gray said there are still large gaps in MAT treatment available in rural parts of West Virginia. That kind of treatment combines behavioral therapy with prescription of a medication that lessens or blocks the high a patient gets from opioids, while also relieving their cravings.  

“We have very few MAT providers in either of the counties I work in,” she said. “In Morgan County, I only have one and they only see people one day a month.”

Doctors must obtain waivers before they are able to prescribe the three Food and Drug Administration-approved MAT drugs: methadone, buprenorphine, and naltrexone.

While more prescribers are obtaining waivers, there is still a hesitancy to do so, Gray said.

At Wednesday’s hearing, Oversight Committee Chairman Rep. Elijah Cummings advocated for passage of the Comprehensive Addiction Resources Emergency (CARE) Act, which he introduced with Sen. Elizabeth Warren. The bill, which is modeled after the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, would allot $100 billion in federal funding over ten years to address the opioid crisis.

Cummings, a Maryland Democrat, said the legislation would go further than the SUPPORT Act, passed by Congress last year, in funding state and local drug treatment efforts and wrap-around services needed to help individuals overcome drug addiction.

Addiction treatment experts who testified at Wednesday’s hearing echoed concern that although MAT is proven to work, administrative barriers are preventing people from getting access to the treatment.  

“Only a small portion, maybe one-third of people with opioid use disorder receive any type of treatment and only a small set of those receive MAT,” said Susan Bailey, president-elect of the American Medical Association.

Obstacles reducing access include requirements by commercial insurers, Medicare, and Medicaid for individuals to have prior authorization for the treatment, Bailey told lawmakers. Maryland was the first state to do away with prior authorization requirements for MAT in 2017, but at least 15 states have pursued similar initiatives since then, Bailey said.

At Wednesday’s hearing, Oversight Committee Ranking member Jim Jordan, an Ohio Republican, stressed the importance of providing access to treatment but also cracking down on the supply chain of narcotics smuggled across the southern border into the United States.

Gray responded urging lawmakers to provide similar levels of funding for treatment as they do for law enforcement prevention efforts. If the underlying addiction isn’t treated, people will just bounce from one drug to the next, Gray said—something she’s already seen play out with methamphetamines in West Virginia.

“I can trace it in my clinic. Whenever there has been a hit on the opioid or heroin supply it’s going to be a heavily meth clinic,” Gray said. “They haven’t addressed the addiction so they move to the next drug that keeps them going. And you can make meth in your home. You can make it in a backpack. So, unless we really put some serious effort in to treating addiction, you can hit that supply all you want.”

Andrea Noble is a staff correspondent for Route Fifty.

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