Rep. Harris Discusses Opioid Reforms with Local Officials
ELKTON — U.S. Rep. Andy Harris (R-1st District) received a list of issues to tackle related to the nation's opioid epidemic during a Friday meeting with officials from Ashley Addiction Treatment and Union Hospital.
"Your passion for this is amazing," he said. "Government is not going to be the solution. We can help, but in the end if you don't have organizations like this it doesn't work."
Harris, who spent Friday attending numerous closed-door meetings around the county as well as touring the county's Amazon fulfillment center with Gov. Larry Hogan, said he was "encouraged" by the recent omnibus spending bill approved by Congress last week, which included $3.3 billion toward the opioid crisis.
On the other hand, some medical professionals around the country have voiced concerns that even that large sum won't be enough, citing the fact that America spends $32 billion annually on HIV. In 2016, the opioid crisis officially became the deadliest drug epidemic in the nation's history with nearly 64,000 dead of overdoses, at least two-thirds of which were linked to opioids, according to the U.S. Center for Disease Control and Prevention. The total overdoses deaths were higher than the number of deaths linked to guns, car crashes, or HIV/AIDS during any single year in America.
On Friday, Harris spent time at Ashley's Elkton office, which opened in December 2016, to get an on-the-ground look at a medication-assisted treatment program and discuss how to target reforms in the opioid industry.
After touring the office and commenting that Ashley is running a "phenomenal program," Harris said he was concerned with how expensive it is to run, noting that 90 percent of patients were on medical assistance.
"Unfortunately addiction is a complicated disease, so to treat it appropriately it's going to be expensive and it's going to be long-term," he said. "This isn't going to be something we solve with an operation or one dose of an antibiotic."
Dr. Mariana Izraelson, Ashley's director of outpatient services, noted that there are many facets of the medical billing process that could be simplified to help providers, including itemizing out bundled reimbursable services to insurance providers and medical assistance programs as well as advocating for mandated behavioral health treatment rate increases under the state regulations.
"One of the difficulties in addiction treatment is that it is very hard to meet a bottom line, a good program maybe breaks even," replied Dr. Greg Hobelmann, Ashley's chief medical officer. "If you have a bad program, you can make money."
Officials estimated that there are upward of 4,000 or 5,000 MAT patients currently in the county, the vast majority of which receive a daily dose of methadone.
While methadone was created many years ago with the intent of finding a cure-all for opioid use disorder, subsequent research has found that it falls short of rehabilitation goals without companion behavioral treatment, Izraelson explained.
"(Without the behavioral treatment), they're not treating the whole addiction, just the opioid addiction," added Rebecca Flood, president and CEO of Ashley Addiction Treatment. "If you have an alcoholic who sometimes uses heroin, a maintenance treatment program won't help them when they go home and drink."
Ashley tracks the progress of its patients at discharge, 90 days and six months, which it provides to the Centers for Medicare and Medicaid Services (CMS), in order to determine the results of its programs. Hobelmann added that Ashley is open to providing the behavioral treatment services to those who are receiving a maintenance medication elsewhere, but such an arrangement hasn't been established.
"We use the term ‘medication-assisted treatment,' but I guess the key is the assisted part," Harris commented, drawing full concurrence from local officials. "Methadone daily is not really medication-assisted treatment, it's just medication treatment."
Flood also noted that more and more methadone programs are adding short 15-minute check-ins with staff as a way to qualify as "assisted treatment."
When Harris asked why more methadone programs aren't offering companion behavioral treatment, Hobelmann replied that because there isn't financial incentive.
"The methadone programs that we have here are venture capitalist-driven organizations," Flood added. "Mission matters."
While Harris agreed that profit cannot be the overall goal for health care, he stressed that for programs to survive they must have a solid financial footing, which can be a difficult balance.
"You can't have a mission unless you have actually don't lose money," he said. "The hospital is not a charity for the greater sense of the word."
Harris said his goal would be to think about a way to de-incentivize trying to create financial windfalls in treatment to reward shareholders, but rather make a healthy bottom-line toward a positive mission.
He also said he would be willing to write a letter to the Maryland Senate Education, Health, and Environmental Affairs Committee voicing his support of a bill seeking reciprocity of licensing for substance abuse professionals across state lines. Current Maryland regulations are quite stringent, requiring longtime licensees to have passed recent graduate level courses among other obstacles, and organizations have voiced their concerns that the requirements are exacerbating the opioid crisis by reducing the number of licensed professional available to help.
Harris said that he was resolved to immediately go back to Washington and question the CMS administrator as to whether funds are given in a results-driven manner.
"We have to make sure that when we spend this money, we spend it on programs that actually work," he said. "If we spend a lot of money on programs that don't work, that doesn't help communities."
After Friday's visit, the Whig asked Harris, who as an anesthesiologist is one of Congress's few medical professionals, about his views on the Trump administration's attempts to weaken the White House Office of National Drug Control Policy, an executive branch office that evaluates and coordinates federal agencies efforts to fight drug abuse. Since taking office, President Trump has not appointed a permanent director to the office and has advocated defunding it and placing its monies in the hands of the agencies with which it coordinates. Other controversies have befallen the office after a top-ranking official was determined to be an unqualified, 24-year-old former Trump campaign employee — he has since resigned.
Harris, however, was unperturbed by the administration's direction for the ONDCP.
"The ONDCP is not the primary force behind any of the treatment or research," he said. "We call them the ‘Drug Czar,' but when you look at how much power they actually have it's not much."
Harris said offices such as the CMS, National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, and Food and Drug Administration make most of the vital decisions or complete relevant research.
Harris said he was much more encouraged by Congress's approval of a $3 million increase in funding for the National Institutes of Health, the nation's foremost medical research center.
"The director of the NIH clearly understands this is a problem where we need research on new types of pain medication," he said. "The FDA commissioner understands we need a fast-track approach to this as well. We need to make sure that the programs that (Ashley officials) talked about, whether it's Vivitrol, suboxone, buprenorphine, etc., are maximized, including encouraging companies to come up with new dosing regiments."
Harris said he also supported Alex Azar, the newly-appointed director of the U.S. Department of Health and Human Services.
"(Azar) grew up less than 100 miles from here and he understands what this problem can do to rural communities. He gets it," he said. "He of all people in Washington, because he has the CDC, NIH and CMS under him, is actually the one who can functionally be the ‘Drug Czar,' and he is all-in on this."