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April 16, 2021

Energy and Commerce Health Subcommittee hearing on substance use and misuse in America

On April 16, the Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled, "An Epidemic Within A Pandemic: Understanding Substance Use and Misuse in America." The first panel featured testimony from Regina M. LaBelle, Acting Director, White House Office of National Drug Control Policy (ONDCP), and the second panel featured testimony from a group of addiction experts representing providers, law enforcement, and academia.

In the first panel, Ms. LaBelle highlighted the Biden administration's drug policy priorities, which include expanding access to evidence-based treatment and prevention, harm reduction and recovery support services, along with advancing racial equity, expanding the addiction workforce, and reducing the supply of illicit substances. She stressed the need for a wholistic approach to addiction and an acknowledgement that it is a chronic condition to be managed across someone's lifetime. Several Republicans on the committee stressed the need to expand a temporary scheduling order for fentanyl analogues, which expires May 6, and Ms. LaBelle said the administration supports a short extension while they work with the Department of Justice (DOJ) and Health and Human Services (HHS) to consider its impact on things like mandatory minimums and drug research. Ms. LaBelle also noted the importance of removing barriers to treatment, including access to buprenorphine. She said they are looking at ways to expand the addiction workforce, and what they can do administratively around the "x-waiver." While Rep. Paul Tonko (D-NY) stressed the importance of eliminating the x-waiver to reduce barriers and stigma in prescribing buprenorphine, Rep. Larry Bucshon (R-IN) expressed his concern that Tonko's bill (H.R. 1384) would expand access only to medication and not comprehensive treatment. Rep. Lori Trahan (D-IL) said her bill (H.R. 2067) would require providers with a DEA number to have a minimum knowledge to treat people with addiction, and Ms. LaBelle said she has long emphasized the importance of addiction training, noting that schools should include addiction training and ensure residents are DATA-waived. Throughout the hearing, LaBelle also expressed support for Certified Community Behavioral Health Clinics (CCBACs), the use of telehealth to expand access to addiction services, the need for targeted workforce solutions to address communities in need, working with the Department of Labor (DOL) to explore gaps in mental health parity, collecting more data and explore additional solutions to address issues of equity, among other items.

The second panel explored the complexities around the scheduling of fentanyl analogues, with some panelists postulating that scheduling reduces incentives to create analogues and thus dampens supply, while others noted their concern with the impact on mandatory minimums and research needs. The panel agreed that there is a great need for additional access to substance use disorder (SUD) services and providers willing and ready to screen and treat patients in need. They also discussed the proliferation of methamphetamine ("meth") and difficulties in treating this population especially in the outpatient setting. There was consensus around the need to reduce stigma in accessing treatment for SUD and panelists also discussed the compounding nature of stigma and racial bias impacting communities of color, noting the need for culturally competent care and equitable access.

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Energy and Commerce Health Subcommittee hearing