West Virginia's Manchin won't stop until the culture underlying prescription opioid abuse changes
May 29, 2016 12:39 AM
Alex Brandon/Associated Press
U.S. Sen. Joe Manchin, D-W.Va., speaks in Washington during a news conference on opioid and heroin abuse earlier this year.
By J. Brady McCollough / Pittsburgh Post-Gazette
WASHINGTON, D.C. — Joe Manchin is late. They’re waiting for him now on the Senate floor, because, as usual, he’s got something to say.
When it comes to the issue of prescription opioid abuse, Mr. Manchin, the U.S. Senator from West Virginia and the state’s former governor, always feels as if he’s running behind, making up for lost time. On this sunny spring afternoon, with the district’s cherry blossoms in bloom, he moves by foot, ignoring a red light and jogging through a crosswalk with the Capitol in his sights. It’s a scene straight out of a network political drama: a 68-year-old elected official in a suit, trailed frantically by three aides who are at least half his age, showing that he’s willing to break a law as long as it means making a new one.
Mr. Manchin won't stop — not until he’s been heard by anyone who has a smidgen of power to change the culture of the medical industry that has devastated the people of his state since the late 1990s.
“I rise to share Jessie’s story,” he begins, now standing on the Senate floor.
Jessie is Jessica Grubb, and her story is West Virginia’s story. It is Appalachia’s story. It is, more and more each year, America’s story. Jessie was 30 years old and training for a marathon when she died March 2, a day after having hip surgery relating to a running injury. Jessie had battled a heroin addiction for much of her 20s, but she was six months sober when she went in for surgery. A doctor did not know about her history of drug abuse, and so he wrote her a prescription for 50 OxyContin. A day later, Jessie was gone.
Jessie was the daughter of David Grubb, a former West Virginia state senator whom Mr. Manchin knew as a respected colleague. And in that case, Mr. Manchin could personally identify with what he’s been telling his fellow senators each week through speeches like this one: With this epidemic, there is no such thing as immunity.
“We talk about Ebola and Zika and all the things we’re concerned about, but you haven’t heard a lot about opioids,” Mr. Manchin said. “It is the silent killer. We’re ashamed if it happens to ourselves or our family. We don’t talk about it. It’s an epidemic and there is not a person in the country, as I say, that doesn’t know someone in their immediate or extended family that hasn’t been affected.”
At this point, Mr. Manchin knows all the numbers by heart. Six-hundred West Virginians died from prescription drug abuse overdose last year, the most per capita in the country. Fifty-one Americans die every day. Since 1999, America has lost 200,000 sons and daughters, mothers and fathers, to a disease that Mr. Manchin wholeheartedly believes is preventable.
“This is a product produced by legal manufacturing companies, a product approved by the Food and Drug Administration, a watchdog trying to make sure we’re safe with our food and drugs,” he continued. “Our doctors are prescribing something they think will help us. And it’s something that is killing Americans everywhere. … It’s unheard of. In any other category, we would be doing something monumental.”
Mr. Manchin finishes his speech with a plea for a united effort from both sides of the aisle. A week later, he will introduce legislation called “Jessie’s Law” that aims to keep careless mistakes like the one that took her life from happening in the future. It is one of many bills Mr. Manchin has drafted relating to the opioid epidemic and holding the Food and Drug Administration accountable for the products it puts on the market.
Despite the White House sounding an alarm about the growing opioid epidemic in 2011, Washington has been slow to move. States have been forced to address the problem mostly on their own. With the issue getting some attention during the New Hampshire primary, Mr. Manchin is hoping that his counterparts on Capitol Hill are starting to listen.
On this April day, down the hall from Mr. Manchin’s office in the Hart Senate Office Building, “hearings to examine America’s insatiable demand for drugs” were in full swing. Of course, Mr. Manchin didn’t need any education on the topic.
“My sense is that Washington has not spoken to that yet,” said Pennsylvania Sen. Bob Casey. “I know in a recent discussion in our caucus someone brought up overprescribing and the doctors’ role. It’s clearly a gap in federal policy.
“There’s no question that there’s a supply and demand issue here, and the supply is going to be increased dramatically if we continue with the overprescribing pathway. There’s still more work to do. What I’m not sure of is whether it will be federal and state sharing the solution or will it be more at the state level?” the Democratic senator said.
David Hickton, the U.S. Attorney for Western Pennsylvania and the co-chair of the National Heroin Task Force, has not been shy about demanding more help from Washington.
“We’ve had the Center for Disease Control authorize intelligent restrictions on prescribing,” Mr. Hickton said, “and the question is whether they’re going to be widely adopted.
“We need our regulators like the FDA, when their panel tells them that a drug shouldn’t be released, to not release it. Now, that’s not my province. That’s the province of the FDA and the Senate and those who make the laws. I’m just saying, there’s a downstream consequence that I will deal with.”
Mr. Manchin has vowed to do his part. He takes great pride in being a royal pain to the medical industry. He is always talking, to officials with the Veteran’s Administration, Medicare and Medicaid, to pharmacists in his state, and, most important, to leaders at the FDA, his No. 1 culprit in the spread of this epidemic.
He recalled the story of how, in 2014, the FDA’s advisory panel voted 11-2 against the approval of the hydrocodone product, Zohydro. Yet, then-FDA commissioner Margaret Hamburg still put the drug on the market. In response, Mr. Manchin proposed a bill that would force the FDA commissioner to come before Congress to argue for the approval of any drug that its panel did not approve.
This year, Mr. Manchin was one of four senators who did not support the appointment of new FDA commissioner Robert Califf. When Dr. Califf came to Mr. Manchin’s office, the senator told him that he did not think Dr. Califf could do what it takes to change the culture because of the support the doctor had received from pharmaceutical companies in doing past research.
“It’s just hard to look at your friends and people who have supported you and say, ‘No more, enough’s enough,’ ” Mr. Manchin said. “I just don’t think it can be done. … But I’m going to be holding him accountable. He knows I’m on him.”
Mr. Manchin was appalled earlier this year when the FDA approved the prescribing of OxyContin for 11- to 16 -year-olds who are in severe pain. So he proposed legislation that would amend the FDAs mission statement “to require the agency to take into account the public health impact of the nation’s opioid epidemic when approving and regulating opioid medications.”
J. Brady McCollough: email@example.com and Twitter @BradyMcCollough.
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