Tom Price Story Archives - West Virginia Public Broadcasting

Science Says: Medications Prevent Opioid Addiction Relapse

Remarks by a top U.S. health official have reignited a quarrel in the world of addiction and recovery: Does treating opioid addiction with medication save lives? Or does it trade one addiction for another?

Health Secretary Tom Price’s recent comments — one replying to a reporter’s question, the other in a newspaper op-ed — waver between two strongly held views.

Medication-assisted treatment, known as MAT, is backed by doctors. Yet it still has skeptics, especially among supporters of 12-step programs like Narcotics Anonymous, because it involves opioid-based medications.

Price appeared to side with that camp when he said during a recent visit to Charleston, West Virginia: “If we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven’t moved the dial much.”

But in an opinion piece published last week in the Charleston Gazette-Mail, he twice mentioned his agency’s support for medication-assisted treatment. Here’s a closer look.

HOW MEDICATION CAN TREAT ADDICTION

Because of how opioids act on the brain , people dependent on them get sick if they stop using. Withdrawal can feel like a bad flu with cramping, sweating, anxiety and sleeplessness. Cravings for the drug can be so intense that relapse is common.

Medication-assisted treatment helps by moving a patient from powerful painkillers or an illicit opioid like heroin to a regular dose of a legal opioid-based medication such as buprenorphine or methadone. The ideal dose is big enough to fend off withdrawal, but too small to produce a euphoric high. Patients can drive, rebuild relationships and get back to work.

“They’re not walking around high” and it gives them the chance to practice new ways of coping with family and psychological issues, said Dr. Joseph Garbely of Pennsylvania-based Caron Treatment Centers.

With counseling and education about addiction, patients can get back on track. They eventually can taper off medications, but some take them for years.

WHAT RESEARCH SAYS

Researchers studying these treatments use drug screening to see whether patients are staying off illegal drugs. If someone uses heroin while in treatment, it shows up in their urine.

A 2014 review of 31 studies found methadone and buprenorphine keep people in treatment and off illicit drugs.

The review by the Cochrane Collaboration, an international group of scientists that evaluates research, found each drug worked better than a dummy medication. A side benefit worth noting: Methadone also helps prevent the spread of HIV by reducing needle sharing, a different research review by Cochrane found.

Methadone and buprenorphine can be abused and both can cause overdoses, particularly methadone. But researchers have found that methadone prevents more overdose deaths than it causes.

For most patients, medication combined with counseling is superior to other strategies, according to the American Society of Addiction Medicine.

OTHER OPTIONS

“What’s right for one person isn’t necessarily right for another person,” Price said during a May 9 visit to West Virginia.

When asked whether he and his team leaned toward medication or faith-based approaches to opioid addiction, his reply lined up with those who favor abstinence.

Abstinence-only philosophies “are not scientifically supported,” according to the first surgeon general’s report on addiction, published in November.

Yet people who describe themselves as in recovery consistently say abstinence is important. All told, remission from opioid addiction can take years and multiple tries at treatment.

“The public needs to know that there are proven, effective treatments for opioid addiction,” former U.S. General Vivek Murthy told The Associated Press. Murthy was fired by the Trump administration after he refused to resign.

Price also mentioned a non-opioid alternative — namely an injection of naltrexone called Vivitrol — as “exciting stuff.” Vivitrol, a newer drug, can be used only with patients who have completely detoxed and has a limited track record compared to buprenorphine and methadone. Early studies have shown promise, but relapse is a danger after injections stop.

Health and Human Services spokeswoman Alleigh Marre told AP that Price’s comments don’t signal a policy change. Price “has argued that we should be open and supportive to the broadest range of options, from medication-assisted treatments – including methadone, buprenorphine, or naltrexone – to faith-based recovery programs,” Marre said.

Not informing patients about the effectiveness of treating addiction with medication is like a doctor not telling a cancer patient about chemotherapy, said Dr. Mark Willenbring, a former director of treatment research at the National Institute for Alcohol Abuse and Alcoholism. “Scientifically, this is a settled matter.”

Trump Administration’s Addiction Crisis ‘Listening Tour’ Gets An Earful

Trump administration officials have been visiting parts of the country affected by the opioid addiction crisis, including the Ohio Valley region. The administration called it a “listening tour,” and they got an earful in events marked by protests and controversies.

Some people working to combat the epidemic in the region say they’re concerned about the potential effects of the administration’s approach, including proposed health care changes and a possible return to harsher criminal prosecutions for drug charges.

The Trump Approach

Last October then-candidate Donald Trump laid out his plan to tackle the opioid epidemic. In a campaign event he focused on stopping the flow of drugs, issuing harsher trafficking penalties, and supporting addiction treatment.

“We’ll make sure they have the top treatment and get better,” Trump told the crowd in New Hampshire.

This month, President Trump sent his top health and law enforcement officials — Attorney General Jeff Sessions and Health and Human Services Secretary Tom Price — to hear from people most affected by the crisis.

Matt Boggs is executive director of Recovery Point West Virginia, which operates long-term recovery centers around the state. He was among those invited to talk with Secretary Price during his visit to the state capital, Charleston.

Matt Boggs takes an abstinence-based approach to treatment at Huntington’s Recovery Point.

“There was about 20 or so folks in the meeting. I was definitely honored to be a part of that,” Boggs said. “I was the only person in long-term recovery in the room. So that meant a lot.”

He said he appreciates that the administration is paying attention to the issue. But he has some concerns about certain aspects of their approach.

Medicaid’s Role

Boggs is worried about the effects of the administration’s approach to health care coverage under Medicaid.

He hopes the administration learned how important the Medicaid expansion from the Affordable Care Act was to those with substance use disorders in West Virginia.

“It provides these folks essential health services so that they can treat the underlying issues they have, other chronic illnesses, things like that,” Boggs said. “Without the Medicaid expansion, it would really hurt our efforts.”

Some projections estimate coverage for substance use disorders would be at risk under the House-passed version of the ACA replacement.

Price disagreed with the premise that individuals will lose health care and said the administration’s focus is on improvement.

“The goal is to make sure that the health care is the kind of care that individuals across this land need.”

Without analysis from the Congressional Budget Office it is unclear what effect the proposed bill will have on coverage for addiction treatment. That analysis is expected as early as next week.

Medical Treatment

Medicaid expansion has also helped those with substance use disorders get medication assisted treatment.

Secretary Price made a comment about such treatments involving methadone and buprenorphine during his stop in Charleston that gave some medical professionals concern.

“If we’re just substituting one opioid for another, we’re not moving the dial much,” Price said during his visit, according to the Charleston Gazette-Mail. “Folks need to be cured so they can be productive members of society and realize their dreams.”

Price then touted faith-based programs and naltrexone — a non-opioid medication.

The comment received responses from treatment specialists around the country who criticized it as going against evidence-based research on keeping every treatment option open.

“Decades of research have shown that the benefits of medication assisted treatment greatly outweigh the risks associated with diversion,” former Surgeon General Vivek Murthy wrote in a Tweet responding to Price’s comment. “It’s critical we get treatment right-millions of lives are on the line. Science, not opinion, should guide our recommendations and policies.”

The HHS office shortly after reaffirmed its dedication to medication assisted treatments and pointed out the HHS website’s link that helps individuals find medication assisted treatment.

Enforcement vs. Treatment

While Price focused on treatment during his visit, Attorney General Jeff Sessions focused on prevention and law enforcement.

Sessions emphasized prevention programs like the “Just Say No” program from the 80s.

“Illegal drugs are dangerous and deadly,” he told the crowd gathered at the University of Charleston. “Say no, don’t do it, it’s not right to do it. It’s wrong to do it. It’s wrong to help other people, lead them into drug use when they have no business doing so,” he said.

Boggs is critical of this old approach, saying while well-intended, the “Just Say No” program was not effective because it didn’t treat addiction as a disease.

“If I’m born with diabetes, I don’t have the ability to just say no,” he said. “So if folks can’t say no to drugs, then they need to be seeking treatment.”

But Boggs does like some of the initiatives put forth by the Trump administration. The creation of a task force led by New Jersey Gov. Chris Christie to develop best practices for addressing the epidemic is encouraging to him.

He would like for someone from West Virginia to be named to the task force as a representative to the unique needs and challenges the state faces in the epidemic. But it’s more important to him that President Trump follow through with the recommendations they make.

Boggs said in the meantime it is important for those working to combat the opioid epidemic to continue to make their voices heard.

“I think it’s important that we continue to advocate, we continue to talk about recovery. We’ve got to talk about prevention.”

Lawyer, CEO Want Charge Dropped Against Journalist

A West Virginia journalist arrested after repeatedly asking U.S. Health and Human Services Secretary Tom Price a question said he did nothing wrong, and his attorney and the media outlet’s founder want the charge dropped.

Reporter Daniel Ralph Heyman, who works for the independent Public News Service, was arrested by police at the state Capitol in Charleston during Price’s visit Tuesday.

He had wanted to ask Price about whether domestic violence is a pre-existing condition under the Republican health care proposal. Heyman got no response. So he tried again. And again.

Capitol police said in a criminal complaint that Heyman, 54, caused a disturbance with his persistent questions and “was aggressively breaching” Secret Service agents who accompanied Price.

Heyman said Wednesday that he used his cellphone to record audio and he had to reach over the shoulders of some of Price’s staffers to get the device closer to him.

Charleston-based Heyman was charged with willful disruption of governmental processes, a misdemeanor, and later was released on $5,000 bond. No court hearing was immediately set. The charge carries a maximum penalty of six months in jail and a $100 fine.

“I’ve never had a case in which a guy got in trouble for speaking, for talking loud,” said Heyman’s lawyer, Tim DiPiero of Charleston.

DiPiero called the statute “very vague.” During a conference call Wednesday, he and Public News Service CEO Lark Corbeil asked that the charge not be pursued by the state.

“There is no reason for this,” Corbeil said. “It’s an overreach.”

At an appearance Wednesday in Concord, New Hampshire, Price said police in West Virginia “did what they felt was appropriate” and that arresting Heyman was “not my decision to make.”

Heyman, a journalist for three decades and a Public News Service employee since 2009, said he was wearing a press badge and his questions were directed only at Price, not at White House aide Kellyanne Conway, who had accompanied Price to learn about efforts to fight opioid addiction in a state that has the nation’s highest overdose death rate.

Price and Conway later took reporters’ questions at a scheduled news conference. But Heyman decided to find Price beforehand in a hallway.

Kristen O’Sullivan, a breast cancer survivor from Athens, West Virginia, was among a small group in the hallway hoping to talk to Price about the health care overhaul. As Heyman asked questions, police officers “grabbed him by the scruff of the neck” and led him away, she said.

“It could have been handled completely differently,” O’Sullivan said. “I saw him as doing his job and asking tough questions and Secretary Price trying not to pay attention to anyone that was there.”

Robert W. Jensen, a media law and ethics professor at the University of Texas School of Journalism and a former newspaper reporter and editor, said reporters have limits on their actions in public places with politicians and public officials, especially those protected by the Secret Service.

However, Jensen also said he’s concerned that President Donald Trump’s administration “has engaged in something like open warfare with journalists. Every time there is a further infringement on the rights of journalists who both collect and disseminate information in this type of atmosphere, it’s troubling.”

The American Civil Liberties Union’s West Virginia chapter said in a statement that Heyman’s arrest “is a blatant attempt to chill an independent, free press.”

According to its website, Boulder, Colorado-based Public News Service manages independent news services in 36 states, reporting on social, community and environmental issues for print and radio customers.

W.Va. Reporter Arrested at Capitol Attempting to Question Trump Officials

A West Virginia reporter was arrested at the state Capitol Tuesday before a meeting held by U.S. Health and Human Services Sec. Tom Price.

Dan Heyman of the Public News Service was charged with a misdemeanor offense of willfully disrupting a governmental process.

According to a complaint filed in Kanawha County magistrate court, police say Heyman approached Price and Counsel to the President Kellyanne Conway as they entered the Capitol Tuesday afternoon, asking them questions. The complaint accuses Heyman of “aggressively breaching” the secret service escorting the two when he was detained by Capitol police.

The West Virginia ACLU held a press conference defending the reporter Tuesday night, saying the arrest sets a dangerous precedent and violates the first amendment of the Constitution.

Heyman could face a fine of up to $100 and 6 months in jail.

Heyman is a former employee of West Virginia Public Broadcasting.

Drug Treatment Funding in Question as U.S. Health Secretary Promises Fight Against Opioids

West Virginia’s opioid overdose death rate is two and a half times the national average, the highest in the country. Last year, 864 West Virginians died from an overdose, up by more than 17 percent from the year prior.

West Virginia Department of Health and Human Resources Sec. Bill Crouch shared those statistics at a press conference Tuesday. Crouch hosted U.S. Health and Human Services Sec. Tom Price for a closed-door meeting about the state’s struggle with substance abuse and what the federal government can do to help.

“We are losing a generation of West Virginians,” Crouch said, “and in some cases with an addicted mother and her newborn baby, I worry we are losing two generations.”

Price said President Trump is committed to battling the opioid epidemic, not just in West Virginia, but across the country.

Shortly after taking office, Trump created a bi-partisan commission on drug addiction, led by New Jersey Gov. Chris Christie, and last month announced nearly $500 million in federal grants awarded to states to combat substance abuse.

Counselor to the President Kellyanne Conway says that’s Trump’s plan- to support efforts on the frontlines.

“This will not be solved from Washington, D.C.,” she said during the press conference. “This will be ameliorated and annihilated at the state and local levels.”

Price said the president’s push to support local efforts is why Price traveling the country to meet with state officials, but it’s also why the administration is supporting two essentially budgetary actions that seem to put substance abuse treatment at risk in West Virginia, at least for some populations.

The first is health care: 170,000 West Virginians received Medicaid coverage when former Gov. Earl Ray Tomblin chose to expand the program as a part of the Affordable Care Act. According Crouch, some 50,000 of those West Virginians also suffer with an addiction.

Medicaid does cover substance abuse treatment, but a Trump-backed plan to repeal and replace the Affordable Care Act would also put an end to Medicaid expansion and result in the potential loss of treatment for those 50,000 West Virginians.

“We have serious concerns about what is going to happen with that population,” Crouch told reporters. “Our crisis right now is difficult to deal with. If we have an additional 50,000 individuals with no coverage, no way to get treatment, we think our problem is going to get light years more difficult.

Considering those difficulties, Crouch was asked about his ability to convince federal officials to keep the expanded version of the program, but the secretary said the ACA repeal comes with something that’s good for West Virginia.

“As a state that wants more flexibility in terms of Medicaid and how we utilize Medicaid monies, that’s very welcome to us,” he said.

“We believe it’s wholly possible and the opportunity exists to provide states the flexibility, the appropriate resources,” Price said of the changes he sees as necessary to the Medicaid system, “so that we can have better outcomes and better coverage for individuals in the Medicaid population.”

The repeal and replace bill that allows for state flexibility, but also ends Medicaid expansion coverage, made it through the U.S. House of Representatives last week, with three supporting votes from West Virginia’s delegation. As it heads to the Senate though, both Senators Joe Manchin and Shelley Moore Capito have expressed concerns.

The second action that may put some substance abuse programs at risk comes in the form of a funding proposal for a federal office. Trump’s administration announced a significant cut to the Office of National Drug Control Policy last week—a 95 percent reduction in his proposed 2018 budget.

Price said while the administration has proposed cutting funding to the office, it is committed to increasing spending to combat the opioid epidemic elsewhere, including through the Department of Health and Human Services, but when asked if the cut was a result of failed outcomes from the office, Prices said that was what he was asking state officials.

Protesters wait outside the Secretary of State’s Office, where HHS Sec. Tom Price held his closed door meeting Tuesday.

“That’s exactly what we’re asking and what the commission is going to be asking: what is the federal government actually doing that’s solving the problem, that’s assisting in getting better outcomes and what is it the that the federal government is doing in wasting federal dollars and resources?” Price said.

Under President Obama, the Office of National Drug Control Policy was responsible for coordinating efforts between public health and safety officials to reduce drug use across the country. The office, which is overseen directly by the White House, does not currently have a page on the administration’s website.

The proposals and their effects have some West Virginia advocacy groups speaking out, attempting to sway West Virginia’s leaders to take a different approach.

Members of the group West Virginians for Affordable Health Care stood outside Price’s Charleston meeting in an attempt to speak with him Tuesday, but were denied access to the listening session.

2 Top Trump Officials Making Stops in W.Va.

Two top officials in the Trump administration have announced stops in West Virginia this week.

Pres. Donald Trump’s Health and Human Resources Sec. Tom Price and Attorney General Jeff Sessions will be in Charleston. Both stops focus on the nation’s opioid epidemic.

Price is holding a listening event at the state Capitol Tuesday afternoon.

Hosted by West Virginia Health and Human Resources Sec. Bill Crouch, Price will meet with policymakers, first responders, representatives of treatment centers and others, according to a press release, for a conversation focused on how the federal government can support local drug programs.

Thursday, Session will give the opening remarks at a daylong opioid conference at the University of Charleston.

The conference is being hosted by the federal Drug Enforcement Agency and the Community Anti-Drug Coalitions of America as a part of the DEA’s 360 Strategy.

It will include sessions focused on drug trends, teaching prevention in schools, and how to use the overdose reversing drug Naloxone.