Our Plan to Combat the Opioid Epidemic

She told me, “The opioid epidemic took my son’s life. I’d like to know what you think we can do to fight it.”

It was after a town hall in Yancey County. She had waited to ask me the question personally, instead of in front of the crowd, because she wanted to tell me her son’s story: How he was first prescribed opioids after an injury at work, then became addicted, and finally died by overdose.

It’s a shockingly common story across our state, and amid all the talk of the pandemic it can feel like we’ve forgotten about the opioid epidemic that preceded it.

But the two are linked, in a tragic way: The pandemic actually made the opioid crisis worse.

Over the past year, more than 100,000 Americans have died of a drug overdose, the highest number ever recorded — and that includes more than 3,500 North Carolinians. That’s almost 10 people in our state who have died from an overdose every single day for the past year.

This epidemic has been raging for over 20 years. Over and over again, we’ve heard from healthcare professionals that the most effective way to address this crisis is by treating it like the public health emergency it is, not as something we can incarcerate our way out of. To that end, we can start by:

1. Expanding Medicaid: The case for Medicaid expansion is absolutely overwhelming. It would help over 500,000 North Carolinians access health care, create 40,000 jobs, and would reduce premiums on the marketplace for everyone. It’s also the biggest single lever that we can pull to fight the opioid epidemic.

A study found that states that expanded Medicaid under the Affordable Care Act had a 6% lower rate of total fatal opioid overdoses and a 10% lower rate of fatal fentanyl overdoses than states that hadn’t. Republican leadership in the General Assembly has blocked Medicaid expansion in North Carolina, leaving hundreds of thousands of North Carolinians in a gap where they make too much for Medicaid but too little to afford insurance on the Affordable Care Act marketplace. Just by taking this simple step — as 38 other states have done — we could prevent scores of fatal overdoses.

2. Increasing Access to Medication-Assisted Treatment: Medication-assisted treatment (MAT) is the gold standard for treatment when it comes to opioid use disorder. It involves the use of medications like methadone and buprenorphine, in combination with counseling and therapy, to address opioid addiction. However, MAT still faces immense stigma and even now, because of a federal rule called the X-waiver, it can be harder for health care providers to prescribe methadone and buprenorphine than opioids like OxyContin. We can’t afford to stigmatize proven treatment options that save lives any longer.

Fortunately, the Biden Administration has taken steps to make the X-waiver process easier for healthcare providers. I would go a step further and support existing bipartisan legislation like the Mainstreaming Addiction Treatment Act of 2021 to do away with it entirely.

3. Ensuring Access to Addiction Treatment for Rural Areas: MAT clinics are often concentrated in urban areas. But we know that the opioid epidemic has impacted every corner of North Carolina, urban and rural. We need to ensure that rural areas have access to MAT and other treatment and harm-reduction methods. MAT can require daily medication and that is a big problem for many in recovery if the nearest clinic is hours away. The DEA recently finalized a rule that will make it easier to license mobile MAT clinics that can better reach patients in rural areas. This is a good start, but we must do more to ensure that those recovering from addiction have access to this important treatment.

This also means increasing access to telehealth resources for addiction treatment. For those struggling with opioid addiction — particularly those in rural areas — in-person appointments can be a significant hurdle to the treatment they need. There is a bipartisan bill in the Senate right now — the CARA 3.0 Act of 2021 — that would expand resources for MAT physician education on opioid addiction and treatment and make permanent a COVID-era waiver that allows healthcare providers to prescribe medication-assisted treatment over telehealth without a prior in-person visit. By removing barriers like this, we can help ensure more patients have timely and regular access to treatment.

4. Expand Treatment Options in Correctional Facilities: Unfortunately, our jails and prisons have become the front line in the battle against addiction, a role they are not currently equipped to handle. We need to ensure that jails and prisons have the resources, training, and staff necessary to help incarcerated individuals escape from the cycle of addiction, relapse, and recidivism.

This summer, the Senate unanimously passed the bipartisan Residential Substance Use Disorder Treatment Act of 2021. This bill aims to break the cycle of substance abuse for those in correctional facilities. It would fund programs that provide substance abuse treatment for people in jails and prisons and incorporate recovery and medication-assisted treatment into reintegration programs so those formerly incarcerated individuals can continue to receive treatment once they are released back into their communities. The House needs to pass this bill immediately and send it to the President to sign into law.

5. Reduce Stigma and Increase Resources for Treatment: It’s clear that the stigma around addiction kills. In recent years, lawmakers on both sides of the aisle have realized this and have taken positive steps to treat the opioid epidemic like the public health crisis it is. As your U.S. Senator, I would work to ensure continued federal resources for North Carolina’s health care providers and law enforcement officers to save lives, reduce barriers to treatment, and fight the stigma that costs lives.

6. Hold the Opioid Industry Accountable: While we’re working to address the public health aspects of the opioid epidemic, we have to hold the companies that started it accountable. Purdue Pharma, the maker of the highly addictive painkiller OxyCotin, recently had its bankruptcy plan approved by a federal bankruptcy judge. Purdue will be dissolved and billions of dollars from the bankruptcy will go towards opioid abatement and recovery efforts nationwide. However, the Sackler family that owned Purdue contributed only $4.5 billion to the settlement, despite making many times more than that over the years from Purdue and the highly addictive drugs they pushed. And in exchange, they received legal immunity from any opioid-related lawsuits, despite the fact that only Purdue declared bankruptcy, not the Sackler family.

This use of bankruptcy law to protect a party not declaring bankruptcy from future suits is incredibly unfair. The SACKLER Act would prevent this abuse of bankruptcy law to shield non-debtor parties from immunity.

I should also note that North Carolina’s Attorney General, Josh Stein, has been diligent in his pursuit of accountability for the distributors who accelerated this epidemic and recently secured a settlement that may bring as much as $850 million to North Carolina over the next 18 years.

7. Stop the Flow of Drugs to Our Communities: In recent years, the artificial opioid fentanyl has eclipsed heroin and other opioids as the leading cause of overdose deaths. Fentanyl is 50 times more powerful than heroin by weight. We need to stop incredibly dangerous and addictive substances like fentanyl at the source. Typically the chemicals needed to create fentanyl are produced in China, usually with the tacit knowledge of the Chinese government, and then smuggled to drug trafficking organizations in Mexico. The cartels then combine the precursor chemicals to create the fentanyl, which they then smuggle across the Southern border.

First, Congress and the Biden Administration need to step up pressure on China to curb the production of fentanyl precursors.

Second, given the incredible potency of tiny amounts of fentanyl, it is very easy to smuggle and conceal so we must ensure that law enforcement officers have the tools necessary to detect and interdict fentanyl. Customs and Border Protection have numerous high-tech devices at the border to help detect fentanyl. However, state and local law enforcement lack access to many of these devices. The bipartisan Providing Officers With Electronic Resources (POWER) Act would provide the resources necessary to equip state and local law enforcement with the same tools.

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