Republican and Democratic senators have shown willingness to give NIH special flexibility to move faster on research connected to the opioid epidemic.
Senate HELP Chairs Sen. Lamar Alexander and Sen. Maggie Hassan (D-NH) used a hearing on December 7 to query NIH Director Francis Collins on the benefits of giving NIH "other transaction authority," and why it would be useful with regard to opioids. Today's hearing focused on implementation of the 21st Century Cures Act.
Collins told the committee NIH could use the special exception from Congress to help it advance programs on non-addictive pain medicines. This would let NIH proactively approach companies or universities instead of waiting for them to submit grant requests. Such a move also could give NIH more muscle to hold contractors accountable if they are not meeting the terms of their work agreements. Collins said.
Sen. Bill Cassidy (R-LA) raised concerns that the National Institute of Drug Abuse wasn't putting enough resources towards opioids and mental health. Cassidy said NIDA's budget has not increased as much as other NIH institutes, despite the high disease burden of the opioid epidemic. Collins said that Congress has line item budgets for each NIH institute, so lawmakers would need to direct more money to help NIDA increase its workload.
The Labor HHS Subcommittee of the Senate Appropriations Committee, which is responsible for funding NIH, held a hearing on opioid issues on Dec. 5. NIH Director Francis Collins briefed the senators about the IPRCC, the National Pain Strategy and the National Pain Research Strategy.
According to Robert Saner of the Pain Care Coalition, there were positive exchanges concerning pain research needs, which may lead the subcommittee to seek more pain research funding in future years, although the reality of budget politics will be a major obstacle. It’s likely Congress will pass a series of short term continuing resolutions (CRs) for FY2018, and maybe 2019 and beyond. Unlike annual appropriation bills, CRs make it difficult to get obtain more than token growth for NIH for pain or other research areas.
There is some exploration now on the Hill of special “supplemental” funding for the opioid problem, but the prospects are far from certain, and there will be strong pressure to put those new dollars, if they materialize, into overdose prevention and addiction treatment.
In the wake of recommendations recently issued by President Trump's commission on combating drug addiction and the opioid crisis, its chairman, New Jersey Governor Chris Christie, announced at congressional field hearing on Nov. 28 that he believes physicians should be required to enroll in continuing education courses on opioid prescribing to maintain their DEA prescribing authority.
As reported by MedPage Today, Christie told the lawmakers: “We’re not educating our future doctors, nurses, and dentists on the dangers of these drugs. We grant DEA licenses to write opioid prescriptions without requiring medical education.”
When asked how mandatory prescriber education programs could be implemented, Christie placed the burden on the states. “The battle will be won with the state and federal government, with the state government taking the lead. Our view is that there should be accountability block grants—block grants should be sent to the states and Congress should be demanding accountability from the state in return for block grants. Force me as a governor to be accountable for what I’m doing.”