By Margaret Wile
The substance use crisis in this country continues—and it’s not just opioids.
That was the clear takeaway from the U.S. Senate Judiciary Committee’s recent hearing on “Tackling the Opioid Crisis: A Whole-of-Government Approach.”
Senator Joni Ernst (R-Iowa) ran the hearing and provided data from the Centers for Disease Control and Prevention (CDC) including that 70,235 drug overdose deaths occurred in the U.S. in 2017, making it the nation's leading cause of injury-related death.
She also echoed a familiar concern, that the opioid crisis goes beyond opioids. For example, in her state, methamphetamines have recently had a resurgence, showing the U.S. needs not only to address the issue of opioids but also substance use.
The committee heard from speakers with the Drug Enforcement Agency (DEA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Office of National Drug Control Policy (ONDCP) and the U.S. Department of Justice (DOJ).
Kemp Chester, assistant director of the National Opioids and Synthetics Coordinating Group within the ONDCP, was the first member of the panel to testify.
He highlighted the challenges of combatting illicit substances, especially synthetic opioids such as fentanyl, and the need to work in a bipartisan manner across state, local, tribal, national and internal policy.
Chester also shared some of the accomplishments of the administration, including the creation of the DOJ Joint Criminal Opioid Darknet Enforcement (J-CODE) within the FBI to stop online sales of fentanyl, the establishment of a 24/7 tele-forensic unit to identify new synthetic opioids as they appear in the marketplace, and the passage of the SUPPORT Act, a 2018 law that increased access to care and treatment and provided resources to states to combat the opioid crisis.
Amanda Liskamm, director of Opioid Enforcement and Prevention Efforts at the Office of the Deputy Attorney General, shared successes, including work to dismantle dark webpages run by criminals selling fentanyl through the J-CODE task force. Since J-CODE was created in 2018, there have been two large takedowns of darknet accounts.
The department has also been working to charge international drug cartels, most notably, winning the conviction of Joaquin “El Chapo” Guzman, the head of a notorious Mexican drug cartel. Liskamm also noted the success of Operation Synthetic Opioid Surge (SOS), an effort that focused on prosecuting cases that included syntenic opioids in the 10 districts that have the highest overdose rates in the country where more than 300 cases were charged in the first year of the program.
Another effort of the DOJ included the Appalachian Regional Prescription Opioid (ARPO) Strike Force, a joint law enforcement addressing health care fraud schemes in the Appalachian Region. Since its creation in October 2018, more than 70 individuals in the region who collectively were responsible for distributing over 40,000 pills have been charged.
She discussed the DEA’s temporary emergency scheduling of fentanyl-like substances in February 2018, and, since the time of that scheduling, says there has been a significant decrease in fentanyl-like substances and a reduced production of them. With the emergency temporary scheduling expiring in the future she encouraged the committee to consider a legislative fix.
William McDermott, assistant administrator, Diversion Control Division of the DEA, discussed the agency’s work to significantly reduce the production quotas for six of the most frequently used opioids by 55% from the levels established at the end of 2016. The DEA has brought down these quotas because doctors across the country are prescribing fewer opioids.
Dr. Neeraj Gandotra, the chief medical officer for SAMHSA, spoke about his agencies’ primary responsibility in providing resources, tools and funding to state and local governments who can provide evidence-based prevention and treatment to their residents.
He also mentioned one of SAMHSA's most downloaded tools, the Opioid Overdose Prevention Toolkit, which is meant for community members, family members, friends, health care professionals or anyone who may be interested to learn more about the signs and symptoms of an overdose and the ways to address it.
Committee members pressed the panel on several issues including the need to increase drug takeback programs, the DEA’s slow response in reducing production quotas, and finding consensus from the panel if they agreed that fentanyl should be a schedule I drug.
Several legislators mentioned that this hearing stirred ideas of legislation that they could file in the current legislative session to further their efforts. While much progress has been made, it was clear there is still much to do.
Margaret Wile is policy director, Health and Human Services, in NCSL's state-federal affairs division.