The House Select Committee on Opioids & Substance Abuse met on August 8 to hear public testimony on all charges heard at previous committee hearings.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing, but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Rebecca Vance, Drug Prevention Resources

  • Gives history of Drug Prevention Resources, a nonprofit operating in Texas focusing on evidence-based intervention and prevention
  • School evidence-based prevention curricula are present in a very low number of schools across the state, network of resources meets only 10% of need
  • Substance abuse problems often begin in the teenage years
  • Roberts – Can you give an example of what you’ve seen as a successful evidence-based program?
    • 8 out of 10 who go through our Positive Action curriculum report change of attitudes & behavior re: substance abuse
    • Were able to reduce past-30-day use by ~30% in Garland due to curriculum work

 

Craig Benton, Texas Chiropractic Association

  • Long-term opioid prescription is connected to lower back pain, one of the most prevalent long-term diseases; chiropractic care can be effective in avoiding need for prescriptions
  • Current health insurance market has barriers to this type of care, experiences network issues in Texas
  • White – Asks after effective prescription policies in other states
    • Other states dispense only short-term prescriptions, with a return visit needed for an extended durations prescription
  • White and Benton discuss services available at the VA, veterans have access to chiropractic, acupuncture, etc.

 

Teresa May, Harris County Community Supervision & Corrections

  • Describes Harris County pre-trial intervention program for low volume offenders, program focuses on specific risk profiles determined by risk assessments; important to focus intensive resources on those with potential to re-offend, e.g. those with a moderate to high risk profile
  • Focusing resources on low risk individuals can be counter-productive
  • Chair Price – Heard of the RIC docket and its success yesterday, what is your next step and your biggest barrier?
    • RIC docket began in 2017, numbers of jail commitments started dropping in 2015 & population needing treatment and services has gone up
    • Impact due to pre-trial intervention program, risk assessment model, etc.
  • Roberts – Would you agree that the criminogenic targets are the be all, end all of these types of programs?
    • Absolutely, targets tell the courts what keeps individuals engaged in the justice system
  • Roberts – Do you feel there are enough resources to get this done? Speaking to how the risk assessment is created and implemented
    • Yes, risk assessment measures actual risk and factors & works very well; every single probation department has this instrument and is required to apply it
  • White – One of the difficulties I hear of is in getting the individual to accept probation with barriers like fees, how are you dealing with that?
    • Docket has a specific focus, Harris County judges have created a system where a number of individuals are released presumptively, some bond out, others are released on PR bonds
  • White and May discuss reoffenders and barriers in getting individuals to report back to the court, May notes that a low risk individual has a 1 in 10 chance to reoffend
  • White – Asks after pre-trail intervention availability for individuals who may have domestic violence charges?
    • Available for misdemeanors, individuals with other charges will likely end up in other courts
  • White – There are also challenges in getting all stakeholders to work together, who is the leader on that?
    • Hard data was the key factor in bringing parties together, Coordinating Council meets every other month
  • White and May discuss applicability of risk/needs model
  • White – Have tried to think of why this wouldn’t work in other parts of the state, and my conclusion is we would be paying less for the similar bad outcomes

 

Julia Heath, Texas Don’t Punish Pain

  • Should be mindful of needs of population with chronic pain management needs
  • 2016 CDC guidelines and push against prescription opioids has created liability for prescribing doctors & has negatively impacted patient’s lives; one size fits all approach is not appropriate
  • Sheffield – Are there certain diagnoses that are more prominent in this group than others?
    • Spinal arthritis probably most common, other issues like cancer, fibromyalgia, etc.

 

 Donald Shipley, Self

  • Opioids medications can be beneficial for many patients, doctors are subject to a good system of checks and balances; dissenters are targeted by the DEA on suspicions of overprescribing
  • Chair Price – Point is well taken, Committee is not intending to remove opioids as an option, only intending to ensure these are used appropriately
    • Doctors are being encouraged against prescribing opioids in favor of other ineffective medications

 

Christian McGarity, Self

  • Not a bad idea to regulate short-term prescriptions, but new regulations could negatively impact patients with rare conditions; regulations currently allow doctors to prescribe with safeguards
  • Need to have a palliative exception for patients with lifelong pain management needs

 

Kaleigh Becker, Texans Standing Tall

  • Prescription drug use is a serious issue in Texas, many high school students have taken prescription drugs without doctor order; key component in reducing youth usage of prescription drugs lies in restricting access, many obtained the medication from relatives
  • Drug take-back programs are an effective solution, but not many resources available to fund and maintain these programs
  • Chair Price – Have discussed take-back programs, many don’t appreciate the existing demand for these programs; asks after states and local governments supporting these programs
    • 4 state and 22 local governments have passed EPR-like policies, pharmaceutical companies tried to block attempts in California
  • Moody – have we looked at the effectiveness of PSAs, etc. in combo with take-back programs?
    • Important to run info campaigns in tandem
  • Roberts – This is a very simple way to deal with a significant issue, Walgreens has a pervasive program in my area periodically, have you spoken with any of the chain pharmacies running programs?
    • Can put you into contact with someone with more information
  • Chair Price – Some of the cost is involved with the collection, DEA needs to pick up
  • Roberts – IS there model legislation front the 4 states you mentioned?
    • Can get you this information
  • Chair Price – have seen language from New York, something to evaluate

 

Robin Peyson, Communities for Recovery

  • Communities for Recovery is a Recovery Community Organization (RCO) focused on community-driven recovery activities and support services, RCOs are designed to bridge gap between treatment and an individual’s personal life
  • RCOs are missing from the state’s opioid toolkit, but RCOs are excluded from the list of allowable providers under Medicaid

 

Andrea Anderson, Alliance for the Treatment of Intractable Pain

  • ATIP is a patient advocacy organization that would like to be included in conversations centering on pain management; has many researchers and pain professionals
  • Roberts – Out intent is to make barriers to obtaining chronic pain management, do you believe a chronic pain patient’s needs are best managed by a pain specialist?
    • Yes and no, someone who is a long-term pain patient likely needs this level of care, but there are only 4,000 pain specialists in the US overall; primary care needs to be included, especially for more common pain conditions

 

Matt Boutte, Texas Academy of Physician Assistants

  • PAs have been prescribing since 2003 with no increase in discipline issues with these prescriptions, PAs are committed to safe prescribing
  • PA profession has the highest level of registrants to the PMP, profession is well-positioned to assist in treatment of opioid crisis through MAT & also co-occurring behavioral health issues
  • Sheffield – Asks after issues with he 1 to 10 pain scale and the difficulty of treating individuals
    • Difficulty comes in with 5th “vital sign” being pain, there is funding and other pressure on keeping these pain levels lower; complicated but the fact that pain is sometimes a key component
  • Nevarez – Pain is not usually associated with a resting pulse, etc.?
    • Generally true
  • Nevarez – And you look at the 5th “vital sign” of pain after the others?
    • Correct
  • Nevarez – Could you come to the conclusion that what drives abnormalities in the previous 4 has nothing to do with the 5th?
    • You could
  • Nevarez – Would it help to separate it out for a cursory look until the other factors are examined?
    • It could help

 

Doug Reed, Phoenix House

  • Phoenix House treats adolescents, cost of treatment has been increasing significantly & reimbursements are ~40% actual cost
  • Phoenix House treats patients at a substantial financial loss, utilizing all of the available resources provided by the state would mean increasing costs; increased funding is needed to meet demand and attract more providers

 

Drew Dutton, Phoenix House

  • Provides overview of Phoenix House operations
  • Treating adolescents has become increasingly complicated, adolescents present with multiple use disorders and often with co-occurring behavioral health disorders

 

Pace Lawson, Self

  • Asking Committee to include recovery residences as part of the state’s opioid response

 

Ralph Fabrizio, House of Extra Measures

  • Should include language clarifying housing rights of persons in recovery, important to consider the fair housing realtion recovery

 

Carl Hunter, Self

  • Encourages legislation supporting recovery housing efforts

 

Adriana Kohler, Texans Care for Children

  • Effective prevention, increased access, & recovery support would promote parent & child wellbeing, also would keep children in the home
  • Although this is a priority population required to be seen in 72 hours, access is limited by resources/space
  • Data on substance use trends is critical
  • White – What is the number one cause of maternal mortality?
    • Leading cause is overdose during pregnancy and up to a year postpartum

 

Jarvis Anderson, Bexar County Community Supervision and Corrections Department

  • Implementing best practices has been very effective, assessment of criminogenic factors useful to develop diversion programs
  • Support on re-entry to society is crucial
  • White and Anderson discuss how success in these types of programs is a community effort, need to collaborate with community resources

 

Lauren Rose, Texans Care for Children

  • Prevention and early intervention is a cost saving measure
  • Schools play an extremely important role in prevention and early intervention, should find paths to treat children while keeping them in the classroom

 

James Strader, Self

  • Presents information on studies detailing alternative generic medications that could assist in pain management, but are not currently approved or supported by industry
  • Chair Price – What should the takeaway be for our report or our consideration
    • Info needs to be spread, needs to be coverage and legislative support for generic drugs
    • PBMs do not support generic drug measures
  • Roberts – One of the things I hope for is a change in the plan design for mandatory generic, PDL is currently designed to chase rebates only and prevents usage of tried & true medications

 

Rodolfo Morales Urby, Texas Doctors for Social Responsibility

  • Advocating for expansion of health coverage and improved access to care
  • Shares personal experience of son lost to overdose
  • Uninsured Texans are at high risk, access to addiction services should be expanded

 

Kenneth Johnson, Quest Diagnostics

  • Have seen the effects of the opioid epidemic in their facilities, would like to be a resource
  • Drug testing can play a vital role in understanding and treating patients
  • Chair Price and Johnson discuss misuse of opioids by patients, studies show over 50% of patients in Texas misuse prescriptions

 

Anais Biera Miracle, The Children’s Shelter San Antonio

  • Gives overview of Children’s Shelter operation, works to restore and maintain families & see many children who are exposed to parental substance abuse, can lead to trauma

 

Ivonne Tapia, Aliviane, Association for Substance Abuse Programs

  • Substance abuse is a disease with severe public health and budgetary concerns if not addressed early; could expand current infrastructure to reach many more individuals with sufficient funding, could address lack of care capacity with proper rates to providers
  • Moody – Can you highlight your recommendations?
    • Provide more funding for prevention and fund rate increases for treatment and recovery

Laura Guerra-Cardus, Children’s Defense Fund

  • Committee should give serious consideration to impact Texas’ high rate of uninsured individuals has on blocking response to the opioid epidemic
  • Safety net programs are stretched thin, only served 5.8% of uninsured Texans with substance abuse disorders

 

Richard Laker, National Alliance on Mental Illness Texas

  • Veterans are unaware of the programs available, many services exist for veterans, but needs to be more education

 

Greg Hansch, National Alliance on Mental Illness Texas

  • Fully supports recommendations of Substance Abuse Disorder Coalition of Texas
  • Integrated care for co-occurring disorders is the best way to respond to substance abuse; mental health disorders commonly co-occur with substance abuse
  • Separate mental health and substance abuse treatment systems leads to fractured care for patients
  • Collaborative care interventions were more likely to lead to evidence-based treatment and saw more sustained recovery
  • CMS recently adopted a new collaborative care model, states can incorporate this model through several reimbursement strategies

 

Alissa Sughrue, National Alliance on Mental Illness Texas

  • Provides statistics on substance abuse disorders in those involved with the foster system/CPS, trauma and parental use if predictive of children developing substance abuse disorders

 

Closing Comments

  • Chair Price – Report is being developed, asks for all material to submitted for consideration, Nov. 1 deadline for completion
  • Moody – We’ve criminalized individuals with mental health issues and substance abuse disorders, work is important
  • Moody – RCOs developed peer-to-peer supports, perform a great service in communities