WASHINGTON — Rahul Gupta, MD, MPH, director of the White House Office of National Drug Control Policy, was hit all over Monday during a House Committee on Oversight and Reform Hearing on the federal response to the overdose crisis.
As often happens during a congressional discussion of substance use disorders, the Republicans on the committee focused on the issue of border control. “A [outstanding question] This is how President Biden’s border crisis and this administration’s open border policies have aided and abetted the trafficking of illicit drugs, like fentanyl, into our country,” said Rep. James Comer (R- Ky.), prominent member of the committee. “Fentanyl is being smuggled across the southwestern border at unprecedented rates…We must act now to secure our southern border to stem the flow of illicit fentanyl.”
Rep. Pat Fallon (R-Texas) also pressed the issue. When Gupta, in response to a question, said the U.S. southern border was secure but the administration continues to work with Mexico on the drug problem, Fallon called that response “shockingly inadequate,” adding “It only shows gross negligence. . The Mexican drug cartels control the southern border, not the federal government. It is a gross dereliction of duty that puts Americans at risk.
Drug therapy questioned
But the Republicans were not the only ones to express their dissatisfaction. Rep. Stephen Lynch (D-Mass.) spoke out against the use of drug treatment as a strategy to help people with substance use disorders. “We allow doctors to have hundreds of patients and just give them Suboxone [buprenorphine/naloxone] and don’t really provide behavioral health services that would address the underlying addictive activity,” he said. they buy fentanyl or methamphetamine, which is even worse. They can’t get high on Suboxone, so they turn to harder drugs,” which leads to more stabbings and other violence.
“We actually see much more violent activity because an individual on meth can be on their feet for days, and we see a lot of stabbings,” he said. Gupta noted that “People have different ways of getting the treatment… Some may go cold turkey OK, while others may need medication for varying times… We need to help people when they need it and where they need it.”
Lynch didn’t seem impressed by this response. “It doesn’t work where I am,” he said. “I’ve got tent cities, hundreds and hundreds and hundreds of people all together, right next to a methadone clinic, multiplying…I think we’re kicking out more of this stuff, and it doesn’t not helping. So I think we have to re-evaluate.”
Should cannabis be reclassified?
Rep. Ro Khanna (D-California) wanted to know why cannabis — which he says could sometimes be a useful alternative to opioids for pain management — has been classified by the Drug Enforcement Administration (DEA) as a drug. Schedule I – a class with the most restrictions – while opioids were classified in Schedule II. Classifying cannabis in Schedule I also means that researchers are not allowed to conduct large-scale, rigorous studies on it, he added. “Do you see this as a contradiction that needs to be resolved? Khanna asked.
Gupta agreed that “it’s important for us to continue to look at this from a research perspective, from a medical use perspective. Obviously, the policies that we’ve had in this country in terms of about marijuana didn’t work, and the president said then.” Khanna reminded Gupta that “the President has the executive authority to direct the DEA, HHS, and FDA to consider administratively deferring marijuana, which would facilitate research, which would facilitate patient access. .. At least make sure it’s postponed so it’s not more restricted than opioids themselves.”
Congresswoman Eleanor Holmes Norton (DD.C.) said she was “extremely disappointed that both Biden administration budgets have offered to uphold the rider that prohibits the District of Columbia from spending its local funds to market marijuana for recreational purposes”. Gupta responded that “as far as the DC racer is concerned, I understand that’s with Congress, and I’ll leave it at that. And that said, the president has been very clear that he supports decisions regarding the legalization of marijuana to be left to individual states, but at the federal level he supported the decriminalization of marijuana use and the automatic suppression of records.”
An equity lens
However, Norton wasn’t entirely negative about the administration’s response to the issue so far. “Since taking office, the Biden administration has demonstrated a strong commitment to advancing fairness and centering recovery on punishment in the federal response to the overdose crisis,” she noted. , and gave Gupta the opportunity to further explain the administration’s policy in this area.
Gupta said that with his office recently released drug strategy“one of the things we do is look at all the measures that are available to us… We were able to come up with a state model for non-violent crimes; if someone has a mental health disorder or an addiction, let’s go help the person; let’s get them treatment; let’s get them a home — instead of incarcerating them. It’s not only a good thing to do and it prevents recidivism, but it’s also cost-effective for communities. Those are the kinds of things that the strategy looks at, figuring out how to address issues at the community level and ensuring that we do so with an equity lens.”
Rep. Debbie Wasserman Schultz (D-Florida) also backed Gupta, praising her understanding of the issue. She saved her ire from Florida Governor Ron DeSantis (R) and other Republican governors who oppose Medicaid expansion in their states. “Research shows that overdose rates are lower in states that have expanded Medicaid coverage under the Affordable Care Act,” she said. “In fact, states that expanded Medicaid coverage experienced at least 10% fewer overdoses involving synthetic opioids like fentanyl, and 11% fewer overdoses involving heroin, compared to states that did not. haven’t expanded Medicaid.”
“Unfortunately, because Governor DeSantis is immune to the facts, the science, and even the shame that families must endure because of his ruthless inaction, he is unlikely to be pressured into action,” he said. concluded Wasserman Schultz. “But that doesn’t mean we stop calling out his callous indifference and that of other Republican governors and how it’s making this crisis worse and adding to the pain that millions of American families will suffer.”