Ag Secretary Vilsack Says Long Past Time For Missouri To Adopt Drug Monitoring Program

Jun 13, 2016

U.S. Agriculture Secretary Tom Vilsack heads an interagency task force charged with addressing the problem of opioid abuse in rural communities.
Credit U.S. Department of Agriculture

In 2014, opioid abuse accounted for more than 28,000 deaths in the United States, according to the Centers for Disease Control and Prevention.

Missourians accounted for more than 1,000 of those deaths, according to Sen. Roy Blunt of Missouri, and last week a bill negotiated by Blunt and approved by the Senate Appropriations Committee hiked federal funding to combat opioid abuse to $261 million, a 93 percent increase over last year’s amount.  

The vote came after the Obama administration in March announced a variety of measures to address the national epidemic of prescription drug and heroin abuse, including expanded access to treatment and increased funding for states to purchase the opioid overdose reversal drug naloxone.

Opioids, a class of drugs used to treat pain, include prescription drugs like OxyContin, Vicodin, morphine and methadone; illegal drugs like heroin; and synthetic drugs like fentanyl, which is used to treat severe pain and is 50 to 100 times more powerful than morphine. The rock musician Prince died from an overdose of fentanyl, according to a report released by authorities 11 days ago.

The University of Kansas Medical Center and Kansas City University of Medicine and Biosciences are two of the more than 60 medical schools that, beginning this fall, will require students to take some form of prescriber education in line with recently released guidelines from the CDC for prescribing opioids for chronic pain. Among other things, the guidelines require clinicians to first consider nonopioid pain relievers, physical therapy or cognitive behavioral therapy.

Rural areas have been hit particularly hard by the opioid epidemic, and President Obama recently asked Agriculture Secretary Tom Vilsack to oversee an interagency task force charged with combating the problem. On Monday, KCUR spoke to Vilsack, a former governor of Iowa, about the initiative. The interview has been slightly edited for length and clarity.

The president has asked you to tackle the problems of opioid and heroin abuse in rural communities. Could you describe the extent of the problem in rural communities and whether it's worse there than in other places? 

Well, in a state like Missouri, it definitely is an issue. With a death rate connected to opioid and heroin overdoses much higher than the national average, it's a serious problem in rural areas for a multitude of reasons: One, because people who live in rural areas work hard and they oftentimes have injuries and issues that require going to a doctor. They get prescribed pain medication and next thing you know they're hooked. And the reality is there's such a lack of treatment options in rural areas that sometimes it's very difficult for people to turn their life around. 

This is a serious problem for the country – rural and urban. We've seen an increased use of opioids, we've seen an increased number of deaths connected to opioids, we have significant health care costs and criminal justice costs connected to opioid abuse. And the reality is the president realizes the need for a very aggressive effort, particularly in rural areas, to expand prevention opportunities and access to treatment, make sure that recovery is supported completely by the community and reforming our criminal justice system, all of which requires resources. 

Some critics have said that the administration waited too long to combat this epidemic. What do you say to that? 

We've been pretty aggressive in an effort to try to expand information, working with the medical community to increase and improve prescriber training, working with medical schools as well and nursing schools. We've expanded access to Narcan and naloxone so that overdose situations can potentially be prevented from resulting in untimely death. We've looked at the CDC and new guidelines for prescribing. We've increased monitoring efforts and encouraged states.

The only state, unfortunately, in the union that does not have a monitoring program is the state of Missouri. It really does need to rectify that, because there's too much opportunity for doctor shopping if you don't have a monitoring system. We've expanded and provided resources for access to treatment, a number of communities now benefiting from those grants. But the reality is that this is a very serious and significant, broad-reaching problem, and it does require additional resources, which is why the president has put a focus on asking Congress to provide mandatory money so that we don't have to negotiate about this. We really need to be aggressive about it. We need to provide additional resources for treatment and providers. 

Where does that request with Congress stand? 

It's in the budgeting process and hopefully during the course of this summer and fall, Congress sees the importance of adding additional resources. Congress right now is passing a series of authorizing acts. These acts are really confirming what's already taking place through executive action, encouraging us to do more in the area of prevention, treatment and recovery support. That's already happening. And authorizing acts are simply permission to do what we're already doing. But without the resources to expand medication-assisted treatment, without the resources to provide for additional providers that have authority to use these medication-assisted treatments, we're not going to be able to help as many people as we could. And that's the sad reality. 

In the meantime, we're working with states – state governors and state legislatures to see if they can appropriate resources to expand access to medications, to expand access to reversal drugs, to continue to expand prevention efforts. But at the end of the day, Congress really has a very significant role to play here as the president continues to encourage them to act and act aggressively. 

You mentioned a moment ago that Missouri is the only state in the union without a prescription drug monitoring program. Does that lack of a PDMP significantly hinder efforts to combat opioid addiction and abuse? 

Well, it clearly does. If you don't have a monitoring system, then essentially you are encouraging people to continue to go to multiple prescribers and get multiple prescriptions. You're encouraging and making it harder for states that do have monitoring programs to avoid people crossing over state lines to get access to additional medications. There are ways to deal with whatever privacy concerns folks have in the state legislature about this, but at the end of the day it's a sad statement, I think, about the state of Missouri that it's the only state in the country that doesn't have a monitoring program. You even have a city and a county in the state of Missouri that see the wisdom of having a monitoring program. St. Louis County and St. Louis City have adopted their own ordinances, and the reality is, the time is long past for Missouri to add itself to the other states that do have monitoring programs.

Opioids were a factor in more than 28,000 deaths in the U.S. in 2014, which is a record. What exactly is driving this epidemic?

Increased use of opioids, first and foremost. A 300 percent increase in their use since 1999. Two hundred fifty-nine million prescriptions have been filled. And unfortunately and tragically, nearly 2 million Americans are currently abusing those prescriptions – they're using them for purposes other than pain medication.

That's why a focus has been placed on encouraging physicians and dentists to use alternative methods for dealing with pain, first and foremost. And then if opioids have to be prescribed, that they're prescribed in appropriate dosages, that individuals are not given more pills than they absolutely need and that physicians do indeed use the monitoring systems that are set up to make sure that they're keeping an eye on potential abuse situations. And if there is an indication of abuse, then trying to provide help and assistance to get people in treatment and make sure that they are in a community that supports their recovery. 

The CDC recently issued guidelines to doctors and dentists regarding the prescription of opioids and there was some pushback from the medical community, thinking that maybe it was a bit of overreaching. How do you respond?

Well, look, it's certainly a difficult situation that doctors and dentists have – when people are in pain they obviously want something to take care of the pain. But I think what the CDC did was to provide a process by which you could go through a variety of steps to make sure that you are providing the treatment that is most effective and most needed without increasing the risk of abuse or addiction. I think everybody understands that; I think a number of medical schools and nursing schools are seeing the wisdom of including that in additional training for medical professionals.

And not only does the CDC take a look at this, but the FDA is also placing a warning now on the prescription pills, making sure that folks know there is a risk of addiction. I mean this is a serious circumstance. You mentioned the number of lives that were lost – 84 on average a day – $25 billion in health care costs that could be avoided, $5 billion in criminal justice costs that could be avoided, $25 billion in lost productivity that our economy needs from people who are no longer working or can't work because of an addiction. These are serious consequences and costs. And I think it does require some aggressive action. Certainly the administration's done what it can do, but it does require a partner and Congress has the opportunity to step up and really provide resources that could significantly expand access to treatment and significantly expand, particularly in rural areas, access to providers and professionals who could provide help and assistance. 

Finally, I understand that this is an issue that is personal for you. Could you talk a little about that? 

Well, it is very personal. I grew up, after I was adopted by my parents, in a home where my mom struggled with prescription drug addiction and alcoholism during my early life, and it was a tough, tough situation in our house. Mom was hospitalized a number of times. She finally decided, on Dec. 25, 1963, to begin the process of turning her life around, but the reality is, she never would have been successful had she not had a supporting community, if she had not had access to long-term treatment, if she hadn't had AA meetings and sponsors and people she could talk to on a regular basis. She lived in a city, so she had the advantages of living in a city. Unfortunately and tragically, today in many rural areas people will look for treatment but can't find it (or) get treatment but then need support of a community, someone they can talk to on a regular basis that understands what they're going through, and oftentimes they find it hard to find those AA meetings or find those treatment centers in rural areas. That's why it's incredibly important that we understand the scope of the problem and the fact that it has to be addressed aggressively in all areas of the country. 

Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR. You can reach him on Twitter @DanMargolies.