[Senate Hearing 119-57]
[From the U.S. Government Publishing Office]
S. Hrg. 119-57
COMBATING THE OPIOID EPIDEMIC
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
FEBRUARY 26, 2025
__________
Serial No. 119-04
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
60-184 PDF WASHINGTON : 2025
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SPECIAL COMMITTEE ON AGING
RICK SCOTT, Florida, Chairman
DAVE McCORMICK, Pennsylvania KIRSTEN E. GILLIBRAND, New York
JIM JUSTICE, West Virginia ELIZABETH WARREN, Massachusetts
TOMMY TUBERVILLE, Alabama MARK KELLY, Arizona
RON JOHNSON, Wisconsin RAPHAEL WARNOCK, Georgia
ASHLEY MOODY, Florida ANDY KIM, New Jersey
JON HUSTED, Ohio ANGELA ALSOBROOKS, Maryland
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McKinley Lewis, Majority Staff Director
Claire Descamps, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Rick Scott, Chairman................ 1
Opening Statement of Senator Kirsten E. Gillibrand, Ranking
Member......................................................... 3
PANEL OF WITNESSES
Honorable Dennis Lemma, Sheriff, Seminole County Sheriff's
Office, Sanford, Florida....................................... 4
Honorable Gregory Duckworth, Commissioner, Raleigh County,
Beckley, West Virginia......................................... 6
Elizabeth Mateer, Grandparent Caregiver, Pittsburgh, Pennsylvania 8
Dr. Malik Burnett, MD, MBA, MPH, Vice Chair, Public Policy
Committee, American Society of Addiction Medicine, Baltimore,
Maryland....................................................... 10
Bradley D. Stein, Director, Opioid Policy, Tools, and Information
Center, RAND Corporation, Pittsburgh, Pennsylvania............. 12
APPENDIX
Prepared Witness Statements
Honorable Dennis Lemma, Sheriff, Seminole County Sheriff's
Office, Sanford, Florida....................................... 40
Honorable Gregory Duckworth, Commissioner, Raleigh County,
Beckley, West Virginia......................................... 42
Elizabeth Mateer, Grandparent Caregiver, Pittsburgh, Pennsylvania 44
Dr. Malik Burnett, MD, MBA, MPH, Vice Chair, Public Policy
Committee, American Society of Addiction Medicine, Baltimore,
Maryland....................................................... 46
Bradley D. Stein, Director, Opioid Policy, Tools, and Information
Center, RAND Corporation, Pittsburgh, Pennsylvania............. 50
Questions for the Record
Dr. Malik Burnett, MD, MBA, MPH, Vice Chair, Public Policy
Committee, American Society of Addiction Medicine, Baltimore,
Maryland....................................................... 62
Bradley D. Stein, Director, Opioid Policy, Tools, and Information
Center, RAND Corporation, Pittsburgh, Pennsylvania............. 63
Statements for the Record
Dr. Stacey McKenna Testimony..................................... 67
James Balda Testimony............................................ 74
ASAM Criteria (Fourth Edition) Handout........................... 76
Moyo Dow and Francesca Beaudoin Testimony........................ 77
Tim Clover Testimony............................................. 88
Dr. Jeffrey B. Reich Testimony................................... 89
COMBATING THE OPIOID EPIDEMIC
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Wednesday, February 26, 2025
U.S. Senate
Special Committee on Aging
Washington, DC.
The Committee met, pursuant to notice, at 3:30 p.m., Room
106, Dirksen Senate Office Building, Hon. Rick Scott, Chairman
of the Committee, presiding.
Present: Senator Scott, McCormick, Justice, Tuberville,
Moody, Gillibrand, Warren, Kim, and Alsobrooks.
OPENING STATEMENT OF
SENATOR RICK SCOTT, CHAIRMAN
The Chairman. The U.S. Senate Special Committee in Aging
will now come to order. Over the last decade, we have lost
hundreds of thousands of Americans lives to drug overdoses.
It's happening in every community across every state. None of
us have been spared from the carnage left by this crisis, and
we've all heard the heartbreaking stories of families who have
lost children, parents and siblings to fentanyl and other
opioids.
Fighting the opioid crisis has been an incredible
challenge. The precursors of these drugs come from Communist
China and are bought by the evil drug cartels to make deadly
opioids like fentanyl. These cartels then traffic these drugs
over the border and into our communities where they poison and
kill tens of thousands of Americans every year.
Thanks for the hard work of our Governors, our state
attorney generals, law enforcement advocates, our sheriff's
departments, police departments, from 2022 to 2023, we saw a
drop in overdose deaths from people aged 15 to 54. Now, that's
good news, but it shows we have more work to do.
While overdose deaths in the U.S. dropped for people
between the ages of 15 and 54, we saw deaths increase from 22
to 23 for Americans who are age 55 and older, after seeing
increase in the 65 and older age group in 2022. In 2023, more
than 29,000 Americans aged 55 and older died from an opioid
overdose. That's 80 seniors dying from opioid overdoses every
single day. Think about it this way. In the two-hours we'll
spend together in this hearing today, six people aged 55 and
older will die. Every overdose is preventable.
Every single one of those nearly 30,000 lives of older
Americans lost could have been saved. While we've all heard the
heart wrenching stories of the children and young people lost
to the opioid crisis, the stories that have been largely untold
are those about the devastating impact that this crisis is
having on American seniors. That includes not only the horrible
deaths I just talked about, but also the toll of being a
caretaker when parents are impacted by these drugs. I know that
we'll hear firsthand today about that from Ms. Mateer.
I believe the Aging Committee must take this issue on, and
that's why we're having this hearing today. This isn't a
partisan issue, it's an American issue, and Congress must act
now. Last year, I was proud to have my bipartisan FEND Off
Fentanyl Act signed of the law, which fellow agent committee
member Mark Kelly co-sponsored.
The END FENTANYL Act was a bipartisan success because it
exposed just how behind parts of the Federal Government were
when it came to fighting the opioid epidemic and stopping the
deadly fentanyl that is killing thousands of fellow Americans.
In 2019, a study from the government accounting office found
that drug interdiction guidance of the U.S. custom and border
patrol protection not been updated in 20 years. That's clearly
unacceptable.
Now that the END FENTANYL Act is law, CBP is required to
update its policies at least once every three years to ensure
operational fuel manuals, including their drug interdiction
guidance are up to date. These are the kind of common-sense
policies we need to get done here in Washington. Seeing the END
FENTANYL Act become law makes me even more optimistic that we
can get things done, and I have more ideas with bipartisan
support to combat the opioid crisis.
Last week, I reintroduced my OPIOIDS Act with Senator Welch
of Vermont. This bipartisan bill is one step we can take to
fight this epidemic here and now. It would provide better
insight into overdose deaths nationwide. Local law enforcement
agencies are on the front lines of this crisis, and this would
provide additional grants to support law enforcement and
communities with high rates of overdose.
It would make Federal agencies collaborate on this problem,
and my OPIOIDS Act would stop the bad practice of stealing
money from the National Drug Control Strategy and Budget, and
this would provide additional grants to support law enforcement
and communities with high rates of overdoses. It would make
Federal agencies collaborate on this problem.
Again, I'm also proud to lead a bipartisan awareness
resolution each year for the lifesaving drug naloxone. As our
witnesses know all too well, naloxone literally stops
overdosing its tracks. That's why each June 6th, we do a
National naloxone Awareness Day Resolution to raise awareness
and educate people on lifesaving drug capabilities is something
so simple to carry.
In addition to those, I also have several other pieces of
legislation on this issue, including National Fentanyl
Awareness Week Resolution, Overdose RADAR Act, for better
health data on overdoses, and SOCIAL MEDIA Act to combat
illicit online sales of drugs. This is by no means all we can
do, but it has to start somewhere. Like I said earlier, I'm
optimistic. I know it may seem like there's not a clear path
forward, but if we keep fighting each and every single day, I
know we can make a change.
I look forward to hearing your testimony and working with
my colleagues on the next step to fight this issue. I now want
to recognize Ranking Member Kirsten Gillibrand for her opening
statement.
OPENING STATEMENT OF SENATOR
KIRSTEN E. GILLIBRAND, RANKING MEMBER
Senator Gillibrand. Thank you, Chairman Scott, and thank
you for calling on today's hearing. There is no community in
this country that has escaped the impact of the opioid crisis.
Substance use disorders are growing at an alarming rate in the
United States. Broadly, 48.5 million people aged 12 or older
had substance use disorder in the past year. While older adults
tend to use substances at lower rates than other age groups,
4.6 million people aged 65 or older have or had a substance use
disorder.
In the past year, fatal drug overdoses decreased
nationally, and while the numbers vary significantly between
states, we have the tools to continue reducing overdose deaths
to reverse the trend in states where this isn't the case. We
know that expanding the availability and affordability of
treatments and harm reduction policies like universal access to
naloxone are strategies that work. We need to make a
multifaceted approach that includes a law enforcement and
criminal justice element that places a larger emphasis on
public health and social policies.
We can't fully address the opioid crisis if we are not also
addressing prevention and access to affordable treatment. It's
why protecting Medicaid is so critical. Medicaid is the primary
care for substance use disorder treatment, and any cuts to the
Medicaid program would devastate our ability to solve this
crisis.
Another critical piece of the puzzle is the impact of drug
use on the whole family. More than 2.5 million children are
currently being raised by grandparents, or relatives, or a
close family friend. Over time, more grandparents are forced to
become family caregivers because of the opioid crisis. I co-
lead the bipartisan Supporting Families Through Addiction Act,
which would provide support to the families of people receiving
treatment for a substance use disorder.
Congress must do a better job of tackling this crisis
holistically. I hope to work with my colleagues in the future
to develop policies that take every aspect of this crisis into
account from providing necessary public safety tools to making
sure those with substance use disorders have access to
affordable evidence-based treatments.
I look forward to today's hearing, and I look forward to
hearing from our witnesses who can speak to the opioid
ecosystem and how we can truly combat the opioid crisis. Thank
you, Mr. Chairman.
The Chairman. Thank you, Ranking Member Gillibrand. I'd
like to welcome our witnesses here today. Before I introduce
our first witness, I'd like to ask each of you to be mindful of
our limited time together and keep opening statements to five
minutes.
First, I would like to welcome Seminole County Sheriff,
Dennis Lemma. Sheriff Lemma serves as the delegate chair on
Florida's statewide Council on Opioid Abatement created to
enhance the development and coordination of state and local
efforts to abate the opioid epidemic, and to support the
victims and families of this crisis.
Sheriff has also served as a member of the Victoria's Voice
Foundation. Victoria's Voice Foundation does amazing life-
saving work to help prevent overdoses by raising awareness of
naloxone, a revolutionary drug to stop an opioid overdose in
its tracks, as well as educating students, parents, educators,
and communities about the dangers of illicit drugs.
I've actually worked with Victoria's Foundation, now for
two years, to introduce the National Naloxone Awareness Day
Resolution, and was happy to see it pass to raise awareness of
this important opioid tool to combat the epidemic.
I've also been honored to work with Victoria's Voice to
help get naloxone into more schools and help them partner with
school districts so these parents can come in and talk directly
to students about the dangers of fentanyl, and the pain and
losses the drug causes.
I've also had the pleasure working with the Sheriff for
years on these important issues. Thank you for being here,
Sheriff Lemma.
STATEMENT OF THE HONORABLE DENNIS LEMMA, SHERIFF,
SEMINOLE COUNTY SHERIFF'S OFFICE, SANFORD, FLORIDA
Mr. Lemma. Well, good afternoon, Chairman Scott, Ranking
Member Gillibrand, and distinguished members of this special
Committee. Thank you for the opportunity to testify on the
devastating crisis of overdoses and fentanyl poisonings in our
country. It is an honor to present a proven strategy from the
State of Florida, one that can be replicated nationwide.
Chairman Scott, your leadership, starting with your time as
Florida's Governor, when you and Attorney General Bondi took
action to shut down pill mills served as a model for the
country. Senator Gillibrand, your efforts through the
legislative effort like FEND Off Fentanyl Act have been crucial
in this fight.
I'd also like to recognize Senator Ashley Moody, who as
Florida's attorney general, provided invaluable leadership in
the fight against this epidemic. Her vision and dedication
inspired my own focus on this issue, which requires both law
enforcement and clinical understanding.
I serve as the elected Sheriff of Seminole County, Florida,
located in the Orlando metropolitan area. Seminole County is
the fourth most densely populated county in the state. Despite
its affluence, we are not immune to the devastating effects of
this crisis. Simply stated, this epidemic does not
discriminate. It affects citizens from all backgrounds, and
demands comprehensive solutions.
In my nearly 33 years of law enforcement, I've come to
believe that the greatest responsibility of any civilized
society is to protect and preserve human life. Overdose death
has tragically become a leading cause of death for individual
aged 18 to 45. In 2022, the average life expectancy of a U.S.
citizen decreased partially due to the rise in overdose deaths.
To effectively combat this crisis, we need a holistic
approach that includes prevention, treatment, advocacy for
lifesaving interventions, and a strong emphasis on law
enforcement strategy that aggressively goes after the drug
dealers who are dealing deadly doses of narcotics in our
communities.
Prevention remains a critical tool in the process. Through
focused education and awareness, we can equip individuals with
the knowledge to avoid addiction before it ever starts.
Prevention also requires ensuring the highest level of access
to opioid antagonists like, Narcan, a lifesaving medication
that can immediately reverse the effects of an opioid overdose.
In Florida, we've made great strides in expanding access to
these antagonists, and they have saved countless lives.
Treatment is equally important in breaking the cycle of
addiction. Medication-assisted therapy combined with cognitive
behavioral therapy has proven to be effective in helping
individuals recover from substance use disorder in both
clinical and correctional settings.
Data collection also plays a critical role in combating
this epidemic. We need to gather and analyze overdose data at
all levels. By understanding overdose trends, we can better
allocate resources and target enforcement efforts.
However, accountability for drug dealers is absolutely
crucial if we're going to put an end to this epidemic. We must
ensure that those who distribute fentanyl and other illicit
substances like the emerging trend of street-level xylazine are
held fully responsible for their actions, whether there's an
associated death or not.
Too often overdoses are treated as accidents when in
reality they are crimes. In Florida, we've passed legislation
with harsher penalties for those drug dealers whose actions
result in fatal overdoses, while at the same time we've created
criminal laws to hold drug dealers accountable for the
individual overdoses that we bring people back to life with an
antagonist.
Drug dealers cannot be let off easily, and the law must
hold these individuals accountable to the fullest extent.
Additionally, we cannot ignore the illicit drug trade,
particularly from cartels like the Sinaloa and Jalisco New
Generation, which still pose a threat to our country. Securing
the border and preventing fentanyl from entering our country is
critical to minimizing its availability and reducing deaths.
This crisis must unite us all regardless of partisan lines,
because it impacts every community across the country.
In conclusion, we must adopt a holistic strategy that
includes prevention, treatment, improved data collection, and
the strictest accountability for drug dealers. This strategy
works, builds safer communities, and ultimately, saves lives.
Utilizing this strategy in Seminole County, we've achieved a 29
percent reduction in overdoses and a 42 percent reduction in
fatalities in 2024 alone. While we have seen this reduction, we
know that the hard work still lies ahead.
Thank you for having me here today and I look forward to
addressing your questions.
The Chairman. Thank you, Sheriff. Now I'd like to recognize
Senator Jim Justice to introduce our next witness.
Senator Justice. Well, first of all, let me just say this,
Greg Duckworth, you're an incredible man, and you've done
incredible work, and it's a real honor for me to be able to
introduce you, but I've got to say just this, I said this
earlier today, but can you just imagine West Virginia, how hard
West Virginia was hit? It was unbelievable, unimaginable in
every way. We had to have people that really stepped up, people
that were superstars. This man's a superstar. He's 27 years, I
think, a veteran of the state police, and absolutely a
superstar in every way.
With all that being said, let me just tell you this story
very quickly. You know, baby dog and I go through a lot of
drive through windows, and maybe we shouldn't go through that
many, but just the other day we're going through the drive
through window at Arby's, and I looked up and the car right in
front of me had Amber and had a cross, and it had 1993, 2023.
Well, we made it to the window to pay for our food, and the
car had left, and they paid for our food. Now, we tried to run
them down. We finally, through a lot of different ways through
the state police found them. Amber had played basketball for me
as a coach, so many situations to where all of a sudden, a drug
takes a life. It's happening all over the place.
Greg, I mean this with all in me. It's an honor to
introduce you. You've done great work with our foundation in
West Virginia. You have absolutely been just what I've just
said. You've been a superstar, because you care, and I am
really proud to introduce you.
Thank you so much, Mr. Chairman.
STATEMENT OF THE HONORABLE GREGORY DUCKWORTH,
COMMISSIONER, RALEIGH COUNTY, BECKLEY, WEST VIRGINIA
Mr. Duckworth. Thank you very much. Chairman Scott, Ranking
Member Gillibrand, and my fellow West Virginian, Senator
Justice, and other members of the Committee, thanks so much for
having me here today. It's truly an honor.
I spent my law enforcement career in the heart of the
opioid epidemic in an area once known as the coal fields.
Today, I want to share some firsthand experiences on how this
crisis has devastated families affected our aging population,
and where we must focus our efforts moving forward.
In 2012, 17-year-old Cheyenne Martin reported to the police
that her father and two younger siblings were missing. She had
already lost her mother, Kerry Hendricks, who under the
influence of OxyContin, had wandered onto the highway and was
fatally struck by a truck. During the missing person
investigation, police found that her father Hendrix, was lured
into a trap by an OxyContin dealer named, Belknap, who owed him
money.
Hendrix, his girlfriend, and the two youngest children,
ages six and four were ambushed and murdered, and their bodies
were discarded as if they were worthless. A decade later,
Cheyenne herself died of an opioid overdose leaving behind
three small children.
Entire families are being erased by addiction. This is not
just a crisis of individuals, it's a crisis of generations.
Children lose parents, and grandparents are forced back into
parenting, and communities crumble.
The second story involves a single mother in her early 30's
with four children: a nine-year-old, a seven-year-old, and
three-year-old twins. For years, she lived with her mother who
helped care for the children. Recently, she had moved into her
own place a single-wide trailer within walking distance of her
mother's home. At night after dinner, she would take the three-
year-old twins home while leaving the older children with their
grandmother who would ensure that they got to school the next
morning. The twins were described as full of life, radiating
joy, as most three-year-olds do.
One night the mother put the twins to bed, and by the time
she checked back on them again, they were deceased. Autopsies
revealed multiple drugs in their systems, including lethal
amounts and fentanyl. The neglect was so severe that rigor
mortis had already set in before she even realized what had
happened.
The children's grandmother had already lost her husband to
cancer, and she's fighting for custody of the remaining
children, but has been unsuccessful. She is, however, allowed
to see them with the help of the Child Protective Services. The
mother is currently in jail awaiting trial on two counts of
child neglect, resulting in death.
The burden on our seniors in West Virginia. one in seven
children lose their parents to overdose or incarceration by the
age of 18 with the highest rate of neonatal abstinence
syndrome, many of these children have medical and developmental
challenges. Grandparents who thought they were retiring are now
primary caregivers. They face physical strain raising young
children at advanced age.
Financial hardship. Many live on fixed incomes and struggle
to meet basic needs, emotional toll raising children while
still grieving the loss of their own, and many of these are off
the record to avoid the foster care system, so they don't
receive financial or legal support either.
The West Virginia First Foundation is supporting grand
families and the aging population, and I'm proud to serve on
the board of the West Virginia First Foundation and to be part
of this organization that is making a real difference in our
communities. The Foundation is committed to addressing the full
impact of the opioid epidemic, including the burdens placed on
West Virginia's aging population, recognizing that addiction
does not just affect the individual, but entire families.
The Foundation is dedicated to supporting grand families,
the grandparents raising grandchildren, by providing resources
and assistance to child advocacy and youth prevention programs.
We recognize that the crisis did not end with one generation.
It continues to ripple outwards, and by investing in solutions
that support full family systems the foundation is helping to
break the cycle of addiction, and ensuring the grandparents
raising grandchildren are not left to struggle alone.
Where we must focus. Having served on the front lines of
the epidemic, I believe that our response must be
comprehensive, treatment, access prevention and education,
recovery support grand families and child advocacy, and of
course, economic recovery. We also must fix some of the
systemic failures as well. The under-reported overdose deaths,
the inconsistent Narcan use documentation and recovery home is
misclassifying overdoses.
In closing, I believe we have to restore hope, and
substance use disorder is our enemy. It's destroying the very
core of the American way; God, family, and self. To win the
war, we must ensure the love of the church, reunite families,
and emphasize the importance of family values, and bring back
support systems that give people a sense of worth.
The crisis is more than just statistics. These are real
people with names, faces, and stories. If there's one thing I
wanted you to take away from today, is that behind every
number, there's a human being. Thank you.
The Chairman. Thank you, Commissioner. Thank you, Senator
Justice. Next, I'd like to recognize Ranking Member Gillibrand
to introduce the next witness.
Senator Gillibrand. Thank you, Chairman Scott. I want to
introduce our next witness, Ms. Elizabeth Mateer. Ms. Mateer is
a grandparent who has been raising her grandson for more than a
decade due to his parents' opioid use disorder. Ms. Mateer,
thank you so much for sharing your story with us here today.
You may begin.
STATEMENT OF ELIZABETH MATEER, GRANDPARENT
CAREGIVER, PITTSBURGH, PENNSYLVANIA
Ms. Mateer. Chairman Scott, Ranking Member Gillibrand, and
members of the Senate Aging Committee, thank you for holding
this important hearing and for inviting me to share my
perspective. My name is Elizabeth Mateer, I am a grandmother
raising my grandson due to the impact of opioids. I also
volunteer as a Generations United GRAND Voices caregiver
advocate.
When my grandson was born, I had no idea that my life would
change forever. I did not know the baby was suffering with
neonatal abstinence syndrome. I also had no knowledge about
opioid use disorder. At first, I did not identify and
understand the harsh reality that both parents were addicted to
painkillers. When we learned of the mom's opioid use, my
husband and I intervened, and arranged for her to be admitted
to a treatment facility. Suddenly, we had a baby. Although we
were very relieved and hopeful for the future, we had no crib,
no diapers, no baby clothing, no formula, and no idea where to
start.
Ten days later, I would receive a phone call that mom was
leaving treatment. We would not hand our infant grandson back
to parents who were using. Fear drove us to find an attorney
who obtained emergency custody, but a few weeks later, the
parents cheated a drug test, and we were ordered to return the
baby. Why do judges misunderstand opioid addiction and the risk
in placing children with parents who are inactive addiction?
The cycle of staging interventions and arranging for
admissions to treatment continued early on. One interventionist
told me to be prepared to keep my grandson long-term because
this would go on for a long time. Each relapse was a crushing
blow, and each time the recommended length of inpatient
treatment increased. The staggering cost for some treatment
facilities included $30,000 deposits for admission, and $10,000
a month. I constantly battled with the insurance company.
Opioid addiction is like none other. It takes a person's
soul and turns them into someone you don't even recognize. We
were desperate to save both mom and baby. The stress of living
in this opioid-created crisis landed me in the hospital with
pneumonia in both lungs. While we were trying to help our
grandson's mom get treatment, we were fighting a custody battle
with the father who was still in the throes of opioid
addiction.
Our legal fees exceeded $85,000. The court was permitting
supervised visits that were actually not being supervised. We
worried every time we went to court. The court halted
visitation privileges when we learned that the father had been
charged with child endangerment of another child under his
supervision. Six months later, he died of a heroin overdose.
When I told my then four-and-a-half-year-old grandson that his
father died, the first question he asked was, "Will I still be
able to live with you?"
I found that working and caring for a child was harder than
when I raised my own children. I had to leave my job. My
relationship slowly disappeared. Friends stopped inviting me to
social events since I didn't have childcare. I felt isolated as
my husband traveled for work. The stigma of addiction that the
child I raised could not raise their child made me feel
ashamed. No one knocks on your door with lasagna in hand to
comfort a family in this kind of crisis. My clergy never
called. Depression set in, and I wondered, "How would I go on?"
By the grace of God, our grandson's mother has been clean
for a long time. Our relationship is challenging because her
son, now 13, wishes to remain in our home. During the years of
battling her addiction, he just grew up. This is his community,
his home where his pets live, where his school is, where his
friends are.
My husband delayed retirement so we could provide for our
grandson, and it is nothing like we envisioned driving the
middle school carpool and hosting the baseball team picnic. We
hope to stay healthy so we can be there for our grandson.
The staggering number of grandparents who care for their
grandchildren, often without any support, is one of the least
recognized populations impacted in the opioid crisis.
Grandparents and other relatives who step forward to keep
children out of foster care and safely with family save
taxpayers more than four billion a year. The child welfare
system would collapse if grandparents did not take in these
children.
Any grandparent raising a grandchild could use financial
help. I urge you to consider these recommendations. Encourage
states to distribute opioid settlement money to help children
and caregivers promote peer support. Being part of Generation
United's GRAND Voices network has been a godsend to me.
I was once told that opioid addiction in a family is like
pouring acid on it. Expand the number of mental health
providers with expertise in grandfamilies. When we enrolled in
Medicare, our grandson lost his health insurance. Expand
healthcare coverage options so grandparent caregivers on
Medicare have coverage for the children they are raising. Allow
grandchildren who are in the legal guardianship of their
grandparent to qualify for Social Security survivor benefits if
the grandparent dies.
SNAP can be a lifesaver. I urge you to protect this
program. Continuing support for kinship navigator programs that
provide information about community-based services. I cannot
imagine what my grandson's life would've been like in foster
care with strangers. Grandparents are committed to protecting
the children under their care, but we need help.
Thank you.
Senator Gillibrand. Thank you, Ms. Mateer. Our next witness
is Dr. Malik Burnett. Dr. Burnett is an addiction medicine
provider and the medical director of several community opioid
treatment programs in Baltimore, Maryland. Dr. Burnett also
serves as the vice-chair of the Public Policy Committee for the
American Society of Addiction Medicine, and oversaw naloxone
distribution for the State of Maryland.
Thank you for being here, Dr. Burnett. You may begin your
testimony.
STATEMENT OF DR. MALIK BURNETT, MD, MBA, MPH,
VICE CHAIR, PUBLIC POLICY COMMITTEE
AMERICAN SOCIETY OF ADDICTION
MEDICINE, BALTIMORE, MARYLAND
Dr. Burnett. Chairman Scott, Ranking Member Gillibrand,
esteemed members of the Senate Committee on Aging. I thank you
for inviting me to participate in this critically important
hearing. My name is Dr. Malik Burnett. I'm a board-certified
addiction specialist physician who takes care of patients with
addiction and co-occurring conditions in Baltimore, Maryland.
Today, I'm testifying in my capacity as vice-chair of the
Public Policy Committee for the American Society of Addiction
Medicine, known as ASAM. ASAM is a national society
representing over 8,000 physicians and other clinicians who
specialize in the treatment and prevention of addiction.
I want to begin today by talking about Baltimore and its
forgotten generation; older adults born between 1951 and 1970,
particularly older Black men. In my city, one in three drug
overdoses come from this demographic. Illicitly manufactured
synthetic opioids are among the deadliest health threats that
they face. Many of these men struggle with addiction or have
struggled with addiction for years, but today, there's no
margin for error. A single relapse can leave them at the mercy
of a lethal dose of fentanyl or other synthetic drugs.
While addiction is a treatable chronic medical disease, it
is also one of the most complex in medicine. It involves
interactions among brain circuits, genetics, the environment,
and an individual's life experiences. As a result, solutions to
our Nation's addiction and overdose crisis can be equally
complex and interconnected.
Supply side approaches are important to public safety, but
yield little net benefit. If demand-side interventions remain
inaccessible, underfunded, and undermined, drug cartels can
quickly replace confiscated synthetic drugs with little effort
and overhead, ensuring unbroken access to dangerous drugs for
fueling this overdose crisis.
The good news, evidence-based addiction treatment works and
reduces the risk of overdose death by 80 percent. As a
physician, I've personally witnessed hundreds of patients'
lives transformed by addiction treatment. People in treatment
restore their marriages, rejoin the workforce, leave criminal
activity, improve their mental and physical well-being, reunite
with their children, and yes, escape the grasp of drug cartels.
We are fortunate to live during a time when effective
evidence-based treatment exists for opiate use disorder, yet
tens of thousands of people in the U.S. continue to just die
from illicit opioids annually. How is this possible?
Unfortunately, the people who need these treatments the most
are not getting the life-saving care that they need when they
need it. In fact, it's this treatment gap that's barely budged
for the last decade. We will not end the opioid epidemic until
evidence-based addiction treatment is easier to get than
illicit opioids.
For many Americans, especially in rural areas, evidence-
based addiction treatment is impossible to find Ease of
treatment access is critically important because people with
addiction often experience a brief window of time between
desiring treatment and experiencing painful withdrawal
symptoms.
Symptoms that cheap Fentanyl, which is easier to get than
addiction medications temporarily stop in an instant, but
easier access to addiction treatment cannot happen without a
substantially larger addiction treatment workforce, including
more addiction specialists, physicians increasing Federal
funding for addiction medicine and addiction, psychiatry
fellowships and financial incentives to encourage more
physicians to enter. These training programs are solely needed
to ensure every community has high quality addiction treatment.
In addition, federal law must be amended to allow these
addiction specialists to prescribe methadone for opiate use
disorder that can be dispensed from community pharmacies.
Today, only about 2,000 opioid treatment programs dispense
methadone for opiate use disorder. They're lacking in about 80
percent of U.S. counties. Methadone for opiate use disorder has
been caught in bureaucratic red tape for nearly 50 years.
Allowing states to regulate their methadone treatment without
undue Federal restriction could lead to the type of innovation
needed in opioid treatment in America.
Yet, continuing individuals or connecting individuals to
treatment is not enough. They must also be able to afford their
care. Medicaid and Medicare are major insurers for people with
opioid addiction, making it essential that these fiscal
mechanisms facilitate rather than hinder access. Many
clinicians in opioid treatment programs do not accept Medicaid,
largely reflecting the program's administrative burdens and low
reimbursement rates. Congress should remove these burdens,
increase Medicaid rates to change this equation.
Medicare and Medicaid must also cover the full continuum of
addiction care. Surprisingly, Medicare does not cover non-
hospital-based residential addiction treatment. This must
change furthermore, assurance of equal reimbursement for mental
health and addiction care must be strengthened by levying civil
penalties for parity violations and incentivizing state
regulators to be more robust in their enforcement.
Stigma toward addiction is arguably the most difficult
barrier to address as it's so entrenched in society. Even when
people recognize that they have a problem with drugs or
alcohol, they're often too embarrassed or too scared to talk to
their physician about it. The Federal Government should stop
wasting money on incarcerating people for nonviolent drug
offenses, and must continue to emphasize that addiction is not
a disease, but a moral addiction is a disease and not a moral
failing.
People already in the criminal legal system also need
better access to addiction treatment. Congress should eliminate
Medicaid's inmate exclusion requirements, and federal funding
for prisons and jails should be contingent upon providing
evidence-based addiction treatment to ensure that taxpayer
money is not wasted on a revolving door of incarceration.
In closing, thank you for the opportunity to share my
perspective and expertise today. One thing is clear about
America's opioid ecosystem: whether it's funding, and training,
more addiction specialists, ensuring access to prescription
methadone, closing Medicare coverage gaps, avoiding harmful
cuts to Medicaid, or enforcing equal access to addiction
treatment in all healthcare settings. Congress owns this. Let's
work together to save lives.
Thank you, and I look forward to answering your questions.
The Chairman. Thank you, Dr. Burnett. Ms. Mateer, I've got
a 13-year-old grandson. I can't imagine trying to stay up with
him as a parent, as my daughter and my son-in-law have to do
so, but thank God, he's got you in his life.
I'd like to introduce Dr. Bradley Stein. Dr. Stein is the
director of the RAND-USC Schaeffer Opioid Policy Center, and a
senior physician policy researcher at the RAND Corporation. Dr.
Stein has worked extensively, examining the effect of state
policies and community outcomes related to the opioid crisis.
Thank you for being here.
STATEMENT OF BRADLEY D. STEIN, DIRECTOR, OPIOID
POLICY, TOOLS, AND INFORMATION CENTER, RAND
CORPORATION, PITTSBURGH, PENNSYLVANIA
Dr. Stein. Thank you. Good afternoon, Chairman Scott,
Ranking Member Gillibrand, and distinguished members of the
Committee. Thank you for inviting me to share insights on
combating the opioid crisis, which is increasingly impacting
older Americans. As the chairman said, I'm a senior physician
policy researcher at RAND, a direct and NIH-funded research
center devoted to better understanding the effectiveness of
opioid related policies. I'm also a practicing child
psychiatrist in Western Pennsylvania, where I see firsthand how
opioid addiction devastates families across generations.
The toll of the crisis extends far beyond fatal overdoses.
It affects millions of Americans, not just older adults
fighting to maintain their own recovery, but also those
spending their life savings to pay for adult children's
addiction treatment or raising their children's children.
Today, I will focus on three topics, particularly relevant to
this Committee. What escalating rates of opioid use disorder
among older adults imply for healthcare. How upstream
strategies of better chronic pain management can help prevent
opioid misuse, and the social toll of grandparents raising
grandchildren due to parental addiction.
Opioid use disorder rates have tripled among Medicare
beneficiaries over the last decade. The rapid increase poses
significant challenges to our healthcare system, which is not
adequately prepared to address the unique needs of this
population, who often have conditions that can complicate
diagnosing and treating opioid use disorders like dementia or
chronic pain.
Primary care providers, the clinicians at the heart of
treating our older adults often lack training or confidence in
managing opioid use disorder. Meanwhile, few addiction
specialists are equipped to handle the complex medical needs of
older patients with conditions like dementia. This mismatch
leaves many older adults with opioid disorders without adequate
care, especially in rural areas experiencing acute clinician
shortages.
The American population is aging, but currently most
clinicians treating chronic disorders in older adults don't
have expertise in substance use disorders, and substance abuse
experts treating older adults who have addiction usually have
little experience in treating chronic disorders in the elderly.
Only with concentrated efforts in federal investments will
the clinical workforce caring for the elderly be prepared to
efficiently and effectively treat individuals with opioid use
disorder, and disorders like dementia, and chronic pain is even
more common than dementia, affecting 36 percent of those over
age 65. Efforts to reduce opioid prescribing have curbed
misuse, but many individuals with chronic pain don't receive
non-opioid treatments, leaving many with without adequate pain
management options.
Some clinicians now avoid prescribing opioids altogether,
even when they're clinically appropriate, leaving patients to
suffer, or turn to elicit opioids for relief. In some
situations, expanding access to non-opioid pain management is
essential to address this gap and can help prevent new opioid
use disorder cases.
Acupuncture, rehabilitative exercise, therapeutic massage
can all reduce reliance on opioids and improve quality of life
for individuals with chronic pain. However, insurance coverage
is often inconsistent or limited in scope, and high out-of-
pocket costs often make these non-medication therapies less
affordable than opioids, and provider shortages can make this
care very hard to find.
Congress can help by considering incorporating non-opioid
therapies for chronic pain in value-based insurance designs to
enhance affordability and ensure that these services are fully
covered by Medicare. It can also possibly consider expanding
existing loan forgiveness programs such as rural health grants
or the National Health Services Corps to include providers
trained in these non-medication therapies to ensure we have an
adequate workforce in the future.
Finally, as we've heard, the opioid crisis has far reached
social consequences for older Americans beyond their own health
needs. An estimated 2.6 million grandparents are raising
grandchildren, often becoming informal caregivers when parents
struggle with addiction or succumb to overdose. Doing so often
entails significant emotional and financial burdens as
grandparents working to keep their family together delay
retirement or take on new expenses like housing or childcare.
These older adults deserve better support.
Better support systems; expanded access to respite care,
and kinship navigator programs, and information to help them
raise children affected by parental substance use and trauma.
Yet, informal caregivers commonly outside the child welfare
system often don't receive such support despite the vital role
these individuals play in providing stability for so many
children.
Congress can help support these families by expanding
access to respite care and affordable childcare through
programs like Head Start or alongside the Child Abuse
Prevention and Treatment Act, CAPTA, reauthorization. It can
seek to ensure grandparent caregivers have access to benefits
such as health insurance for the children and kinship navigator
programs, whether they participate in the formal child welfare
system or not.
It's important that we support the development of
educational resources tailored specifically for grandparents
stepping up to raise children affected by parental substance
use disorders. Supporting grandparent caregivers not only
strengthens families, but also reduces long-term social costs
associated with parental addiction.
There's no single solution to the opioid crisis, but
healthcare reforms, improving non-opioid, chronic pain
management, and better supporting families affected by
addiction, like so many of the patients I treat, will help keep
families together, and ensure that our healthcare system is
better prepared to meet the diverse needs of older Americans.
Thank you again for this opportunity and I look forward to
your questions.
The Chairman. Thank you, Dr. Stein. Thanks for all of you
for being here. Now we'll start going to some questions. First,
we'll start with Senator Tuberville.
Senator Tuberville. Thank you, Mr. Chairman. Dr. Stein, I
spent 40 years coaching, and all those 40 years, I saw the
correlation between family and some kind of addiction. There's
direct correlation, and if we don't figure out something to do
with family in this country and get back to mom and dad, and
discipline, and responsibility, we're going to have a tough
time and continue to have a tough time.
Also, I saw over the years, I'd bring young men into my
football teams, and of course, with their mom and dad, you
know, for four years, and we'd bring doctors in, and for first
part of my career, you know, we had a few that was on insulin
for sugar diabetes or something, but my last 10 years, there
was very few that was not on Adderall or Ritalin for attention
deficit. Kids are overprescribed by doctors for some reason. Do
you see a direct correlation between over-the-counter drugs or
prescription drugs that lead to addiction?
Dr. Stein. Thank you for your question, Senator. You know,
this is a question that scientists have been looking at, and so
far, the data really suggests that there isn't a direct
relationship between children receiving some of these
medications and later addiction.
I also think it's important to recognize that we also do
recognize that there is a relationship between mental health
disorders in children generally, or in adults in substance use
disorders, and so, I think it's important that recognizing that
there is this relationship, and individuals may have both
mental health disorders and substance use disorders.
I do think it's very important to make sure that not only
while we're here focused on opioid use disorders and substance
use disorders to try to address the opioid crisis or substance
use disorder crisis more generally without recognizing how many
of those individuals suffer from mental health problems. Really
makes us suggest we're trying to fight that battle with one
hand tied behind our back.
Senator Tuberville. Do you think we need to roll back the
prescription of childhood drugs, of what I was just talking
about a few minutes earlier?
Dr. Stein. Sir, I----
Senator Tuberville. Are we over drugged, is what I'm
asking, at a young age?
Dr. Stein. That's well beyond the sort of research that I'm
currently involved in. As a clinician, I can say it's important
that we need to make sure that we're using medications and
other therapies appropriately, and that means making sure that
individuals who are not being treated and may benefit from
medications do receive them, and also making sure that we're
not providing medications to children or adults who may not
benefit from them.
Senator Tuberville. Thank you. Mr. Duckworth, how have
states like West Virginia used opioid settlement funds to fight
back against epidemics?
Mr. Duckworth. That's a great question. The West Virginia
First Foundation's brand new, it's in its infancy, so, May
24th, was when----
Senator Tuberville. How is it funded, by the way?
Mr. Duckworth. It's the opioid settlement money, so, the
executive director actually wasn't hired until May 24th, so,
between May and September it took a lot to get the homework
done, the policies, procedures, the staff hired. We put an
initial opportunity grant together that went out for
application, receiving applications in September.
By the end of December, we've committed over $20 million,
and most of it at this point has went to youth prevention and
child advocacy, and I think we'd all agree that the, the hidden
epidemic of our seniors isn't really so hidden anymore. I can
anticipate in the future having a lot more funding going toward
the grandparents raising grants because of the seniors, that's
the direction we want to go in West Virginia.
On to answer your question on the short-term child advocacy
and prevention education, things like that is where it went
recently.
Senator Tuberville. Yes. Do you think there's anything that
you use that we could do on a federal level to help more from
this program?
Mr. Duckworth. I think Senator Scott's on a data sharing,
education. The data sharing, the support for law enforcement I
think is so, it's so important, and I love the mission that
you're on there, and hope we can see that come together.
Senator Tuberville. Thank you. Sheriff, we've heard a lot
about how children are now able to purchase drugs, which are
awful, often laced with fentanyl, and there's this godawful
stuff that you can go into one of these convenience stores and
buy that all of it's made in China, that's for some reason
we're allowed to be sold here in this country.
What can we do here in Washington to curb practices and
raise awareness to parents about the things that the kids are
able to buy?
Mr. Lemma. Well, thank you for the question, Senator, and
you're spot on. I mean, Chinese really created this epidemic,
illicit substances. Now we've seen the most recent number is
actually 50 percent of the pills that are made in clandestine
labs or somebody's dirty bathroom, in many cases, contain a
lethal dose of fentanyl. That's down from 70 percent, seven out
of ten people that were taking it for the first time were
likely to die with a pill that was manufactured illicit listed
environment.
We see these things, these trends. It was just yesterday
where we were talking about methylenedioxy, methamphetamine,
MDMA, flunitrazepam, Rohypnol, where roofies were available,
and then things got confusing for Americans with designer drugs
where they would walk in and illicit chemists would stay one
step ahead of what the DEA would approve as illegal, and we
would clean the shelves off.
I think we have that under control now. There's no longer a
problem in this country of over-prescribing. Clearly, you have
to have your head in the sand to not realize that we have a
problem that's down at our southern border with Mexican
chemists now picking up precursor chemicals from China and
learning how to process this.
Education is so incredibly important. That's why when we
talk about greater access to opioid antagonists, the most
significant thing that we can do to prevent people from having
a drug overdose is never starting. Many of us remember Nancy
Reagan saying, "Just say no." Well, just say no - works
incredibly well if you've never started, so, when people have
started on a regimen, we have to give them access to science-
based, medical-based treatment therapy combined with cognitive
therapy.
Not just do that for the person on the journey. Make sure
that the family members, and the loved ones, and partnership
with businesses and corporations, and the private companies
have a big role to play in that, because many people who are on
this journey are actually going into an environment, whether
they're going to a public school system, or that type of
environment, or they're going to work, somebody is formally
supervising them, and when they first see the first signs of
it, it's important to not only say something, but know what
resources are available and stay current with the current
trends.
Last, we all remember the program, DARE, which was an
incredibly successful program across the country, but DARE had
nothing to do with what the challenges are of our kids today.
Sexting, texting, cyber bullying, vaping. All of these other
things have to be incorporated in educational curriculums, K
through 12.
The Chairman. Thanks, Senator Tuberville. Senator
Gillibrand.
Senator Gillibrand. Senator Kim, would you like to take the
time?
Senator Kim. Sure.
Senator Gillibrand. Go ahead.
Senator Kim. Thank you. I appreciate it, Ranking Member.
Ms. Mateer, I wanted to just start by just saying how grateful
I am that you took the time to come up here and share your
personal story. It's so important that we talk about the
difficulties that are faced, and I'll be honest with you, I've
heard a lot of stories about the opioid crisis but I haven't
heard as much about the challenges that it puts upon
grandparents, and I thought that was very powerful.
I wanted to ask you, I don't know if you have this off
hand, but you were talking about numbers and figures in terms
of how much, in some ways, is being saved by grandparents
stepping up, but is there an actual figure in terms of the
number, the estimated number of grandparents who are in this
situation right now, like you?
Ms. Mateer. Thank you for the question, and to my
knowledge, according to what Generations United has at their
fingertips, the grandparents save taking care of their
grandchildren, save $4 billion a year.
Senator Kim. Do we have a sense of how many grandparents
are in this situation?
Ms. Mateer. Yes, we do. There are probably--I know there
are around 2.6 million children in our country being raised by
caregivers other than their parent, and of those, the majority
of them are being raised by grandparents. There is a website
that has statistics for every state, and I think it's
grandfamilies.org.
If you look at that, where I'm from in Pennsylvania, I know
there are over 250,000 grandparents or children in Pennsylvania
being raised by other caregivers. It does show you the
grandparent statistics. The problem is a lot of these
situations stay under the radar because they're unreported and
they're not part of the system, so, there are probably many
more than we know about.
Senator Kim. Yes, and I think that that stands to be
something that this Committee can try to look into. Because
kind of as Dr. Stein was saying, we want to make sure that that
support is available to all that are struggling. We don't want
to have bureaucracy getting in the way or regulations in that
specific way, getting in the way of getting support out to
those that need it, so, thank you for illuminating me on this,
and I certainly promise to continue to followup with you and
others to figure out how we can move this needle forward, both
in terms of the caregivers.
Dr. Burnett, you know, what I've come to understand is just
not just the challenges it is to the caregivers, but that we as
a nation right now are not resourced in terms of the workforce
needed to be able to address it, both from a practitioner
standpoint, and more broadly, against other types of addiction-
related specialists.
I guess I wanted to ask you, what can we do at the Federal
level to try to increase that sense of workforce to make sure
we can rise up to the magnitude of this challenge that we face?
Dr. Burnett. Sure. Thanks for the question. One thing I
would say that we can do is reauthorize a couple of different
programs. One called the Substance Use Disorder Treatment and
Recovery Act Loan Repayment Program, which is the STAR LRP
Program, is a great program that provides loan reimbursement
for providers and clinicians up to $250,000 to work in mental
health professional shortage areas, or in places where the
overdose rate is greater than three times the national average.
Also, there's another HRSA program that currently exists
that could be reauthorized that provides fellowship support for
addiction medicine and addiction psychiatric fellowship
programs to be able to increase the number of these types of
providers. Because, currently, we're about at half the capacity
that is estimated to be needed to be able to address and treat
the current substance use disorder need for the country.
Senator Kim. One thing you raised as well was just the
challenge sometimes getting providers to be able to engage with
Medicaid, for instance, and you were actually suggesting maybe
increasing the rates to be able to try and get more providers
on board.
I guess I just want to end here. We're having a debate here
in Congress, in the Senate, about Medicaid right now, and I
just want to hear from you just what you think would happen if
we saw cuts to Medicaid. What would happen to our ability as a
nation to respond to the opioid crisis?
Dr. Burnett. Sure. I think Medicaid is vital to the ability
for us to be able to take care of our patients with substance
use disorder. I'd say about 80 percent of the patients in my
clinic utilize Medicaid as the financing mechanism for their
care. If we were to cut Medicaid funding, it would
significantly reduce our capacity to be able to fight the
addiction crisis, fundamentally.
Senator Kim. Thank you, and with that, I yield back.
The Chairman. Senator Justice.
Senator Justice. Thank you so much, Mr. Chairman. I'm going
to be very official. I'm going to call Greg, Mr. Duckworth, but
I have two questions. I really do. You know, the first question
is about our aging, but of course you've seen the crisis on
both sides. You've seen it from the law enforcement side, and
you've seen it from the community advocacy side. How does this
particularly affect the aging population in West Virginia?
Mr. Duckworth. Thank you Senator. It starts with the
grandparents raising their grandchildren, so, if a grandparent
is raising a grandchild, we've lost a generation out of their
family tree, so, the senior is mourning the loss of their child
and raising their grandchildren.
It's not just grandparents. It's great grandparents, and
there's great aunts and great uncles that are also raising, so,
it's like the floods and fires; everything that it touches, it
destroys, and it starts with the babies being born with
addicted to opioids, or in West Virginia, we have a large
amount of babies being born addicted to Suboxone, so, we're
dealing with the neonatal abstinence issues, and the seniors
who are mourning the loss and raising their grandkids. It's a
huge impact. 40 to 50 percent of West Virginia grandparents are
raising their grandchildren.
Senator Justice. I hope everyone heard that. You know, the
magnitude of the percentage in West Virginia of grandparents
that are raising the grand babies. It's terrible. It's all
there is to it, and I've said this over, and over, and over,
but I said this when I was a Governor, I said, if we don't
really get a handle on this, it will cannibalize all of us, and
we better absolutely get a handle on. You know, there's so much
more we can do.
I've got one more question, and this is I'd like you to
talk about the ways we can see hope restored. You know, when it
really boils down to this level of crisis, what really keeps
our West Virginia families even going? You know, Greg, we
started with Jim's Dream, and then we went to Jobs and Hope,
and we made a dent, but there's got to be a lot more dents
that's just all risk to it.
You know, I've said so many times in life that you'll never
get out of the hole till, you know, really where you are in the
hole, and the hole in this situation is bad. That's all there
is to it, so, I just think that we have got to give people all
across this land, if not all, across the globe, hope. I mean,
optimism, a chance to be better. This situation has got to have
every single one of us arm in arm pulling the rope together. We
can do it, but that's exactly what we've got to do.
Tell me your thoughts real quickly on how do we address
this terrible crisis and give hope to our West Virginia
families?
Mr. Duckworth. Yes, thank you. In my mind, the treatment
centers, and the detox centers, the doctors, they do a fine job
for those 30 days, and then, our addict gets released from
either jail or a recovery home, and there's nowhere to go
except back where they came from, so, there's a piece of this
in the economic development part of creating jobs, so that when
these folks get detoxed or they get out, they have hope for a
job, something they can support their family in.
That's where we lack sometimes, is a place for them to go,
either when they get out of jail--the overdose rates are
highest when someone first gets out of jail or out of a
treatment program, and they don't have a place to go to a
recovery center or somewhere different than where they came
from, and they just go back to the community they were in to
start with.
Senator Justice. Isn't that exactly what we tried to do
with Jobs and Hope? I would tell everyone just this, you know,
we have to have treatment. We know we have to have treatment,
and we know we have to have sympathy to bring people back, but
these people got to have a job. They have to have training.
They can't be trained on a pickup truck, how to drive a dump
truck. Absolutely. They got to have real life training, and we
got to spend dollars to be able to do that.
I thank you all so much for being here, so, thank you,
Greg.
The Chairman. Thank you. Senator Alsobrooks.
Senator Alsobrooks. Thank you so much, Mr. Chair, for
hosting this important hearing today. Thank you so much as well
to each of our witnesses.
Baltimoreans are dying from overdose at a rate never seen
before in a major American city, with the number of deaths
quadrupling over the last 10 years. The frequency of overdose
deaths in senior homes has likewise increased. More than 340
people have died in Baltimore senior housing complexes in
recent years. Black men aged 55 to 74 lead drug fatalities over
all other demographic groups in the city, a death rate that is
20 times that of the rest of the country.
Yet, this administration is working to slash funding for
research treatment, and our public health workforce, nearly one
in ten employees at the Substance Abuse and Mental Health
Services Administration known as SAMHSA, were just recently
summarily fired by this administration as a part of DOGE's
governmentwide cuts. Cuts at SAMHSA threaten continued access
to essential mental health and substance use services,
including crisis support and suicide prevention, and as you
know, SAMHSA is yet another Federal agency that is based in
Maryland.
I'd like to start with Dr. Burnett. First of all, to thank
you so much for the work that you have done every day on the
front lines of the opioid crisis in Baltimore, and just want to
ask you, how will public health efforts be impacted by this
administration's slashing of the Federal workforce at SAMHSA,
and will leaving SAMHSA with a skeleton staff worsen the
situation on the ground in Baltimore?
Dr. Burnett. Thank you, Senator Alsobrooks. I can answer
definitively, and talk about a little bit about my experience
working for the Maryland Department of Health and how SAMHSA
funding was integral to not only ensuring that prevention and
public health efforts around opioid overdose were implemented.
The SAMHSA funding supported a large percentage of our
efforts toward naloxone distribution statewide, and so, any
cuts to SAMHSA funding would significantly curtail our ability
to be able to provide naloxone across the State of Maryland,
and I'm sure that that's true for many other states here, and
it's particularly true in states that have not expanded
Medicaid.
SAMHSA funding provides integral not only prevention
support, but treatment support in places where patients don't
have access to Medicaid. You can provide the funding from
SAMHSA to be able to get into community health programs so that
people can get access to medications, opiate use disorder, so,
it's very, very critical funding.
Senator Alsobrooks. Thank you. You know, also, it's really
shocking, but the New York Times recently reported that dealers
are targeting senior apartments in Baltimore, yet health
officials have done little targeted outreach to older people.
We're seeing that this is an epidemic that is affecting them.
What more can be done on the ground to help address the
pattern of deaths among low-income seniors and to stop
vulnerable communities from being preyed upon.
Dr. Burnett. I see that every day in Baltimore where I
work. We have a senior living facility just down the street
from our opioid treatment program, and we've taken steps toward
partnering with the senior community to be able to talk about
treatment and recovery.
You know, the population of seniors experienced opioid
treatment in the years before major reforms to opioid treatment
took place, and so, they have a very negative perception of
opioid treatment, very strong stigma toward medications for
opioid use disorder, and so, there's got to be a significant
amount of education to be able to bring those individuals back
into treatment.
It requires partnerships and peer recovery support services
going into these senior homes to be able to talk about what
recovery looks like and being able to access medications and
really reducing the stigma associated with opiate use disorder
because it's very pervasive within the community.
Senator Alsobrooks. I think there was a question that
addressed at least a part of this, but also would you speak to
the importance of supports for seniors who are caring for
children impacted by the opioid crisis, and how does keeping
families together reduce the trauma experienced by these
children?
Dr. Burnett. Just to clarify, was that question from you?
Senator Alsobrooks. That's for anyone who might want it,
who can answer.
Dr. Burnett. I'm happy to take the question. In my clinic,
one of the things that we really look for in terms of people's
capacity to recover is their connection to community and having
family support. Sometimes, people come into treatment and they
are by themselves, they don't have any social support systems,
and so, it's critical toward your recovery process if you
actually have people that can help you through the process.
It's a long one. It's much more than the 30-day timeframe that
most treatment access provides.
It's really critical that you have family members,
especially if you're in an older generation and you're caring
for younger individuals. That support and that community-based
experience is critical to being able to help people get into
recovery. Because a lot large percentage of people who suffer
from opiate use disorder are wholly disconnected, right?
They're suffering from trauma, they don't have any resources or
any places to turn to, and so, they use drugs to cope with
their isolation.
Being able to bring them back into the community, whether
through faith-based organizations, community partnerships and
relationships, non-profit organizations, all of that is
critical to their recovery.
Senator Alsobrooks. Thank you.
The Chairman. Thank you. Senator McCormick.
Senator McCormick. Mr. Chairman, thanks for hosting this
important meeting on such an important topic. Good to see some
fellow Pennsylvanians on the panel, so, thank you for being
here today to talk about such an important issue for the
Commonwealth of Pennsylvania and the country.
4,000 Pennsylvanians died last year from fentanyl, about
100,000 nationally. This is a crisis of sort of historic
proportion. You know, I see it all the time in Pennsylvania. I
was in Cambria County, a couple years ago, and I talked to a
woman, and she was describing a family member who died of
fentanyl poisoning and the devastating effect on her family,
so, I started to make these campaign visits. I'd ask people,
who among you has been affected by fentanyl? Almost half the
people in the audience would put their hands up. Either their
immediate family or their friend's group affected by fentanyl.
We've got to get our hands around this, and of course, it's
a problem that begins at the southern border, primarily with
the precursors from China, comes across our border, and then
goes out into a network of drug dealers and cartels in the
United States.
My first question is for you, Sheriff Lemma, about the
coordination among law enforcement, and is there any gaps you
see in the way the federal, state, and various law enforcement
bodies coordinate, and any insights you can give us on what we
might do better?
Mr. Lemma. Yes. Thank you for the question, Senator, and I
think that first there were gaps. I think that we're reigning
those gaps in right now. I think that there is potentially some
confusion and need for deconfliction in the past between the
law enforcement agencies that worked under the Department of a
Homeland Security Secretary, and those that worked for Main
Justice. I suspect now those problems are going to be cleaned
up pretty quickly.
I do think deconfliction is incredibly important, not only
between Federal agencies, but local, state, and there's
platforms, and relationships, and task forces that are a huge
benefit to the country, so, what we can do better, I think more
of what we're witnessing right now. We're witnessing a
bipartisan effort to focus on things that move beyond politics
and find a way to at least tackle what we agree on, and I think
that through that process should build chemistry and comradery.
When we look at what works we cannot lose focus treatment,
and access to prevention programs, and access to lifesaving
opioid antagonists like Narcan Kloxxado, and generic versions.
All of those things are incredibly important, but the bad guys
have to go to jail. The cartels are a big part of this. They
are a threat to this country, particularly the Sinaloa and the
Jalisco New Generation Cartels. We have to be incredibly
aggressive about that.
Unfortunately, many overdoses or poisonings across the
country are still being treated as accidental, tragic events.
Every person who's dealt from those dealers is likely to
experience similar fate, so, I've recently had some
conversations with incoming Attorney General, Pam Bondi, our
association, Major County Sheriffs of America, have had the
same conversations, and I think that we're going to see a lot
of great progress, so, more of this is good.
Senator McCormick. Thank you, and, Ms. Mateer, fellow
Pittsburgher, I want to say, I think your grandson is extremely
blessed to have your support. It must be emotionally taxing and
financially challenging, but it sounds like you're making it
work. Unfortunately, as Senator Justice was saying, many
grandparents, hundreds of thousands of grandparents across our
country suffer through.
Any advice that you would offer to families going through a
similar situation, and particularly grandparents faced with a
similar set of challenges?
Ms. Mateer. The best advice I can offer is to join some
sort of a peer-to-peer support group. That has been my
lifesaver. Because of my advocacy with GRAND Voices, I connect
with grandparents raising grandchildren across the country, in
the tribal nation, and everywhere, and that's where I get my
mojo, because we support one another and we understand one
another.
Senator McCormick. Good. Thanks Mojo, and Sheriff Lemma,
back to you. Just one final question. You talked about
collaboration and, of course, common data, referring to your
testimony. Common data is an important part of a unified
effort. Any commentary on the quality of the data, and anything
in particular Congress could do to ensure common data standards
and availability to combat this horrible fentanyl crisis.
Mr. Lemma. Yes. I think that we have a lot of great things
that are going on, and Congress has really been, you know,
responsible for those things. The elimination of the X-Waiver I
really think that really we should take on permanently
scheduling xylazine. Many states have already moved down that
path. We're seeing the deadly substance xylazine end up in,
again, mixed in substances and a growing problem across this
country, but yet still is not scheduled at the Federal level.
What's incredibly frightening about xylazine, it's an
animal tranquilizer. It really eats the skin away and is non-
responsive to opioid antagonists, so, these success numbers
that were presented across the country in various areas would
absolutely decline, or the drug dealer would kind of move down
the path to move into that business if we don't kind of tighten
up on that.
One last thing, is kind of looking at that scheduling of
that, and then making sure that we have programs that work.
Operation Overdrive is a DEA program that has shown great
success, great data tracking. Last report, I think it was in 37
cities across the country. Those should spread out, not to new
cities necessarily, but into the unincorporated counties that
those major municipalities are in, and I think that data
collection, OD Maps, is another great effort to expand research
data collection and allow us to kind of let science move the
path.
Senator McCormick. Thank you.
The Chairman. Thank you, Senator McCormick. Senator Warren.
Senator Warren. Thank you, Mr. Chairman, and thank you and
Ranking Member Gillibrand for holding this hearing today. It's
a really important topic, and I appreciate the care with which
you treat this issue.
Since 2017, the opioid epidemic has taken the lives of
nearly half a million Americans. Their families, and so many
more people around this country need Congress to come up with
some real solutions. For example, I know that Chairman Scott
and I agree on the need to close a trade loophole that lets
China ship fentanyl precursors into the country uninspected,
and it's time to put a stop to that.
As we sit here today, President Trump and congressional
Republicans are working hard to advance budget legislation that
would make the opioid epidemic worse and not better. They have
proposals to cut over $800 billion from Medicaid, which is the
largest single payer of substance use disorder services in the
entire country, and why? That they can fund tax cuts for
billionaires.
Let's be clear about this. Slashing Medicaid funding,
either through per capita caps or backdoor cuts, like work
requirements in an area that already have work requirements,
would mean ripping away healthcare from millions of vulnerable
Americans, including about a million people right now who are
getting treatment for their opioid addiction.
Dr. Burnett, you've worked on the front lines of the opioid
crisis. You have helped countless people overcome addiction. I
want to thank you for your work and express my admiration for
that, but tell me, in this budget space, what percentage of
your patients rely on Medicaid for their treatment?
Dr. Burnett. I would say, currently, about 80 percent of my
patients rely on Medicaid for treatment.
Senator Warren. Wow. In other words, Medicaid, as I
understand it, is not just one option for how people get
treatment, it is the backbone of the entire system for treating
opioid addiction. Is that fair?
Dr. Burnett. That's a fair comment.
Senator Warren. All right, and yet, Republicans are talking
about gutting that system to the tune of nearly $1 trillion
dollars, so, I'd like to look at just a little deeper level
about what those cuts would actually mean for our country's
battle against the opioid crisis. Two of the policies proposed
by House Republicans are capping Medicaid payments to states,
and imposing red tape like additional work requirements.
Dr. Burnett, can you just talk for a minute about how those
changes would affect access to treatment if they were put into
law?
Dr. Burnett. Absolutely. I think there was a recent Kaiser
Family Foundation study that talks about the work requirements
issue, and that actually almost 92 percent of people on
Medicaid already are either working or involved in some sort of
part-time or full-time work, so, the work requirements
situation would just really add a lot of administrative
burdens, ultimately resulting people getting kicked off of
Medicaid.
Senator Warren. I just want to make sure we say that again.
What proportion of people are now already subject to work
requirements?
Dr. Burnett. There are 92 percent.
Senator Warren. Ninety-two percent. All right, so, adding
more work requirements on top of this has what impact?
Dr. Burnett. It would certainly increase the administrative
burdens of keeping people on Medicaid.
Senator Warren. That's right, and what's the consequence of
increasing those administrative burdens?
Dr. Burnett. They would lose access to their addiction
care.
Senator Warren. That's right. People just can't get the
paperwork filled out. More people fall by the wayside. I think
that was the Arkansas experiment, as I recall.
Dr. Burnett. That's correct.
Senator Warren. Yes, but there's another part to this as
well. What about capping the funding?
Dr. Burnett. Yes. Capping the funding would create two
problems. One, it would definitely curtail the amount of choice
that patients have relative to the types of addiction treatment
that they would have, and then capping the funding would also
create a network advocacy problem because more providers would
disenroll from accepting patients on Medicaid, so, patients
would not have the ability to access treatment close to where
they live.
Senator Warren. Yes. In fact, we don't have to speculate on
what the consequences would be. In states expanding Medicaid,
treatment for opioid addiction increased over four times faster
than in states that refuse the expansion. Meanwhile, Republican
states that imposed so-called work requirements did not
actually increase employment because that was never the point.
Instead, opioid overdoses went up and access to treatment
actually went down, so, look, there is no denying the critical
role that Medicaid plays in fighting the opioid epidemic.
Cutting that program is not just cruel, it's totally backward
in what we're trying to accomplish.
Might I ask one more question, Mr. Chairman? Thank you, so,
Dr. Burnett, I want to ask about something you've done some
scholarly work on and you've published. You've written
extensively about the positive effects of investing in
treatment, and how that ultimately lowers costs down the line
so that if you cut the investments for treatment, like cutting
Medicaid. The question is, is that really going to save any
money?
Dr. Burnett. No. I think it as I said in my testimony
people who experience treatment are much faster to return to
work, be productive members of society, and ultimately not be a
burden on the social safety net, so, it would actually be more
detrimental to cut Medicaid funding in terms of the amount of
expenditure that states and public dollars would be needing to
use to be able to,
Senator Warren. This treatment gets people back to work,
fewer trips to the emergency room----
Dr. Burnett. Correct.
Senator Warren. Long-term cost----
Dr. Burnett. Totally.
Senator Warren [continuing]. is that we save money by
making these investments. One study found that for every
patient treated with medication for opioid addiction, the
government saves up to $100,000 over the course of that
person's lifetime.
Let's be clear, the budget cuts the Republicans are
proposing are not about saving money. If Republicans really
wanted to save money, they'd be expanding treatment to folks
that they claim they want to represent here, rather than
ripping it away so that we can bankroll tax cuts for
billionaires.
Families and communities across this country are counting
on us to deliver real solutions to the opioid epidemic, not
play politics, and I won't stop fighting for that. Thank you
very much. Thank you all for being here. Thank you, Mr.
Chairman.
The Chairman. Thanks, Senator Warren. Senator Moody.
Senator Moody. Thank you, Senator Scott, and I've always
been impressed, Senator Scott, and as a former Governor as
well, of the great State of Florida, you have always dug into
the details and cared about things that were harming
Floridians, and this Committee hearing is a perfect example of
that.
You saw how it was affecting seniors, and I don't know how
that isn't abundantly clear, and I love that you are the one
that highlighted this and brought it as the chairman. When we
say working and fighting age Americans are dying at a faster
rate than anyone else, the largest bulk of the number of people
we lose to overdose death, those are often our parents. They
are our parents, in this country.
I'm so grateful Ms. Mateer, that you were here and willing
to share your story and your experience. I think it certainly
informs everyone and raises awareness that those parents when
they fall victim to addiction and that affects not only the
children, but the generation before them, and I really
appreciate you being here.
Much of what we did in Florida addressed really aiding many
levels, and some of that went to helping caregivers and family
members of those addicted. I think it is a false narrative and
very shortsighted to say that we have to stop incarcerating
drug traffickers. In fact, Sheriff Lemma is a leader in our
State. I have proudly supported him to numerous boards to
oversee not only how we are tackling this problem, but how we
are expending the resources that our office recovered going
after pharmaceutical companies, distributors, pharmacies for
the opioid epidemic itself. He now helps oversee responsible
spending.
We broke it down into, No. 1, you have to put the peddlers
of this poison, the traffickers of opioid, synthetic opioids
like fentanyl behind bars, because they will do violence to our
communities by selling them lethal doses of opioids or
synthetic opioids, and to call that nonviolent, I think, is
shortsighted, and I think if we do not take them out of the
communities, they will continue to create daughter after son,
after mother after father falling prey to this, and that is
step one.
I'm so proud of law enforcement efforts in Florida. We led
the Nation at one point in fentanyl seizures. We are focused on
that. We have dedicated resources to that funding, pushing into
law enforcement, making sure that they were focused on that and
had the resources to go after those traffickers.
You can say, honestly, we cannot arrest our way out of this
crisis. That is true, but we cannot stop going after the people
who pedal poison indiscriminately that our children, and our
mothers, and fathers are taking. That has to be our first step,
and going after the cartels and everyone that's helping them
spread this is No. 1.
After that, we broke it down into how do we; one, make sure
that Narcan is available to family members, caregivers? Readily
available, and we pushed it to our first responders. Because of
that, we are leading the national rate in decreasing the number
of deaths that we are seeing every year, and I'm so proud of
that statistic. We're going to keep doing better.
Past that, we want to make sure that people can receive
treatment, good treatment, treatment that's proven successful
with few rebounds, and that's done so with science-based
methods. I agree that that is the case. The problem is, I think
a lot of money is getting shoved because this is such a problem
and we're trying to fix it, and, tragically, we often try to
fix things by just shoving money at the problem and not doing a
very efficient and intelligent way of distributing that or
accounting for that.
What would you say, Sheriff Lemma, is the independent body
that rates these substance abuse providers?
Mr. Lemma. Well, first, Senator, I want to thank you for
your leadership. It was your work that inspired many of us to
go down the path, in the first place, and I think it's so
incredibly important.
I also think that for the first time in recent history, the
stars have aligned and funds have been made available because
of work of attorney generals in various states, and Big Pharma
settlement money, and, federally, candidly, I think that if you
cannot explain what you did last week, you probably don't have
that important of a job.
I think when we talk about healthcare, it is incredibly
important, and these programs are incredibly important. We said
medical-based treatment therapy is the gold standard for
treatment, greater access to naloxone, but when it comes to the
drug enforcement, connecting the dots, making all of these
things work together, I think that there has to be a sensible
strategy because many of the cartel members that are in here,
they're selling drugs. Some of them are not even legal citizens
anyway. It creates an incredibly challenging dilemma.
We have boards, we have committees in the State of Florida.
We have an opioid abatement settlement team that you led when
you were attorney general, and it has these checks and balances
for 20 qualified counties out of the 67 in the State of Florida
that have populations of over 300,000 people, and a
comprehensive strategy to make sure that all of the checks and
balances are in place, followed by organizations like the
Department of Children and Families in the various states that
work through the managing entities that are, again, adhering to
the gold standard, to making sure that there's checks and
balances, and people who are, who are responsible for the money
at a local level, are held accountable to make sure that
they're doing the right thing.
We don't want patrol cars, and fire trucks, and water
treatment plants, because as Big Pharma who created this by
saying proper use of OxyContin, the patient was less than one
percent likely to become addicted, and the world said, no, no,
no, that's simply not true. Well, the money should go to enrich
programs that help those individuals and those families.
Senator Moody. Thank you, Chairman Scott, I appreciate it.
Dr. Stein, I'll direct my attention to you. One of the things,
as Attorney General, and I dug into this, it was heartbreaking
to see so many people in Florida and across our Nation dying.
I was very hands-on on this, and I was shocked to know that
there wasn't a directory of sorts that people could go to in
the moment when they were ready to get help that had reputable,
proven, quality-assured treatment with beds available right
then. I ultimately ended up speaking with--and, thankfully,
Florida was supportive, and we contracted with a group called
Shatterproof Treatment, atlas.org.
I think I was one of the first states, certainly Republican
states, that was pushing something like Treatment Atlas.
Because as you know, as a mother, as a parent, a family member,
when somebody's ready for treatment, you want it then, right
now, when the bed is available, but you don't want to put it
somewhere where they're just going to take your money and turn
them out.
This is what I want to get to; is there an independent body
that is ranking the success of these treatment services that
are grasping all the grants and the funding from federal, or
state government, or even recovery settlements?
Dr. Stein. Senator, thank you for the question. I think
it's an incredibly important issue. This is a topic that has
come up over a long period of time in terms of helping people
find the places they can offer them the best treatment, right?
As you point out, when someone needs treatment, you need to
connect them. Now you have a window of opportunity.
Unfortunately, I am not aware of any organization that does
this routinely and standardly in the type of way that I think
many families look for. I think you're supportive of
Shatterproof in naming them. There's certainly an organization
that has done tremendous work in this area, and I think has
been a leader in many people look to and support the work
they've done, and that certainly is helpful.
I want to pick up on your comment and sort of point out two
things, though. I think one is sort of identifying places that
are providing good evidence-based care, medication treatment
for opioid use disorder, cognitive behavioral treatment.
Senator Moody. I don't want you to get it off-track.
Dr. Stein. Yes.
Senator Moody. To your knowledge, is there an independent
organization that rates the quality of these drug treatment
facilities?
Dr. Stein. To my knowledge, the organization that comes
closest right now is Shatterproof, but I am not aware of
anything beyond that.
Senator Moody. There's probably very limited attention or
resources being given to something like that before we're
handing out billions, and billions, and billions of dollars.
Dr. Stein. I certainly think that that is one area that
absolutely does need attention. Yes, Senator
Senator Moody. Would necessarily be a helpful filter. Thank
you. Thank you, Chairman Scott.
The Chairman. Thank you, Senator Moody. Thanks for what you
did as attorney general. Senator Kelly.
Senator Kelly. Thank you, Mr. Chairman. Dr. Stein, and
everyone who is appearing here today, thank you. Thank you for
being here. It's a very important topic.
Dr. Stein, we know, well, based on the conversation with
Senator Moody, seniors are rather vulnerable, a vulnerable
population when it comes to opioid use disorder. The number of
adults who need treatment for this have tripled between 2020, I
think is what the statistics on this say, and a study from the
Moran Company recently found that opioid use disorder costs
$4.3 billion each year for newly diagnosed Medicare
beneficiaries.
If you think about not just newly diagnosed beneficiaries,
but if you think about all Medicare beneficiaries, and you
extrapolate that $4.3 billion each year to the size of the
Medicare population, it looks like the treatment for this could
be in the tens of billions of dollars.
Dr. Stein, I believe, you know, I think we can stop
addiction before it starts for many of these individuals that
wind up in treatment, and I have a bill that would improve
access to non-opioid pain medication for seniors who are on
Medicare. Now, my bill would make sure that seniors aren't
paying more for a non-opioid pain reliever than they would pay
for an opioid.
Dr. Stein, do you think addressing that financial barrier
is important to ensuring folks have alternatives and aren't put
on the pathway to addiction?
Dr. Stein. Senator, thank you very much for the question. I
think multiple steps such as making sure that there are not
financial barriers to allow adults who could benefit from non-
opioid management of their pain and decrease use of opioids
would help to decrease the risk for opioid use disorder in that
population. I absolutely believe the financial benefit is one
barrier that's important to address.
I also believe that we need to have a sufficient workforce
providing these treatments that are available. We need to, to
make sure that Medicare,
Senator Kelly. What would that workforce look like? Because
isn't it just a decision for a doctor to say, "Hey, I've got
these two options. I've got this non-opioid pain reliever. It
costs X out of your pocket. I got the opioid. I'd prefer you
take the non-opioid. I understand you got financial issues, you
might be on a fixed income as a senior. This is a choice we're
going to have to make here." But what is the workforce beyond
that?
Dr. Stein. Absolutely, I think non-opioid medications is
one option, but there are also non-medication options that can
very much help people: therapeutic massage and acupuncture.
Does it work for everyone? No, but it certainly works for a lot
of people, and has been shown to reduce the amount of opioids
they need.
We need to make sure that we have sufficient individuals,
so, that's an option for the doctor you're talking about that
it's not just opioid or non-opioid, but I've got three options.
What works best for you and your family? Making sure that
Medicare reimburses those services.
For example, right now, non-pain management for
chiropractors is limited to back pain, but there are other
things within their scope of practice that might be useful: an
acupuncturist, so, I think the financial barrier is one. It's
critically important, but there are others to make sure that
our older adults get the care they need for the pain to reduce
the risk of opioid use.
Senator Kelly. The financial barrier extends beyond just
the cost of the medication, I think is, you know, one of what
you're referring to. Do you have a sense for how many folks
wind up on opioids because they can't afford a non-opioid pain
medication?
Dr. Stein. I do not.
Senator Kelly. Does anybody know of any studies that's been
done. I'm trying to get this sense for my legislation, and if
we were to implement this, how big of an impact it would have.
Do you think reducing the price of the non-opioid pain reliever
would result in less people addicted to opioids?
Dr. Stein. I think options that allow the elderly non-
opioid medication treatment to better control their pain are
all things the less elderly exposed to opioids and potentially
more opioids than they need, the more likely we're going to be
reducing.
Senator Kelly. Dr. Burnett, it seemed like you wanted to
comment?
Dr. Burnett. Yes. I would just say that when we're talking
about chronic pain management, a multimodal approach that Dr.
Stein is talking about is critical, and this is something that
I see regularly in my clinic, and Dr. Stein highlights this
point in that you're actually only limited to pharmaceutical
options a lot of the time relative to your pain management.
Coverage for the physical and occupational therapy, being
able to get into people's homes to be able to improve their
living environments, and having people go in and make those
evaluations and those changes in addition to aqua therapy,
acupuncture, all these alternative and complimentary strategies
would be instrumental to improving the overall quality of life
for people with pain and making their pain much more manageable
so that we don't have to turn to the pharmaceutical options and
avoid people getting addicted.
Senator Kelly. All right. Thank you. Thank you, Mr.
Chairman.
The Chairman. Thank you, Senator Kelly, so, you know, I ran
a large hospital company for a long time, and then I was
Governor of Florida, and then one of the frustrating things
about any issue, this is an example, but I think all of us have
stories that we believe that some sort of treatment, some sort
of something is going to save money down the road, and if you
believe that, man, you jump at it, right? Nobody comes with
comes with an analysis and nobody ever wants to take the risk.
I had at times I had hundreds of thousands of employees in
some of my companies and people come and say, oh, if you'll do
this test, it'll cost you X dollars. You'll save multiples of
that in healthcare. I mean, who wouldn't do that? I said, "I'll
tell you what, I'll do it. I'm going to double what I'll pay
you, but you take the risk that I'm going to save the money."
"No, wait a minute. We're not in that business. We're not going
to take the risk."
That's the issue you have on all these programs. Nobody
wants to go through what Ms. Mateer's going through. Everybody
wants to do what all of you have talked, you know, almost
everybody's talked about is some program. Nobody, nobody,
nobody comes with data. Nobody comes with data, and nobody's
willing to take the risk, I mean, on any program whether it's a
Medicare program, Medicaid program, and so, it makes it so
difficult to say, "Oh man, I am all in for doing that because
there's no data, there's nothing." Nobody was willing to take
the financial risk.
Like, I've never been in the insurance business, but you
would think, right, if you were in the insurance business, and
somebody came to you and you could really prove that they could
save money by providing this service, or this drug, or this
blah, blah, whatever it is, they would jump at it, but for
whatever reason it doesn't happen.
I always ask, you know, the biggest thing I always ask
everybody is, are you willing to take the risk? I mean, it's a
great story. Are you willing to take the risk that it's going
to save money? If you are, then, man, you people should jump at
that, but nobody does.
Sheriff Lemma, can you just talk about your community for a
second? You're not in a big downtown area, you're more of a
suburban and a little bit rural area. How is an area like that
that most people think of this country? Oh, you don't have
drugs in that area. I mean, this is sort of the heartland of
America and it never happens, so, how does it happen in an area
like yours?
Mr. Lemma. Yes. Thanks so much, Chairman. You know,
Seminole County is, again, the fourth most densely populated
per square mile, but we're a small county. We have a population
of about 500,000 people, and a little more than 300 square
miles. Very affluent county has the highest level of education
per capita that does not host home to a major university, and
great quality of life. One of the top school systems in the
entire state.
When we look at the significance of the reduction, we're
proud about that. I talked about a 29 percent reduction in
overdoses or poisonings, and a 42 percent reduction in
fatalities, but when you look at the volume of numbers even of
a community like that, the overdoses last year representing the
29 percent decrease is 427, and the fatalities are 66.
If we had a community meeting just there in Seminole
County, and laid 66 body bags and the tragic effects that they
have on the entire family, it would be devastating, and it
would be a topic of conversation that everybody would like lean
in and talk about tremendously, and, again, this is one of the
most successful counties in the State of Florida based on
recent data.
Palm Beach County is another county that had a remarkable
reduction. Forty percent or more reduction in fatalities. I
think this is a testament to the strategy that absolutely
works, and in addition to that, and I hadn't mentioned it yet,
but in Seminole County alone, we've charged 39 drug dealers
with first degree murder for dealing deadly doses of narcotics,
and at the same time, we worked with the Florida legislature to
change the burden of proximate cause of death to substantial
factor.
Another key success point there is in areas across the
country, the most important thing is to protect and preserve
human life. Greater access to opioid antagonists and reversing
the effects of the overdose, or bringing people back to life
literally with medicine on gun belts, and in back of patrol
cars, and in private citizens' pockets, but we created a new
law in the State of Florida that allows us to charge every drug
dealer with second degree felony culpable negligence if we can
prove that they dealt a deadly dose of drugs and we've revived
them with the use of naloxone.
This is creating momentum. It's something that people are
talking about, not only in the State of Florida and in our
community, but across the country, and we would be happy to
share it, and I think that it really saves lives.
The Chairman. Thank you. Ranking Member Gillibrand.
Senator Gillibrand. Thank you, Mr. Chairman. Thank you to
each of you for your testimony. I was very moved by everyone's
perspective and the work that you're doing on the ground every
day to save lives, and what's happened to your practice, and
what's happened to your community, it really does matter.
Ms. Mateer, thank you so much for sharing your story about
your grandson. He sounds like he's a wonderful boy, and you
gave some very persuasive recommendations at the end of your
testimony. I thought they were excellent. Can you give us a
little more guidance on what types of services or supports
would make a difference?
I have a piece of legislation called Supporting Families
Through Addiction Act, which would provide $25 million to
community programs so they can provide families with the
resources they need to support loved ones battling addiction,
so, that grant money is pretty flexible, but I'd love to hear
directly from you at different stages in your life raising your
grandson, what types of supports could have made a difference
for you and your family?
Ms. Mateer. Thank you for the opportunity to speak and for
your reinforcement. It means so much. I think from my
standpoint, when I first was showing up at the pediatrician's
office with an infant child, and I wasn't the parent right then
and there, it would've been so helpful for that community to
provide me with at least some basic information where to go for
things, what to do, a pamphlet on what kind of crib to buy,
what kind of car seat to buy. Because a generation later, all
of these things change; how to feed a baby, everything's
different.
I think wherever we touch, it would be good to have some
sort of supportive measure in place that at least would provide
information and maybe a list of where to go for resources, what
community groups are there, where you could get baby clothing,
things like that. I think those things would really be helpful.
Senator Gillibrand. Maybe services through pediatrician's
offices, at a minimum?
Ms. Mateer. Yes. It just seems to me that they don't see
the issue, they don't recognize it. I know there are so many of
us out there, but it's just not on the radar. It's just quiet.
Senator Gillibrand. Very helpful. Thank you.
Ms. Mateer. Thank You.
Senator Gillibrand. Dr. Burnett, thank you for testifying
about what you're doing to help older adults access these
critical addiction services in your community. In your
testimony, you discuss the challenge of accessing evidence-
based addiction treatments for those who need it. You also
discuss the impact on older adults who are struggling with
their addiction.
Can you expand on some of the challenges that older adults
face with regard to substance use disorder treatment, and are
there policy changes that you would, that you would recommend
that could address some of those barriers?
Dr. Burnett. Yes, sure. You know, I think Dr. Stein also
highlighted this very eloquently in so far as older adults have
a multitude of chronic disease issues that you have to manage
in addition to their substance use disorder care. They've got
issues related to transportation, polypharmacy. Being able to
connect your substance use disorder care to their general
medical care in and of itself is a challenge, and so, it
requires a team-based effort between the nurses on the team,
the peers on the team, and collaboration with other physicians
that might be taking care of this patient population.
There's definitely lots of different strategies and policy
solutions that we can come up with largely focusing on
Medicare. We could certainly expand the Mental Health Parity
and Addiction Equity Act to Medicare so that reimbursement for
these services could be paid at an equal rate within the
Medicare population, because currently, that's excluded. We
could authorize Medicare coverage of non-hospital-based
residential treatment. Currently it is difficult for
individuals to be able to participate in community-based IOP
and PHP programs because they don't have--Medicare doesn't
cover that. The Medicare SUD bundled payments provisions could
be in increased.
There's lots of different ways that we could ensure that
more providers are able to take Medicare and take care of those
patients with substance use disorder.
Senator Gillibrand. Thank you. Dr. Stein, you also
discussed some of the challenges with treating an older
population with substance use disorder, and you mentioned one
of the challenges is being the acute shortage of the workforce
and the lack of preparedness among the workforce to treat older
adults with co-occurring substance use disorder and dementia.
Can you elaborate on this issue and what we can do to help?
Dr. Stein. Sure. Senator, thank you very much for the
question. It's a challenge, right? Because as we've heard many
of the individuals providing treatment under the addiction
specialists, and they don't necessarily have this expertise.
I think one solution that has come up, as I've talked to
colleagues, is either to enhance training in geriatrics for
those individuals, or find ways to support those systems in
bringing in physicians' assistants or people who may have more
basic medical training in geriatrics to partner within the care
system so they don't have to move back and forth.
I think the other one that we really need to focus on,
though, is primary care, because that honestly is where the
majority of elderly are going to continue to get care, and
despite so many of our efforts, many of them still don't
provide medication treatment for opioid use disorder with
buprenorphine that we know to be effective.
One of our recent studies actually showed that there are
probably only about 1,200 clinicians in the country that treat
over a third of the older adults receiving buprenorphine. It's
highly concentrated, and so, I think one of the things we
really need to think about is in that group of primary care
clinicians treating the elderly, so much of our focus has been
trying to get a new clinician to prescribe buprenorphine.
Maybe we need to start focusing on the types of supports,
whether it be additional supports within the office, better
connections with non-physician substance abuse treatment
services to make those clinicians more likely not to just
prescribe one buprenorphine, but one patient, one elderly
patient with buprenorphine, but more of those physicians and
physician's assistants, nurse practitioners to treat more
elderly with buprenorphine. Let's try to build a greater a
workforce of somewhat higher volume prescribers toward the
elderly that can merge this expertise.
Senator Gillibrand. Got it. Thank you so much. Thank you,
Mr. Chairman.
The Chairman. Thank you. Commissioner Duckworth, what's
some examples of success that you think we ought to try to do
at the federal level?
Mr. Duckworth. Thank you very much for the question. Some
of the issues in West Virginia, and to the sheriff's point, his
county of 500,000 would represent about one-third of our whole
state, so, we're very rural and very family oriented.
Going back to the seniors and what I came prepared with
today was the grandparents raising their grandchildren, so,
helping those folks and getting programs in place that helps
the seniors. That, I think, is key. I think we're missing a
whole generation of people. We're missing workforce. Like I
said earlier, the whole generation of the family tree is
missing.
You know, to Senator's point of non-opioid medications.
Like, 50 and every 1,000 of the babies born in West Virginia
are addicted to Suboxone. You know, curbing those things,
getting into to some of the non-opioid treatments, I think
would be a huge success for what West Virginia needs anyway,
and where my space is.
The Chairman. Yes, I think we have over 50 million
Americans, working age, I think like 16 or 15, something like
that, to 64 that don't have a job. That didn't help, so, Dr.
Stein, your research at RAND has highlighted unintended
consequences of past opioid policies. We know that increased
access to naloxone, for example, works. What are some of the
lessons learned from past missteps that we should keep in mind
in designing future policy.
Dr. Stein. I think the awareness that there are sometimes
unintended consequences for well-meaning policies is critically
important, and so, one area that we've certainly seen this and
learned about it goes back to actually 2010 and the
reformulation of OxyContin, which was approved by the FDA and
it was well intended. It took OxyContin, at that point, was
subject to being abused and misused and reformulated it to make
much more that much more difficult, and about three years
later, that old formulation was taken off.
What we've learned in terms of unintended consequences
there, though, is subsequently that reformulation led to higher
rates of heroin use, higher rates of over overdoses from
opioids, and the consequences still stay with us. The
communities that were subject to more subject to the effects of
that reformulation continue to have higher rates of fentanyl
overdoses, cocaine problems, and recent research from a
colleague actually shows higher rates of child suicide.
I think as we're putting in place these policies, one of
the things that becomes critical that we've learned from that
is to continue to monitor and evaluate. It's not one and done.
We can't do these things and turn away. We have to continue to
learn because the crisis is going to continue to evolve, and
our ability to understand how to respond to the changing
landscape requires us to continue to pay attention.
The Chairman. Thanks. Sheriff, are there any different law
enforcement issues dealing with seniors? Is there anything that
makes it more challenging?
Mr. Lemma. Yes, Chairman. I think when we look at the baby
boomers particularly--you know, their name, baby boomers, for a
reason, and we saw a significant population growth in that
time, and we find many of that generation are evolving into
really some dependency.
What I think the unintended consequences of Covid was, a
senior population was thrusted into having a greater online
presence that they weren't necessarily prepared for. A clue is
if you're still paying $25 for an AOL account, you're probably
victim, prime target for a victim of some online scamming.
We're seeing an increase in white collar crimes and
victimization of seniors.
When it comes to substance use and all of that, I think
that we've always tried to balance the need for really reliable
services and opioids have its place in certain environments and
making sure that people who need the medicine are not getting
it--not living in pain as a result of it.
I think that back when you were Governor, we saw that occur
in the State of Florida with prescribing three and seven days
and for acute pain. Then, prolonged issues, whether it's cancer
or other type of items, seniors are able to get access to that.
Again, the greatest increase that we're seeing is victimization
because many of our senior population were thrusted into this
online presence, and because of that, they become more
vulnerable.
The Chairman. Well, I just want to thank each of you for
being here. Thank you for caring so much about this issue. It's
impacted--I don't know, actually, of a family that's not been
impacted either by alcohol abuse or drug abuse. I mean,
everybody has. I lost my brother last spring. He started out,
used some marijuana, eventually used all the drugs, and he
impacted his life, and so, it screwed up. It doesn't just
impact him, impacts my whole family. Just I feel sorry for
everybody that does that, goes through this.
Thank each of you for being here, and I want to thank the
ranking member for her hard work.
Senator Gillibrand. Thank you.
The Chairman. Thanks.
[Whereupon, at 5:20 p.m., the hearing was adjourned.]
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APPENDIX
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Prepared Witness Statements
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U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Prepared Witness Statements
Honorable Dennis Lemma
Good afternoon, Chairman Scott, Ranking Member Gillibrand,
and distinguished members of the Special Committee. Thank you
for the opportunity to testify on the devastating crisis of
overdoses and fentanyl poisonings. It is an honor to present a
proven strategy from Florida-one that can be replicated in
communities nationwide.
Chairman Scott, your leadership, starting with your time as
Florida's Governor when you and Attorney General Bondi took
action to shut down pill mills, served as a model for the
country. Senator Gillibrand, your efforts through legislation
like the FEND Off Fentanyl Act have been crucial in this fight.
I would also like to recognize Senator Moody, who, as Florida's
Attorney General, provided invaluable leadership in the fight
against this epidemic. Your vision and dedication inspired my
own focus on this issue, which requires both law enforcement
and clinical understanding.
I serve as the elected Sheriff of Seminole County, Florida,
located in the Orlando Metropolitan area. Seminole County is
the fourth most densely populated county in Florida, and
despite its affluence, we are not immune to the devastating
effects of this crisis. Simply stated, this epidemic does not
discriminate-it affects citizens from all backgrounds and
demands comprehensive solutions.
In my nearly 33 years of law enforcement, I've come to
believe that the greatest responsibility of a civilized society
is to protect and preserve human life. Overdose deaths have
tragically become the leading cause of death for individuals
aged 18 to 45. In 2022, the average life expectancy in the
United States decreased, partially due to the rise in
overdoses.
To effectively combat this crisis, we need a holistic
approach that includes prevention, treatment, advocacy for
life-saving interventions, and a strong emphasis on a law
enforcement strategy that aggressively goes after drug dealers
who are dealing deadly doses of narcotics in our
communities.Prevention remains an incredibly powerful tool.
Through focused education and awareness, we can equip
individuals with the knowledge to avoid addiction before it
starts. Prevention also requires ensuring the highest levels of
access to opioid antagonists, like Narcan, a life-saving
medication that can immediately reverse opioid overdoses. In
Florida, we've made great strides in expanding access to these
antagonists, and they have saved countless lives.
Treatment is equally important in breaking the cycle of
addiction. Medication-assisted therapy, combined with cognitive
behavioral therapy, has proven effective in helping individuals
recover from substance use disorder in both clinical and
correctional settings.
Data collection also plays a critical role in combating
this epidemic. We need to gather and analyze overdose data at
all levels. By understanding overdose trends, we can better
allocate resources and target enforcement efforts.
However, accountability for drug dealers is absolutely
crucial if we are going to put an end to this epidemic. We must
make sure that those who distribute fentanyl and other illicit
substances, like the emerging trend of street-level Xylazine,
are held fully responsible for their actions, whether there is
an associated death or not. Too often, overdoses are treated as
accidents when, in reality, they are crimes. In Florida, we've
passed legislation with harsher penalties for drug dealers
whose actions result in fatal overdoses, while at the same
time, we have created laws that criminally charge dealers if an
individual overdoses and is brought back to life with an opioid
antagonist. Drug dealers cannot be let off easily, and the law
must hold these individuals accountable to the fullest extent.
Additionally, we cannot ignore the illicit drug trade,
particularly from cartels like the Sinaloa and Jalisco New
Generation, which still pose a threat to our country. Securing
the border and preventing fentanyl from entering our country is
critical to minimizing its availability and reducing deaths.
This crisis must unite us all, regardless of partisan
lines, because it impacts every community across the country.
In conclusion, we must adopt a holistic strategy that
integrates prevention, treatment, improved data collection, and
the strictest accountability for drug dealers. This strategy
works, builds safer communities, and ultimately saves lives.
Utilizing this strategy in Seminole County, we've achieved a
29% reduction in overdoses and a 42% reduction in fatalities in
2024. While we have seen a reduction, we know the hard work
still lies ahead.
Thank you for having me here today. I look forward to
addressing any questions you may have.
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Prepared Witness Statements
Honorable Gregory Duckworth
"HOPE"
Introduction
My name is Greg Duckworth. I am a County Commissioner in
Southern West Virginia, a board member of the West Virginia
First Foundation (WVFF), and a 26-year retired veteran of the
West Virginia State Police.
I spent my law enforcement career in the heart of the
opioid epidemic, an area once known as "The Coal Fields."
Today, I want to share some firsthand experiences on how this
crisis has devastated families, affected our aging population,
and where we must focus our efforts moving forward.
State Trooper Experience 1: 2012
In 2012, 17-year-old Cheyenne Martin reported to police
that her father and two younger siblings were missing. She had
already lost her mother, Kerri Hendrix, who-under the influence
of OxyContin-wandered into a highway and was fatally struck by
a truck.
During the investigation, police found that her father,
Hendrix, was lured into a trap by a drug dealer named Belknap,
who owed him money. Hendrix, his girlfriend, and his two
youngest children were ambushed and murdered. Their bodies were
discarded as if they were worthless.
A decade later, Cheyenne herself died of an opioid
overdose, leaving behind three small children. Entire families
are being erased by addiction.
This is not just a crisis of individuals-it's a crisis of
generations. Children lose parents. Grandparents are forced
back into parenting. Communities crumble.
State Trooper Experience 2: 2023
The second story involves a single mother in her early 30s
with four children: a nine-year-old, a seven-year-old, and
three-year-old twins.
For years, she lived with her mother, who helped care for
the children. Recently, she had moved into her own place-a
single-wide trailer within walking distance of her mother's
home.
At night, after dinner, she would take the three-year-old
twins home while leaving the older children with their
grandmother, who ensured they got to school each morning. The
twins were described as full of life, radiating joy, as most
three-year-olds do.
One night, the mother put the twins to bed. By the time she
checked on them again, they were deceased. Autopsies revealed
multiple drugs in their systems, including lethal amounts of
fentanyl. The neglect was so severe that rigor mortis had
already set in before she realized what had happened.
The children's grandmother had already lost her husband to
cancer. She fought for custody of her remaining grandchildren
but was unsuccessful. She is, however, allowed to see them with
the help of Child Protective Services.
The mother is currently in jail, awaiting trial for two
counts of child neglect resulting in death.
The Burden on Our Seniors
In West Virginia, one in seven children loses a parent to
overdose or incarceration by age 18. With the highest rate of
neonatal abstinence syndrome (NAS), many of these children have
medical and developmental challenges.
Grandparents-who thought they were retiring-are now primary
caregivers. They face:
Physical Strain - Raising young children at an advanced
age.
Financial Hardship - Many live on fixed incomes and
struggle to meet basic needs.
Emotional Toll - Raising children while grieving the loss
of their own.
Many do this off the record to avoid the foster care
system, meaning they receive no financial or legal support.
West Virginia First Foundation: Supporting Grandfamilies
and the Aging PopulationI'm proud to serve as a board member
for the West Virginia First Foundation (WVFF) and to be part of
an organization that is making a real difference in our
communities.
WVFF is committed to addressing the full impact of the
opioid epidemic, including the burdens placed on West
Virginia's aging population. Recognizing that addiction does
not just affect the individual but entire families, WVFF is
dedicated to supporting grandfamilies-grandparents raising
grandchildren-by providing the resources and assistance to
child advocacy and youth prevention programs.
We recognize that this crisis does not end with one
generation-it continues to ripple outward. By investing in
solutions that support the full family system, WVFF is helping
to break the cycle of addiction, ensuring that grandparents
raising grandchildren are not left to struggle alone.
The Fight Against Addiction: Where We Must Focus
Having served on the front lines of this epidemic, I
believe that our response must be comprehensive. This includes:
Treatment Access - Making detox and rehab services more
available.
Prevention & Education - Stopping addiction before it
starts.
Recovery Support - Ensuring people have pathways to long-
term sobriety.
Grandfamilies & Child Advocacy - Protecting children and
supporting caregivers.
Economic Recovery - People in recovery need jobs,
stability, and hope.
We must also fix systemic failures, such as:
Underreported overdose deaths.
Inconsistent Narcan use documentation.
Recovery homes misclassifying overdoses.
Closing Statement: Restoring Hope
I believe that hope can be restored.
Substance use disorder is our enemy. It is destroying the
very core of the American way-God, family, and self.
To win this war, we must:
Ensure the love and support of the church.
Reunite families and emphasize the importance of family
values.
Bring back support systems that give people a sense of
self-worth.
This crisis is more than just statistics. These are real
people with names, faces, and stories. If there is one thing I
want you to take away from today, it is this: behind every
number, there is a human being.
We must act. We must restore hope.
Thank you.
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Prepared Witness Statements
Elizabeth Mateer
Chairman Scott, Ranking Member Gillibrand, and members of
the Senate Aging Committee, thank you for holding this
important hearing, and for inviting me to share my perspective.
My name is Elizabeth Mateer. I am a grandmother raising my
grandson due to the impact of opioids on our family. I also
volunteer as a Generations United GRAND Voice caregiver
advocate.
When my grandson was born, I had no idea that my life as I
knew it would soon be forever changed. I did not know that the
baby was suffering from Neonatal Abstinence Syndrome (NAS). I
also had no knowledge about Opioid Use Disorder and this made
it difficult to identify and understand the harsh reality that
both parents were addicted to painkillers.
A few months later my husband and I intervened. We arranged
for the mom to be admitted to a treatment facility and suddenly
we had a baby! Although we were very relieved and hopeful for
the future, we had no crib, no diapers, no baby clothing, no
formula and no idea where to start.
Ten days later I received a phone call that the mom was
leaving treatment. What were we to do? How could we hand our
infant grandson back to parents who were using? Fear drove us
to contact an attorney who obtained emergency custody and we
were relieved to have the baby safe in our care. However, a few
weeks later the parents cheated a drug test and we were ordered
to return the baby. Why do judges appear to misunderstand
opioid addiction and the risk in placing children with parents
who are struggling with it?
For years we lived an endless cycle of staging
interventions and arranging for admissions to treatment. Early
on, one interventionist told me to be prepared to keep my
grandchild long term because this would go on for a long time.
Each relapse was a crushing blow and each time the recommended
length of inpatient treatment increased.
The cost for all these treatment facilities was staggering.
We paid $30,000.00 deposits for admission and $10,000.00/month.
I constantly battled with the insurance company. If you have
ever known a person to be caught up in opioid addiction, it is
like none other. It takes a person's soul and turns them into
someone you don't even recognize. We were desperate to save
both mom and baby. The stress of living this opioid-created
crisis landed me in the hospital with pneumonia in both lungs.
Usually, when your loved one heads to treatment you are
relieved that they are safe, and you have a break from the
crisis mode. Unfortunately, we did not have that break and were
instead slapped with a custody case from our grandson's father
and had to obtain legal counsel. Our legal fees mounted over
more than two years of custody proceedings and exceeded
$85,000.00. The court permitted "supervised" visits that were
not actually being supervised. We were treated like bad people
who had stolen a baby. Every time we went to court, we worried.
We requested that the court stop the father's visitation
privileges when we learned that the father was charged with
child endangerment when another child of his was under his
supervision. Six months later, he died of a heroin overdose.
When I told my then four-and-a half-year-old grandson that his
father died the First question he asked was "Will I still be
able to live with you?".
I found that working and caring for a child was harder than
when I raised my own children. I tried to stay in the workforce
but managing the daycare requirements of drop off, packing
lunches, pickup on time and all the preparation that goes along
with it while getting to the office on time was overwhelming. I
resigned from my position.
My relationships slowly disappeared. There were no more co-
workers. Friends stopped inviting me to social events since I
did not have childcare, and social outings at my age are not
typically conducive to bringing children along. I felt isolated
at home while my husband traveled for work. The stigma of
addiction, that the child I raised could not raise their child,
made me feel ashamed. No one knocked on my door with a lasagna
in hand to comfort our family in crisis. The clergy where I was
ordained an elder and served twenty-four years never called.
Depression set in and I wondered, how could I go on?
By the grace of God our grandson's mother has been clean
for a long time. Our relationship is challenging because her
son, now age 13, wishes to remain in our home. During the years
of battling her addiction he just grew up. This is his
community, his home where his pets live, where his school is,
where his friends are. If this is where he wants to be we will
support his choice.
Though the years were difficult in many ways, there is
great joy knowing that our grandchild is thriving and happy. We
are now both retired, my husband delayed retirement so we could
provide for our grandson. Our retirement is nothing like we
thought it would be, driving the middle school carpool and
hosting the baseball team picnic. We hope to stay healthy so
that we can be there for our grandson.
The staggering number of grandparents who care for their
grandchildren, often without any support from the child welfare
system, appears to be one of the least recognized populations
impacted by the opioid crisis. According to Generations United,
grandparents and other relatives who step forward to keep
children out of foster care and safely with family, save
taxpayers more than $4 billion each year. The child welfare
system would collapse if grandparents did not take in all these
children. Any grandparent raising a grandchild could use
financial help.
I urge you to consider the following recommendations:
Encourage states to support grandfamilies with opioid
settlement funds. Why is there hardly any consideration to
distribute opioid settlement money to help the children and
caregivers in grandfamilies that have formed out of the opioid
crisis? Anything would help. Seniors on fixed incomes struggle
to pay for school supplies, activities, clothing, camps, and
orthodontic treatment among many other things for a child they
did not plan to raise.
Peer Support for grandparents raising grandchildren. Peer
support from Generation United's GRAND Voices Network has been
an important way for me to engage with others in my situation
and share ideas. It has eliminated my feelings of isolation.
There is a great need for grandparents to connect and support
one another.
Increase availability of knowledgeable mental health
providers who work with the whole family. There are few mental
health providers who are qualified to provide care to
grandfamilies. How can the number of these providers be
expanded? The dynamics in the family are difficult to navigate
when the parent loses custody. I was once told that opioid
addiction in a family is like pouring acid on it. None of the
treatment facilities provided any support to our family, the
only focus was on the inpatient and yet our whole family was
suffering.
Ensure access to health care and social security for
grandfamilies. When we enrolled in Medicare, our grandson lost
his health insurance. The Affordable Care Act ensures coverage
of children up to age 26, but we had to purchase private health
insurance for our grandchild in addition to paying for Medicare
and a supplemental policy for us. Why are grandchildren not
included in the Affordable Care Act? Allow grandchildren who
are in the legal guardianship of their grandparent to qualify
for survivor benefits if their grandparent dies. Social
Security requires a grandchild to be legally adopted if they
are to receive any benefit should the grandparent die. Legal
fees for adoption can be $30,000.00 on top of initial custody
proceedings.
Protect SNAP. SNAP can be a lifesaver when a grandparent
suddenly takes in a child. I urge you to protect this critical
program from cuts.
Continue federal support for kinship navigator programs.
When grandparents step in suddenly to raise children they often
do not know where to turn for help. Kinship Navigator Programs
offer important information, referral and support to help
families connect to community-based services and supports.
Children in the care of grandparents are loved and thrive.
I cannot imagine what my grandson's life would have been in
foster care with strangers. Grandparents feel a connection and
commitment to protecting the children in their care, but we
need help. Any grandparent raising a grandchild could use
support regardless of their station in life. Please, do what
you can to help us.
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Prepared Witness Statements
Dr. Malik Burnett
Chairman Scott, Ranking Member Gillibrand, and esteemed
Members of the Special Committee on Aging, thank you for
inviting me to participate in today's critically important
hearing.
My name is Dr. Malik Burnett. I am a board-certified
addiction specialist physician who takes care of patients with
addiction and co-occurring conditions in Baltimore, Maryland. I
serve as the medical director of several community opioid
treatment programs, an Adjunct Assistant Professor at the
University of Maryland, and a consultant for the Maryland
Addiction Consultation Service.
Today, I am testifying in my capacity as Vice Chair of the
Public Policy Committee of the American Society of Addiction
Medicine, known as ASAM. ASAM is a national medical society
representing over 8,000 physicians and other clinicians who
specialize in the prevention and treatment of addiction.
I want to begin by talking about Baltimore and its
forgotten generation - older adults born between 1951 and 1970,
particularly older Black men.1 In my city, almost one in three
drug overdose deaths come from this demographic.1 Indeed,
illicitly manufactured synthetic opioids are among the
deadliest health threats they face. Many of these men have
struggled with addiction for years, but today, there is no
margin for error. A single relapse can leave them at the mercy
of a lethal dose of fentanyl and other synthetic drugs.
While addiction is a treatable, chronic medical disease, it
is also one of the most complex in medicine. It involves
interactions among brain circuits, genetics, the environment,
and an individual's life experiences. As a result, solutions to
our nation's addiction and overdose crisis can be equally
complex and interconnected.
Supply-side approaches - like the DEA's record seizure of
fentanyl pills in 20232 - are important to public safety, but
yield little net benefit if demand-side interventions remain
inaccessible, underfunded, or undermined. Drug cartels can
quickly replace confiscated synthetic drugs - no crops,
farmland, or irrigation required - just some precursor
chemicals, a few chemists, and hundreds of traffickers, all
making more money than most of us will see in a lifetime.
The good news? Evidence-based addiction treatment works,
and it as effective as treatments for other chronic diseases.3
As a physician, I have personally witnessed hundreds of
patients' lives transformed by addiction treatment. Practicing
addiction medicine is an immensely satisfying profession,
because I get to see people get really well - they restore
their marriages, rejoin the workforce, leave criminal activity,
improve their mental and physical wellbeing, reunite with their
children, and yes - escape the grasp of drugs cartels.
Addiction treatment not only improves their lives, but the
lives of those around them.
We are fortunate to live during a time when effective,
evidence-based treatments exist for opioid use disorder. These
treatments cut the risk of death, decrease or eliminate drug
use, and facilitate transitions into healthy, productive roles
in society.4,5 Yet, tens of thousands of people in the US
continue to die from illicit opioids annually.
How is this possible?
Unfortunately, the people who need these treatments the
most - people with opioid use disorder - are not getting the
lifesaving care they need, when they need it. In fact, this
treatment gap has barely budged over the last decade.6 We will
not end this opioid epidemic until evidence-based addiction
treatment is easier to get than illicit opioids.
For many Americans, especially in rural areas, evidence-
based addiction treatment can be impossible to find.7,8 Ease of
treatment access is critically important, because people with
addiction often experience a brief window of time between
desiring treatment and experiencing painful withdrawal symptoms
- symptoms that cheap fentanyl, which can be easier to get than
addiction medications, can temporarily stop in an instant.
Easier access to addiction treatment cannot happen without
a substantially larger addiction treatment workforce,9
including more addiction specialist physicians. Specialist
physicians like me are critical for helping patients with
complex, interconnected health conditions, for leading
interdisciplinary care teams, and for serving as mentors to
primary care clinicians who would like to integrate addiction
treatment into their practices but need greater guidance to do
so. Increased federal funding for addiction medicine and
addiction psychiatry fellowships and financial incentives to
encourage more physicians to enter these training programs are
sorely needed to ensure every community has access to high-
quality addiction treatment.
In addition, federal law must be amended to allow these
addiction specialist physicians to prescribe methadone for
opioid use disorder that can be dispensed from community
pharmacies. Today, only about 2,000 clinics dispense methadone
for opioid use disorder, and they are lacking in 80% of US
counties.10 Methadone for opioid use disorder (but not for
pain) has more federal restrictions than just about any other
FDA-approved medication. It has been caught in bureaucratic red
tape for nearly fifty years - despite an opioid epidemic that
has continued to worsen. Allowing states to regulate their
methadone treatment, without undue federal restrictions, could
lead to the type of innovation needed in opioid addiction
treatment in America.
Yet, connecting individuals to treatment is not enough -
they must also be able to afford their care. Medicaid and
Medicare are major insurers for many people with opioid
addiction, making it essential that their policies facilitate,
rather than hinder, access. For example, if states are expected
to implement Medicaid work requirements, then they also should
have the ability to exempt beneficiaries with substance use
disorders that make it difficult for them to meet those
requirements. While completing addiction treatment can increase
the likelihood of employment,11 beneficiaries struggling with
severe, unmanaged substance use disorders and associated
criminal records may not be able to obtain or maintain
employment. Without such an exemption, our nation could face an
unnecessary increase in expensive emergency room visits, as
well as in overdose deaths.12
Many mental health therapists,13 opioid treatment
programs,14 and buprenorphine prescribers15 do not accept
Medicaid, largely reflecting the program's administrative
burdens and low reimbursement rates.13 Congress should remove
these burdens and increase Medicaid rates to change this
equation. In the meantime, addiction treatment providers who do
not accept Medicaid are essentially unavailable to the
approximately 40% of nonelderly adults with opioid use disorder
who rely on Medicaid.16
Medicare and Medicaid must also cover the full continuum of
addiction care. (See the enclosed handout on The ASAM
Criteria). Surprisingly, Medicare does not cover non-hospital-
based residential addiction treatment,17 even though the rate
of drug overdose death rates quadrupled among older Americans
between 2002 and 2021.18 This must change. Further, enforcement
of mental health and addiction parity must be strengthened by
requiring robust data collection and evaluation, levying civil
penalties for parity violations, and incentivizing state
regulators to be more robust in their enforcement.19 Consumers
should not have the burden of initiating investigations into
insurance practices that may violate parity, especially as many
addiction treatment patients lack financial resources or legal
knowledge.
Additionally, countless studies indicate that the stigma of
addiction prevents treatment access. Even when people recognize
they have a problem with drugs or alcohol, they are too
embarrassed or scared to talk to their physician about it.20
Stigma is arguably the most difficult barrier to address, as it
is so entrenched in society.21 The federal government should
stop wasting money on incarcerating people for non-violent drug
offenses and must continue to emphasize that addiction is a
disease, not a moral failing. When government resources are
spent on incarcerating people with addiction for non-violent
drug offenses, this message gets muddled, and society continues
to view addiction as a moral failing, disincentivizing people
from seeking help.21 Incarcerating people for low-level drug
crimes is also incredibly fiscally irresponsible. Every dollar
spent on addiction treatment saves $7 of justice system
resources.22 Research continues to show that treatment can
reduce illicit drug use and associated criminal activity.23
People already in the criminal legal system also need
better addiction treatment. Congress should eliminate
Medicaid's inmate exclusion, and federal funding for prisons
and jails should be contingent on providing evidence-based
addiction treatment - to ensure that taxpayer money is not
wasted on a revolving door of incarceration.24 The Department
of Justice should continue investigating criminal legal
institutions that refuse to offer or permit use of methadone
and buprenorphine.25 There is a high risk of overdose death for
people leaving jail or prison,26 as they lose opioids tolerance
but may return to drug use without a connection to community-
based treatment. Prisons and jails should be incentivized to
hire professionals, like social workers, to connect people who
are reentering the community to continued addiction treatment,
housing, and employment services - critical services that
reduce the chances of returning to environments that involved
drug use.27
In closing, thank you for the opportunity to share my
perspective and expertise today. Prior to this hearing, I had
the privilege of reading RAND's report on America's Opioid
Ecosystem and related policy ideas.28 Throughout it, there is
one fundamental question: Who owns this?
Whether it is funding the training of more addiction
specialists; ensuring that they can legally prescribe
methadone; closing the dangerous Medicare coverage gap for
residential addiction treatment; equipping the criminal legal
system to provide evidence-based addiction care; enforcing
mental health and addiction parity, or avoiding harmful cuts to
Medicaid, the answer is the same: Congress owns this.
Let us work together to save lives.
Thank you, and I look forward to answering your questions.
REFERENCES
1.Thieme N, Zhu A, Gallagher J. Seniors in Baltimore Are Being
Devastated by Drugs: five Takeaways. The New York Times. June
3, 2024. https://www.nytimes.com/2024/06/03/us/baltimore-
opioid-epidemic-seniors-takeaways.html
2.Operation Engage Seattle-Top Local Drug Threat:Fentanyl.
Accessed February 20, 2025.www.dea.gov/engage/operation-engage-
seattle#:text=In20calendar20year202320DEA,enough20to20kill20ever
y20American
3.McLellan AT, Lewis DC, O'Brien CP, Kleber HD. Drug
dependence, a chronic medical illness: implications for
treatment, insurance, and outcomes evaluation. Jama. Oct 4
2000;284(13):1689-95. doi:10.1001/jama.284.13.1689
4.Santo T, Jr., Clark B, Hickman M, et al. Association of
Opioid Agonist Treatment With All-Cause Mortality and Specific
Causes of Death Among People With Opioid Dependence: A
Systematic Review and Meta-analysis. JAMA Psychiatry.
2021;78(9):979-993. doi:10.1001/jamapsychiatry.2021.0976
5.Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and
after opioid substitution treatment: Systematic review and
meta-analysis of cohort studies. BMJ. 2017;357:j1550.
doi:10.1136/bmj.j1550
6.Krawczyk N, Rivera BD, Jent V, Keyes KM, Jones CM, Cerd M.
Has the treatment gap for opioid use disorder narrowed in the
U.S.?: A yearly assessment from 2010 to 2019". Int J Drug
Policy. Jul 19 2022:103786. doi:10.1016/j.drugpo.2022.103786
7.Andrilla CHA, Patterson DG. Tracking the geographic
distribution and growth of clinicians with a DEA waiver to
prescribe buprenorphine to treat opioid use disorder. The
Journal of Rural Health. Mar 18 2021;doi:10.1111/jrh.12569
8.Stopka TJ, Estadt AT, Leichtling G, et al. Barriers to opioid
use disorder treatment among people who use drugs in the rural
United States: A qualitative, multi-site study. Soc Sci Med.
Feb 13 2024;346:116660. doi:10.1016/j.socscimed.2024.116660
9.Jones CM, Campopiano M, Baldwin G, McCance-Katz E. National
and state treatment need and capacity for opioid agonist
medication-assisted treatment. Am J Public Health.
2015;105:e55-e63. doi:10.2105/AJPH.2015.302664
10.J.H. Duff and J.A. Carter, "Location of Medication-Assisted
Treatment for Opioid Addiction: In Brief" (Congressional
Research Service, 2019),tps://www.everycrsreport.com/files/
20190624--R45782--ed39091fadf888655ebd69729c3180c3f7e550f6.pdf
11. Zarkin GA, Dunlap LJ, Bray JW, Wechsberg WM. The effect of
treatment completion and length of stay on employment and crime
in outpatient drug-free treatment. Journal of Substance Abuse
Treatment. 2002;23(4):261-271. doi:10.1016/S0740-5472(02)00273-
8
12.Andrews CM, Humphreys K, Grogan CM. How Medicaid work
requirements could exacerbate the opioid epidemic. Am J Drug
Alcohol Abuse. 2020;46(1):1-3. doi:10.1080/
00952990.2019.1686760
13.Zhu JM, Huntington A, Haeder S, Wolk C, McConnell KJ.
Insurance acceptance and cash pay rates for psychotherapy in
the US. Health Aff Sch. Sep 2024;2(9):qxae110. doi:10.1093/
haschl/qxae110
14.Substance Abuse and Mental Health Services Administration.
(2023). National Substance Use and Mental Health Services
Survey (N-SUMHSS) 2022: Data on Substance Use and Mental Health
Treatment Facilities (SAMHSA Publication No. PEP23-07-00-002).
Rockville, MD: Center for Behavioral Health Statistics and
Quality, Substance Abuse and Mental Health Services
Administration. Retrieved from https://www.samhsa.gov/data/
sites/default/files/reports/rpt42714/NSUMHSS-Annual-Detailed-
Tables-22.pdf
15.Saunders H, Britton E, Cunningham P, Saxe Walker L, Harrell
A, Scialli A, Lowe J. Medicaid participation among
practitioners authorized to prescribe buprenorphine. J Subst
Abuse Treat. 2022 Feb;133:108513. doi: 10.1016/
j.jsat.2021.108513. Epub 2021 Jun 1. PMID: 34148758.
16.Orgera K, Tolbert J. The opioid epidemic and medicaid's role
in facilitating access to treatment. Kaiser Family Foundation.
http://files.kff.org/attachment/Issue-Brief-The-Opioid-
Epidemic-and-Medicaids-Role-in-Facilitating-Access-to-Treatment
17.Legal Action Center. Medicare's Expanded Coverage of
Substance Use Disorder Treatment:Important Progress and
Recommendations to Fill Remaining Gaps. 2024.
18.Humphreys K, Shover CL. Twenty-Year Trends in Drug Overdose
Fatalities Among Older Adults in the US. JAMA Psychiatry. May 1
2023;80(5):518-520. doi:10.1001/jamapsychiatry.2022.5159
19.Ard JP. An Unfulfilled Promise: Ineffective Enforcement of
Mental Health Parity. Annals of Health Law. 2017;26 70-85.
20.Farhoudian, A., Razaghi, E., Hooshyari, Z., Noroozi, A.,
Pilevari, A., Mokri, A., Mohammadi, M. R., & Malekinejad, M.
(2022). Barriers and Facilitators to Substance Use Disorder
Treatment: An Overview of Systematic Reviews. Substance abuse :
research and treatment, 16, 11782218221118462. https://doi.org/
10.1177/11782218221118462
21.Tsai AC, Kiang MV, Barnett ML, et al. Stigma as a
fundamental hindrance to the United States opioid overdose
crisis response. PLoS Med. Nov 2019;16(11):e1002969.
doi:10.1371/journal.pmed.1002969
22.Fardone, E., Montoya, I. D., Schackman, B. R., &
McCollister, K. E. (2023). Economic benefits of substance use
disorder treatment: A systematic literature review of economic
evaluation studies from 2003 to 2021. Journal of substance use
and addiction treatment, 152, 209084. https://doi.org/10.1016/
j.josat.2023.209084
23.Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2009).
Treating drug abuse and addiction in the criminal justice
system: improving public health and safety.MA,01(2), 183-190.
https://doi.org/10.1001/jama.2008.976
24.Daley M, Love CT, Shepard DS, Petersen CB, White KL, Hall
FB. Cost-Effectiveness of Connecticut's In-Prison Substance
Abuse Treatment. Journal of Offender Rehabilitation. 2004/10/07
2004;39(3):69-92. doi:10.1300/J076v39n03--04
25.The Americans with Disabilities Act and the Opioid Crisis:
Combating Discrimination Against People in Treatment or
Recovery 2022. Accessed June 2, 2023. https://archive.ada.gov/
opioid--guidance.pdf
26.Binswanger IA, Blatchford PJ, Mueller SR, Stern MF.
Mortality After Prison Release: Opioid Overdose and Other
Causes of Death, Risk Factors, and Time Trends From 1999 to
2009. Ann Intern Med. 2013;159:592-600. doi:10.7326/0003-4819-
159-9-201311050-00005
27.Hoffman KA, Thompson E, Gaeta Gazzola M, et al. "Just
fighting for my life to stay alive": a qualitative
investigation of barriers and facilitators to community re-
entry among people with opioid use disorder and incarceration
histories. Addict Sci Clin Pract. Mar 21 2023;18(1):16.
doi:10.1186/s13722-023-00377-y
28.America's Opioid Ecosystem: How Leveraging System
Interactions Can Help Curb Addiction,Overdose, and Other Harms.
The Ecosystem Approach to Opioid Policy.RAND Corporation; 2023.
https://www.rand.org/pubs/visualizations/DVA604-1/ecosystem-
approach-to-opioid-policy.html
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Prepared Witness Statements
Bradley D. Stein
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
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Questions for the Record
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U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Questions for the Record
Dr. Malik Burnett
Senator Raphael Warnock
Question:
Medicaid is the largest payer of behavioral health care
services in the United States, providing access to mental
health and substance use disorders.\1\ Additionally, Medicaid
expansion plays a significant role in access to treatment for
opioid use disorder (OUD) across the U.S. For example, research
shows that Medicaid expansion leads to an increase in access to
treatment for individuals with OUD.\2\
---------------------------------------------------------------------------
\1\ Behavioral Health Services, Centers for Medicare and Medicaid
Services, https://www.medicaid.gov/medicaid/benefits/behavioral-health-
services/index.html.
\2\ Richard G. Frank, The Role of Medicaid in Addressing the Opioid
Epidemic, Brookings Institution (Feb. 25, 2025), https://
www.brookings.edu/articles/the-role-of-medicaid-in-addressing-the-
opioid-epidemic/ .
---------------------------------------------------------------------------
Can you describe the barriers in access to treatment for
OUD for people in non-expansion states like Georgia?
Response:
Senator Warnock, states that have not expanded access to
Medicaid have populations that face significant barriers to
affording SUD treatment. Lack of access to programs like
Medicaid means that individuals with an SUD would be required
to pay with cash for treatment. Furthermore in non-expansion
states individuals would be required to travel farther to
access treatment given these states have smaller provider
networks due to the limitations on reimbursement for services.
Ultimately, these individuals either delay or forgo treatment
entirely, and if they do end up in the hospital for medical
complications associated with the SUD, these complications are
much worse than the otherwise would have been if they were able
to be treated sooner. This reality is particularly concerning
given that in non-expansion states 60 percent of people in the
coverage gap are people of color, closing the gap would also
advance more equitable access to behavioral health care and
reduce overdose rates in these communities which are some of
the highest in the country. The research demonstrated that
Medicaid expansion increases coverage for patients, expanded
behavioral health care provider capacity, increases the
likelihood that substance use disorders are identified and
treated. This reduces the likelihood of hospitalization and
ensures individual are more likely to participate in the labor
force and be value added to the community.
Question:
How would proposed cuts to Medicaid exacerbate these
existing barriers to treatment?
Response:
Senator Warnock as of October 2024, there were over 70M
people Medicaid enrollees, with approximately 14 million
enrollees having a mental health or substance use disorder
(SUD). ASAM is extremely concerned about the potential harmful
cuts to the Medicaid program which are being discussed by some
lawmakers, as the program provides lifesaving care to Americans
living with SUD. Proposals that would impose burdensome work
requirements on people with SUD are just unnecessary
administrative burdens considering 92% of adults on Medicaid in
2023 were reported to be working full or part time, or unable
to work due to illness, caregiving obligations, or schooling.
America is in the middle of an addiction and overdose crisis.
We have evidence-based treatments for addiction, but if
patients can't afford or access them, their lives are at risk.
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Questions for the Record
Bradley D. Stein\1\
---------------------------------------------------------------------------
\1\ The opinions and conclusions expressed in this addendum are the
author's alone and should not be interpreted as representing those of
RAND or any of the sponsors of its research.
---------------------------------------------------------------------------
RAND\2\
---------------------------------------------------------------------------
\2\AND is a research organization that develops solutions
to public policy challenges to help make communities throughout the
world safer and more secure, healthier and more prosperous. RAND is
nonprofit, nonpartisan, and committed to the public interest. RAND's
mission is enabled through its core values of quality and objectivity
and its commitment to integrity and ethical behavior. RAND subjects its
research publications to a robust and exacting quality-assurance
process; avoids financial and other conflicts of interest through staff
training, project screening, and a policy of mandatory disclosure; and
pursues transparency through the open publication of research findings
and recommendations, disclosure of the source of funding of published
research, and policies to ensure intellectual independence. This
testimony is not a research publication, but witnesses affiliated with
RAND routinely draw on relevant research conducted in the organization.
---------------------------------------------------------------------------
Senator Raphael Warnock
Question:
According to the Centers for Disease Control and
Prevention, non-opioid treatments are effective in managing
chronic pain.\3\ However, barriers like step therapy
requirements and prior authorization create unnecessary burdens
on a patient's access to non-opioid pain management treatment.
---------------------------------------------------------------------------
\3\ Centers for Disease Control and Prevention, "Nonopioid
Therapies for Pain Management," webpage, January 31, 2025, https://
www.cdc.gov/overdose-prevention/hcp/clinical-care/nonopioid-therapies-
for-pain-management.html.
---------------------------------------------------------------------------
How can increasing access to non-opioid pain medications,
like through the Alternatives to Prevent Addiction in the
Nation Act, help address the opioid epidemic in the United
States?\4\
---------------------------------------------------------------------------
\4\ The question is presented verbatim as it was submitted to RAND.
---------------------------------------------------------------------------
Response:
Thank you for the question, Senator. With approximately one
in four Americans experiencing chronic pain,\5\ there is an
urgent need to develop comprehensive solutions that will
effectively meet the diverse needs and preferences of chronic
pain patients across the nation.
---------------------------------------------------------------------------
\5\ J. Lucas and I. Sohi, "Chronic Pain and High-Impact Chronic
Pain in U.S. Adults, 2023," Centers for Disease Control and Prevention,
November 2024, https://www.cdc.gov/nchs/data/databriefs/db518.pdf.
---------------------------------------------------------------------------
Recent clinical practice guidelines from leading health
organizations-including the Centers for Disease Control and
Prevention, Department of Veterans Affairs, and World Health
Organization-have aligned in recommending non-opioid treatments
for the majority of chronic pain conditions.\6\
---------------------------------------------------------------------------
\6\ World Health Organization, WHO Guideline for Non-Surgical
Management of Chronic Primary Low Back Pain in Adults in Primary and
Community Care Settings, December 7, 2023; Use of Opioids in the
Management of Chronic Pain Work Group, VA/DoD Clinical Practice
Guideline for the Use of Opioids in the Management of Chronic Pain,
U.S. Department of Veterans Affairs and U.S. Department of Defense, May
2022, https://www.healthquality.va.gov/guidelines/pain/cot/; Centers
for Disease Control and Prevention, "2022 CDC Clinical Practice
Guideline at a Glance," webpage, May 7, 2024, https://www.cdc.gov/
overdose-prevention/hcp/clinical-guidance/index.html.
---------------------------------------------------------------------------
These guidelines include both non-opioid pain medications
and non-pharmacological therapies. Despite this robust evidence
foundation, a variety of policies continue to impede
implementation in routine clinical practice.
When evaluated solely on direct costs to patients and
insurers, generic opioids appear relatively inexpensive.\7\ In
contrast, non-opioid analgesics face barriers, including tiered
formulary placement, elevated cost-sharing, prior
authorization, and step therapy protocols that mandate
treatment failure with cheaper alternatives (often opioids)
before covering preferred non-opioid options. These obstacles
rarely apply to generic opioid medications, creating a
situation in which the clinically preferred options face a
broader range of cost and non-cost barriers compared with the
less clinically preferred and higher-risk opioid analgesic
alternative.
---------------------------------------------------------------------------
\7\ Hilary Aroke, Ashley Buchanan, Xuerong Wen, Peter Ragosta,
Jennifer Koziol, and Stephen Kogut, "Estimating the Direct Costs of
Outpatient Opioid Prescriptions: A Retrospective Analysis of Data from
the Rhode Island Prescription Drug Monitoring Program," Journal of
Managed Care & Specialty Pharmacy, Vol. 24, No. 3, 2018.
---------------------------------------------------------------------------
Administrative and reimbursement policies also restrict
access to evidence-based non-pharmacological interventions for
pain. For example, although the Centers for Medicare & Medicaid
Services began covering acupuncture for chronic low back pain
in 2020,\8\ reimbursement is limited to select providers. This
restriction disproportionately affects patients in medically
underserved areas and excludes those with other chronic pain
conditions. Similarly, Medicare's coverage of chiropractic care
is restricted to spinal manipulation,\9\ requiring
beneficiaries to pay out of pocket for essential services, such
as physical examinations or rehabilitative exercises.
---------------------------------------------------------------------------
\8\ Medicare.gov, "Acupuncture," webpage, undated, https://
www.medicare.gov/coverage/acupuncture.
\9\ Medicare.gov, "Chiropractic Services," webpage, undated,
https://www.medicare.gov/coverage/chiropractic-services.
---------------------------------------------------------------------------
Approaches to addressing these barriers and expanding
access to non-opioid pain medications that Congress could
consider include
limiting patient cost-sharing for non-opioid pain
management medications
limiting prior-authorization requirements and step therapy
protocols for non-opioid pain management medications
enhancing shared-decisionmaking approaches with patients
regarding pain management preferences.
These possible policy changes would enable meaningful
shared decisionmaking regarding non-opioid versus opioid
medications, which can decrease opioid misuse.\10\ It is likely
that these changes would reduce opioid prescriptions as
patients gain access to alternatives. Additional policy reforms
that Congress could consider to reduce barriers to non-
pharmacological interventions include the following:
---------------------------------------------------------------------------
\10\ Vanessa C. Somohano, Crystal L. Smith, Somnath Saha, Sterling
McPherson, Benjamin J. Morasco, Sarah S. Ono, Belle Zaccari, Jennette
Lovejoy, and Travis Lovejoy, "Patient-Provider Shared Decision-Making,
Trust, and Opioid Misuse Among US Veterans Prescribed Long-Term Opioid
Therapy for Chronic Pain," Journal of General Internal Medicine, Vol.
38, September 2023.
---------------------------------------------------------------------------
Cover nonpharmacological therapies-for example, expand
coverage for licensed acupuncture for more than chronic low
back pain and to any trained provider and add coverage of
chiropractic services within Medicare to align with scope of
practice.
Generate a larger workforce and a more robust provider
network by including providers of non-pharmacological therapies
in existing loan forgiveness programs, such as rural health
grants or the National Health Service Corps.
Provide funding for integrative training opportunities to
complementary and integrative health providers, similar to
those available through Centers for Medicare & Medicaid
Services-funded graduate medical education residency programs.
In conclusion, the policy options presented above could
help align payment and administrative policies with evidence-
based guidelines for non-opioid pain medications while helping
to address additional barriers that exist in accessing non-
pharmacological therapies.
=======================================================================
Statements for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Statements for the Record
Dr. Stacey McKenna Testimony
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Statements for the Record
James Balda Testimony
On behalf of Argentum, the leading national association
representing assisted living and memory care communities and
the older adults and families they serve, I want to commend you
for holding today's hearing: "Combating the Opioid Epidemic."
We appreciate the opportunity to share insights on the
importance of supervised medication management, especially for
seniors who struggle with physical limitations and/or various
forms and levels of dementia. Medication management is often
confusing and daunting to seniors and can lead to misuse, abuse
and addiction, especially with opiates. Our communities offer
residents medication management to both control chronic
conditions as well as effectively mitigate pain.
The members of Argentum operate senior living communities
offering independent living, assisted living, memory care, and
continuing care. The members of Argentum and our state partners
represent approximately 75 percent of the professionally
managed communities in the senior living industry-an industry
with an annual national economic impact of nearly a quarter of
a trillion dollars and responsible for providing more than 1.6
million jobs. These communities are home to nearly two million
seniors, offering choice, dignity, security, and an enhanced
quality of life.
The American population is aging rapidly. According to data
just released by the U.S. Census Bureau, the median population
age reached 39.2 years in 2022-the highest on record. Every
day, 10,000 Americans turn age 65, and the U.S. population age
65 and older grew from 2010 to 2020 at the fastest rate since
the 1800's and reached 55.8 million-a 38.6 percent increase in
just 10 years. The data also showed that for the first time in
a century the number of adults over 60 in the U.S. is greater
than the number of children under 10 years of age.
Senior living providers start their support of residents
and families with an evaluation or assessment of a resident's
condition, which helps identify and establish the level and
types of care needed. This assessment is conducted by a trained
and qualified professional, such as the resident's primary care
physician, and takes place at or around the time of move-in for
new residents, periodically (e.g., annually), and upon changes
in a resident's condition. Senior living community staff
participate in this assessment to ensure the community is
capable of providing the level of support the resident needs.
Individuals who require assistance with activities of daily
living - the type of care provided by family members in the
home, such as bathing, walking, dressing, and dining - are
recommended for assisted living. Residents living with low to
moderate cognitive disability may receive care in an assisted
living community, whereas more pronounced levels of cognitive
disability typically require higher levels of care offered by
memory care or continuing care communities.
A resident's current medications are typically reviewed as
part of the resident assessment, with medication optimization
being a primary goal. Medications are reviewed for whether or
not they're (still) needed, effectiveness, and potential
harmful interaction with other medications taken by the
resident. Residents are also assessed to determine whether
they're able to self-administer their medications, or if this
is a service that should be provided by trained staff. Best
practice is for a consultant pharmacist to be part of the
medication review process.
Senior living residents typically also suffer from multiple
chronic conditions. As reported in NCHS Data Brief No. 506, the
10 most frequently observed chronic conditions among senior
living residents include high blood pressure (58%), Alzheimer's
disease or other dementias (44%), heart disease (33%),
depression (26%), arthritis (18%), chronic obstructive
pulmonary disease (16%), diabetes (16%, osteoporosis (12%),
stroke (7%), and cancer (6%). Further, the Data Brief states
that 55% of residents were diagnosed with two to three chronic
conditions and 18% of residents with between four and 10
chronic conditions. As reported in Senior Housing News, a
September 2020 study conducted by NORC at the University of
Chicago showed that assisted living residents specifically
manage 14 chronic conditions, on average. Memory care residents
are comparable, at just under 13 chronic conditions.
These chronic conditions are often accompanied by chronic
pain. Assisted living providers collaborate with each
residents' physician and with a consultant pharmacist to
explore options for deprescribing, replacement with non-opioid
medications, and implementing non-medicinal interventions such
as physical therapy, strength conditioning, walking clubs, and
heat and ice treatments, to name a few. All of these options
are preferable due to the side effects of opioids in the
elderly, such as increased falls, changes in cognition,
constipation, and other well-known issues.
Although pharmaceutical developments have increased the
availability of nonopioid options in recent decades, many
geriatric patients have comorbidities that preclude the use of
many other classes of medications. Millions of Americans are
treated with opioids each year, and many of these patients are
elderly. According to the CDC, 17.4% of the U.S. population, or
56,935,332 persons, filled at least one opioid prescription in
2017, and opioid prescribing was highest at 26.8% in adults
aged 65 and up. (See Mayo Clinic Proceedings, Volume 95, Issue
4, April 2020, Opioids in Older Adults: Indications,
Prescribing, Complications, and Alternative Therapies for
Primary Care.) Due to the multitude of chronic conditions they
face, some residents need and benefit from opioid therapy.
According to the Kaiser Family Foundation, more than half
of adults 65 and older report taking four or more prescription
drugs compared to one third of adults 50-64 years old (32%) and
about one in 10 adults 30-49 years old. Medication management
is an important support provided in assisted living
communities, with up to 85% of residents wanting or needing
assistance with taking medications.
This dispensing of medication by trained community staff
generally makes it safer for residents, providing a structured
system for managing medications, including reminders to take
medications as prescribed and reducing the risk of missed
doses. Community personnel maintain detailed records of each
medication administration, allowing for tracking and
communication with healthcare providers. Staff also help
monitor for potential interactions or side effects. All of
these factors help to significantly reduce the risk of
medication errors compared to self-administration by
individuals with memory issues or declining cognitive
abilities. Medication administration is governed by state
regulation.
It is important to note that senior living residents
typically retain their own primary care physician - the people
who know residents well - when moving into a senior living
community.
Senior living community personnel spend a lot of time
supporting and getting to know residents and as a result, are
in a unique position to advocate for residents. The following
statement was provided by Kim Butrum, RN, MS, GNP-BC, Senior
Vice President, Clinical for Silverado - a senior living
provider operating 27 standalone memory care communities.
The average length of stay in assisted living communities
is two to three years. Susan Mitchell's seminal work on those
with advanced dementia, found that people living with dementia
have a similar degree of pain and suffering in the last 18
months of life as those living with terminal cancer; yet
unfortunately many times a behavioral expression in dementia is
seen as a psychiatric symptom rather than that the resident
with difficulties with language and perception is demonstrating
that they are having discomfort.
Despite more than 20 years of regulatory guidance and
research showing that pain and behavioral expressions in
dementia are correlated, it can be very difficult to get
adequate analgesic treatment for residents with moderate to
advanced dementia. Pain medications are limited... non-
steroidals usually can't be used due to renal impairment, which
is common in the elderly, and many prescribers, unfortunately
are fearful of prescribing adequate analgesia. Opiates, while
dangerous when used inappropriately, are also very effective
analgesics when used appropriately. Even the 2022 CDC guidance
on chronic opiate use stated that those on palliative care, at
end of life, and those with cognitive impairment are at high
risk of inadequate treatment for pain.
I hope if further regulations are added that there will be
a carve-out around opiate use for those on palliative care,
those living with dementia, and on hospice.
Please do not hesitate to contact my office with any
questions or requests for additional information.
Sincerely,
James Balda
President & CEO
Argentum
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Statements for the Record
The ASAM Criteria (Fourth Edition) Handout
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Statements for the Record
Moyo Dow and Francesca Beaudoin Testimony
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Statements for the Record
Tim Clover Testimony
Thank you, Chairman Scott, Ranking Member Gillibrand, and
distinguished members of the Senate Special Committee on Aging,
for holding this critically important hearing, "Combating the
Opioid Epidemic," to examine addiction and abuse in older
Americans. As President and CEO, Rayner Global, I appreciate
the opportunity to highlight new laws that have taken effect
this year to help combat the opioid crisis, and the shared
commitment we have in fighting addiction and curbing the opioid
crisis. Rayner is a global ophthalmic company that operates
across the United States and is one of the few companies who
has developed a non-opioid alternative for use during cataract
surgery, the most commonly performed surgery in the USA with
nearly five million surgeries per year.\1\ Our non-opioid
pharmaceutical product, OMIDRIA (phenylephrine and ketorolac
intraocular solution) 1%/ 0.3% is the only FDA-approved
intracameral Non-Steroidal Anti-Inflammatory Drug (NSAID).
OMIDRIAr is indicated for maintaining pupil size by preventing
intraoperative miosis and reducing post-operative pain after
cataract surgery.
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\1\ Market Scope, Forecast for the Global IOL Market, 2024, p. 199
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Substance abuse and overdose deaths are rapidly growing in
Americans who are 65 years and older. The most common
substances abused are alcohol, prescription drugs such as
opiates and benzodiazepines (BZD), and over-the-counter (OTC)
medications. Due to the highly addictive nature of opioids,
many ophthalmologists want to avoid opioid use in cataract
surgery, and therefore, having alternative pain management
strategies is critical. Sadly, drug-related deaths have
skyrocketed since the COVID-19 pandemic and are increasing in
seniors. In 2020 alone, over 5000 American seniors died by
overdose.\2\ For any individual, and especially one who has
struggled with addiction or is predisposed to addiction, being
prescribed opioids during or after surgery is highly
problematic.
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\2\ https://www.cdc.gov/nchs/data/databriefs/db455.pdf
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There is not one magic bullet solution to the opioid
epidemic, it will take a multipronged approach. To that end, at
Rayner, we are focused on legislation intended to incentivize
development of non-opioid pain treatments, such as the Non-
Opioids Prevent Addiction in the Nation (NO PAIN) Act, which
passed as part of the Consolidated Appropriations Act (CAA) in
December 2022. NO PAIN was created to reduce financial barriers
in prescribing innovative non-opioid therapies to Medicare
patients for improved management of postsurgical pain. The law
was a bipartisan effort led by Senator Shelley Moore-Capito (R-
WV) and co-sponsored by several members of this committee,
including Chairman Scott (R-FL), Senator Mark Kelly (D-AZ), and
Senator Raphael Warnock (D-GA). The law directs the Centers for
Medicare and Medicaid Services (CMS) to make a separate payment
for certain non-opioid pain relief treatments in the hospital
outpatient department (OPD) setting between January 2025 and
December 2027. These products may not be bundled into the
underlying procedure payment, and CMS may not reduce the
payment level of the underlying procedure to offset the
separate payment.
For any senior, and especially one who has struggled with
addiction or is predisposed to addiction, being prescribed
opioids during or after surgery is highly problematic. With the
passage of the NO PAIN Act, doctors and surgeons can now
provide innovative, non-opioid alternatives -like OMIDRIA-to
Medicare patients without facing financial barriers. Policies
that promote new, innovative non-opioid treatments and options
are a critical component to combating this terrible epidemic
with a straightforward solution - prevent addiction before it
starts. We want to work with the Committee to ensure that this
law and others remain in place to curb the epidemic.
I applaud all the work that the Committee is doing to
highlight the issues around opioid abuse in older Americans and
look forward to working with you on this law and our shared
goal of preventing abuse.
Tim Clover
President and CEO of Rayner Global
U.S. Senate Special Committee on Aging
"Combatting the Opioid Epidemic"
February 26, 2025
Statements for the Record
Dr. Jeffrey B. Reich Testimony
Overview
Sparian Biosciences is grateful for the opportunity to
submit a statement for the record for the Special Committee on
Aging hearing on February 26, 2025, entitled, "Combatting the
Opioid Epidemic." This timely hearing brought a much-needed
spotlight to the challenges and issues engendered by the
ongoing opioid and drug use epidemic, which collectively
claimed an estimated 105,000 American lives in 2023, according
to the Centers for Disease Control and Prevention (CDC).\1\
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\1\ Garnett, M. F., & Minino, A. M. (2024). Drug overdose deaths in
the United States, 2003-2023. (NCHS Data Brief No. 522). National
Center for Health Statistics. www.cdc.gov/nchs/products/databriefs/
db522
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About Sparian Biosciences
Sparian Biosciences is a clinical stage biopharmaceutical
company headquartered in Ranking Member Gillibrand's home state
of New York. Sparian Biosciences is developing innovative
medications to combat substance use disorders (SUDs), a public
health crisis that the congressional Joint Economic Committee
estimates costs the United States nearly $1.5 trillion
annually.\2\ Despite recent advances in addiction medicine,
there are still significant unmet medical needs as noted by the
CDC and other federal health agencies.\3\ To address this gap,
Sparian is developing four novel medications. Sparian's AEAr
agonists (SBS-1000 and SBS-147) are first-in-class novel
analgesics that hold the promise of offering a non-opioid
treatment for patients requiring both acute and chronic pain
management. In November 2024, Sparian completed a Phase 1 trial
that SBS-1000 was safe and well tolerated in healthy
volunteers.\4\ The company's second program (SBS-226) is a pre-
clinical drug candidate that has potential to treat opioid use
disorders, which if successful, would provide clinicians with a
new pharmacological treatment and an incremental advance over
current therapies such as buprenorphine and methadone. Sparian
is also developing a third drug candidate (SBS-371) that could
vastly improve how first responders reverse drug overdoses from
fentanyl and other powerful synthetic opioids. Lastly, Sparian
is developing a new therapeutic (SBS-518) for stimulant use
disorders. Currently, there are no FDA approved treatments for
methamphetamine and cocaine. Sparian is proud that it has built
this impressive and innovative pipeline with nearly $60 million
in NIH/NIDA grant funding. Sparian Biosciences is a prime
example of a successful public-private partnership.
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\2\ The Economic Toll of the Opioid Crisis Reached Nearly $1.5
Trillion in 2020 - The Economic Toll of the Opioid Crisis Reached
Nearly $1.5 Trillion in 2020 - United States Joint Economic Committee
(senate.gov)
\3\ Dasgupta, S., Tie, Y., Beer, L., Broz, D., & Vu, Q. (2021).
Unmet needs and barriers to services among people who inject drugs with
HIV in the United States. Journal of HIV/AIDS & social services, 20(4),
271-284.
\4\ Sparian Biosciences. (2024, November 12). Sparian Biosciences
announces results from the Phase 1 clinical trial of first in class
novel arylepoxamide receptor (AEAr) agonist analgesic SBS-1000. https:/
/www.sparianbiosciences.com/news/sparian-biosciences-announces-results-
from-the-phase-1-clinical-trial-of-first-in-class-novel-arylepoxamide-
receptor-aear-agonist-analgesic-sbs-1000
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Introduction
The SUD epidemic in all of its manifestations, including
opioid use disorders, has affected all corners of the United
States or as Ranking Member Gillibrand noted in her opening
statement, "There is no community in this country that has
escaped the impact of the opioid crisis."\5\ Sparian
Biosciences strongly supports Ranking Member Gillibrand's call
for a "multi-faceted approach"\6\ to end this public health
crisis. In that spirit, Sparian Biosciences recommends building
a coalition of multi-disciplinary stakeholders ranging from law
enforcement to healthcare professionals. Sparian Biosciences
appreciates Chairman Scott's efforts to recognize that "local
law enforcement agencies are on the frontlines of this
crisis"\7\ and their need for additional resources.
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\5\ U.S. Senate Special Committee on Aging. (2025, February 26).
Combating the opioid epidemic [Video]. U.S. Senate. https://
www.aging.senate.gov/hearings/combatting-the-opioid-epidemic
\6\ U.S. Senate Special Committee on Aging. (2025, February 26).
Combating the opioid epidemic [Video]. U.S. Senate. https://
www.aging.senate.gov/hearings/combatting-the-opioid-epidemic
\7\ Scott, R. (2025, February 26). Combating the opioid epidemic:
Opening statement. U.S. Senate Special Committee on Aging. https://
www.aging.senate.gov/imo/media/doc/31cc37f1-dfa0-063e-8205-
0b4c3645bfd5/Opening20Statement--Scott2002.26.25.pdf
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Legislative Accomplishments
Sparian Biosciences commends Chairman Scott and Ranking
Member Gillibrand for their leadership to address all facets of
the SUD epidemic and its disproportionate impact on seniors.
Chairman Scott's leadership was instrumental in the enactment
of the End Fentanyl Act (S.206) last Congress; this bipartisan
law modernizes Customs and Border Protection's procedures and
tools to interdict as well as seize illicit opioids. Sparian
Biosciences is also grateful for Senator Gillibrand's
authorship of the bipartisan Supporting Families Through
Addiction Act (S.1810) that provides resources to help
individuals and their loved ones through the experience of
recovery. Sparian Biosciences urges the committee to continue
its tradition of bipartisan leadership to finally end the SUD
crisis.
Recommendations
As the Special Committee on Aging considers its next
iteration of bipartisan efforts, Sparian Biosciences
respectfully submits the following proposals for the
committee's review:
1. Empower the National Institutes of Health (NIH) to
catalyze the biomedical innovation ecosystem: The committee has
a bipartisan record of supporting policy mechanisms to drive
research and innovation to better care for aging Americans. On
February 12, 2025, the committee brought this to the forefront
by holding a hearing on strengthening research around longevity
and aging.\8\ To continue this legacy, the committee should
push for additional resources for NIH's Helping to End
Addiction Long-term (HEAL) Initiative. This initiative
represents NIH's largest commitment to combatting SUDs and
currently supports more than 1,800 projects in all 50 states.
Some of these projects are aimed at addressing the nexus of
SUDs and aging. For example, the HEAL Initiative funded a study
in 2023 to explore non-opioid based treatment options for older
Americans suffering from chronic pain.\9\ Another funded study
in 2022 assessed how regulatory changes around opioids might
affect care in older lung cancer patients.\10\ The HEAL
Initiative has a demonstrated track record of success and
should receive additional resources to combat the SUD epidemic.
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\8\ U.S. Senate Special Committee on Aging. (2025, February 12).
Optimizing longevity: From research to action [Hearing]. U.S. Senate.
https://www.aging.senate.gov/hearings/optimizing-longevity-from-
research-to-action
\9\ National Institute on Aging. (2025) Addressing the chronic pain
epidemic among older adults in underserved community center. National
Institutes of Health. https://reporter.nih.gov/project-details/10789061
\10\ National Cancer Institute. (2025). The effects of hydrocodone
rescheduling on pain management of older lung cancer patients. National
Institutes of Health. https://reporter.nih.gov/project-details/10599385
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2. Support a whole-of-government initiative to combat SUDs:
Republican and Democratic presidential administrations have
both recognized SUDs are a pressing public health and national
security challenge that require a coordinated and disciplined
response. To that end, presidents from both parties have
consistently declared SUDs a public health emergency.\11\ While
these declarations have helped marshal additional resources,
they have failed to materialize in a whole-of-government effort
analogous to Operation Warp Speed, a public-private partnership
that delivered lifesaving COVID-19 vaccines in record time.
Given the rising toll of SUDs, Sparian would urge the committee
to take a leadership role in developing and implementing a
whole-of-government SUD initiative. Sparian Biosciences would
also encourage committee Members to convey to their
congressional colleagues, FDA, the White House, and other
relevant stakeholders on the pressing need for such a program.
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\11\ https://aspr.hhs.gov/legal/PHE/Pages/default.aspx
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3. Strengthen the SUD workforce to improve access to care:
Multiple hearing witnesses spoke about the need to improve
access to SUD care and treatment. Dr. Bradley Stein, who
testified on behalf of the RAND Corporation, contextualized
this in the case of older Americans, "Despite widespread
federal efforts to increase access to such treatment, few older
adults with OUD receive medication treatment. Only 15 percent
of Medicare beneficiaries with OUD received medication
treatment in 2022, lower rates than among younger cohorts."\12\
Patients with SUDs also face numerous hurdles in accessing
care, one of which is a shortage of qualified physicians
certified in addiction medicine, a trend that Dr. Malik
Burnett, who testified on behalf of the American Society of
Addiction Medicine (ASAM), reiterated, "Easier access to
addiction treatment cannot happen without a substantially
larger addiction treatment workforce, including more addiction
specialist physicians."\13\ ASAM reports the U.S. needs an
additional 1,600 physicians to adequately meets its current
demand for SUD care. To address this workforce shortfall,
Sparian Biosciences urges committee members to consider
proposals such as the Substance Use Disorder Workforce Act
(H.R. 7050), which would add 1,000 residency slots for pain and
addiction medicine over five years.\14\
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\12\ Stein, B. D. (2025, February 26). Addressing the opioid crisis
among older Americans: Strategies for prevention, treatment, and
supporting families affected by addiction. RAND Corporation. Testimony
presented before the U.S. Senate Special Committee on Aging. https://
www.aging.senate.gov/imo/media/doc/31cc37f1-dfa0-063e-8205-
0b4c3645bfd5/Testimony--Stein%2002.26.25.pdf
\13\ Burnett, M. (2025, February 26). Combating the opioid
epidemic. Testimony presented before the U.S. Senate Special Committee
on Aging. https://www.aging.senate.gov/imo/media/doc/31cc37f1-dfa0-
063e-8205-0b4c3645bfd5/Testimony--Burnett2002.26.25.pdf
\14\ Schneider, B. S. (2024, January 18). H.R.7050 - Substance Use
Disorder Workforce Act. 118th Congress (2023-2024). Congress.gov.
https://www.congress.gov/bill/118th-congress/house-bill/7050
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Thank you for the opportunity to share Sparian's
perspective. Sparian Biosciences shares the committee's mission
of improving care for aging Americans. If Sparian can serve as
a resource on these matters, please do not hesitate to reach
out to Sahil Chaudhary at [email protected].
Thank you,
/s/
Jeffrey B. Reich, MD
CEO, Sparian Biosciences, Inc.