In 2011, one of the first things I did as a new U.S. senator was to crisscross the state and meet with county officials. I wanted to hear about the most important issue facing their communities. After only four meetings, a pattern emerged that I wasn’t expecting. From Pittsburgh to Philadelphia and across central Pennsylvania, families were being torn apart by a heroin epidemic.
More Pennsylvanians will die this year from overdoses and misuse of heroin and opioid painkillers than from influenza or homicide. Heroin abuse today is spread across all age and demographic groups. Stopping this epidemic and healing our communities will require a three-prong approach that I am pursuing as chairman of the Senate Finance Subcommittee on Health Care: stopping the illegal diversion of prescription painkillers, reducing the overuse of opioids for treating long-term pain and helping those battling addiction receive appropriate treatment.
The seeds of this crisis were planted two decades ago with the advent of readily available painkillers like hydrocodone and oxycodone. While these drugs can help provide immediate pain relief, they are also easily abused, highly addictive and commonly diverted. In fact, nearly 80 percent of heroin users previously abused prescription opioids. Despite the crackdown on many so-called “pill mills” where unethical physicians prescribed large amounts of powerful opioids in exchange for cash, the problems of diversion and overprescribing still exist.
The nonpartisan Government Accountability Office has found there are more than 170,000 Medicare enrollees actively engaged in “doctor shopping” for physicians who will unknowingly write redundant opioid prescriptions. When other insurance plans, including Medicaid, spot this kind of fraud, the insurer limits or “locks” the individual to a single doctor or pharmacy to stop pill diversion and help control access to the addictive medication.
Unfortunately, Medicare doesn’t have this tool. The bipartisan Stopping Medication Abuse and Protecting Seniors Act that I’ve introduced not only would help individuals battling addiction get treatment, it also would save taxpayers $79 million by curbing the illegal diversion of pain pills. A companion bill has passed the House of Representatives on an overwhelmingly bipartisan basis.
Medicare and other insurers must also work with physicians to stop the medically unnecessary use of opioids to treat pain. This year, about 260 million painkiller prescriptions will be filled, enough for all American adults to have their own bottle of pills.
While opioids can help to quickly control intense pain, long-term use becomes less effective in most patients and is associated with higher rates of substance abuse, emergency room visits, accidental overdoses and falls, especially in senior citizens. Medical specialty societies are developing new guidelines that reduce both the dosage and the length of time prescription opioids can safely be taken. For instance, the American Academy of Neurology recently found that the risks of opioids outweighed any benefits for treating headaches, lower back pain and fibromyalgia.
When opioids are used with other narcotics like Valium or Xanax, the combination is deadly. Broader usage of prescription-drug monitoring programs would help providers know the panoply of medications a patient is taking and enable law enforcement to spot diversion and abusive prescribing practices.
Finally, we also must explore ways to improve access to and quality of addiction care. While addiction to an opioid or alcohol is often viewed as a moral failing, in many ways it is a chronic disease such as diabetes and heart disease. The medical profession continues to debate the optimal approach, but everyone agrees that opioid addiction can be treated with professional help. We in Congress are examining a number of legislative proposals in this area.
Ending the epidemic of heroin addiction will require changes in the practice of medicine, government regulation and societal views. There are steps we can and should take today that end diversion, reduce non-medical use of opioids and approach addiction like a treatable disease. By working together at the federal, state and local level, I am confident that opioid abuse is an enemy we can defeat.
Pat Toomey, R-Lehigh County, is convening a Senate health care subcommittee field hearing on heroin and opioid abuse at Allegheny General Hospital Thursday at 2:15 p.m. For more information, call412-803-3501.