Fentanyl has made the opioid crisis ever more deadly. The sharp increase in fatal overdoses from fentanyl and fentanyl analogs (e.g., synthetic opioids) accounted for nearly 30,000 overdose deaths alone out of the estimated 72,000 Americans who died from drug overdoses in 2017. Even more concerning, the DEA has seen a sharp increase in fatal overdoses due to fentanyl-laced counterfeit opioids and non-opiate prescription medications. Counterfeit prescription pills containing fentanyl or fentanyl analogues have now been found in 45 states and have been linked to deaths in 26 states. This dangerous trend is alarming as fentanyl is lethal at minimal doses. Once it is mixed into pill form with a pill press, Americans cannot distinguish if the pill is counterfeit or not. Counterfeit drugs are further complicating the already complex opioid epidemic.
Venture Global is actively engaged in combatting the opioid crisis and fentanyl counterfeits through its client work and several projects in the opioid space. Most recently, we were selected to work with the Partnership for Safe Medicines’s Fentanyl Council, a joint project to raise awareness of illicit fentanyl's danger and develop state and federal solutions. Like many policymakers, pharmaceutical manufacturers, law enforcement, and healthcare professionals, Venture Global has been increasingly concerned by the deadly impacts that counterfeit drugs, and especially fentanyl-laced counterfeit drugs are having on Americans. Fentanyl is continuing to worsen the opioid epidemic and comprehensive, decisive steps, policies and programs are needed to stem this epidemic. The opioid package, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act or HR 6, which was recently passed by Congress and was signed into law on October 24th is a critical legislative step in combatting this dangerous crisis.
Today, we want to voice our sincere support and appreciation to Members of Congress and the Administration on the passage and enactment of the comprehensive HR 6. This law provides important tools and resources for opioid use disorder prevention, recovery, and treatment. The bipartisan, bicameral bill was worked on by 8 committees in the House and 5 committees in the Senate. The approximately $8 billion package includes provisions on developing new non-addictive painkillers, improving prescription drug monitoring programs (PDMPs), and establishing comprehensive opioid recovery centers. We thank Congress and the Administration for the provisions which give law enforcement better capabilities to combat opioids and counterfeit medicines, including dangerous fentanyl-laced counterfeits.
HR 6 includes the Synthetics Trafficking and Overdose Prevention or STOP Act. The amount of inbound international mail is almost impossible to inspect and not all mail shipped through foreign posts require the same advance electronic data (AED) as already required for private carrier (i.e. FedEx, UPS) shipments. At present, only about 36% of incoming packages include AED. HR 6 will require 70% of AED to go to the USPS for all foreign countries and 100% of all mail shipments from China by end of the year (12/31/2018). If there is not compliance, the GAO has to report to Congress by June 30, 2019 of the reasons and recommendations for full compliance.
The Office of National Drug Control Policy (ONDCP) was reauthorized as part of the package. One of its key programs, the High-Intensity Drug Trafficking Area (HIDTA) programs, was reauthorized at its current FY18 funding level. ONDCP will also receive funding to provide supplemental grants to high-drug trafficking areas to be able to test fentanyl, purchase protective equipment, and training on how to handle dangerous substances.
HR 6 also reauthorizes funding for first responder training, authorized through the Comprehensive Addiction and Recovery Act, to include training on safety around fentanyl, carfentanil, and other synthetic and dangerous substances. It expands the eligible entities substantially to include health care providers, pharmacies, community health centers, tribal health facilities, and mental health providers. This is needed more than ever as a number of first responders and law enforcement officers have experienced dangerous overdose events as a result of exposure to fentanyl.
A pilot program to detect fentanyl and other synthetic opioids is also included in the legislation. This grant program will allow public health laboratories and law enforcement laboratories to work together to determine best practices on handling and testing of these dangerous substances, as well as improved diagnostic technologies, postmortem data collection, and portable testing equipment.
Finally, HR 6 includes several provisions on prescription drug disposal, a key component in medication safety. This includes grants to states to increase the access of prescription drug disposal programs. Another component will allow hospice workers to dispose of unused medications on site or in patients’ homes.
This bipartisan effort is a critical and expansive step in addressing the opioid epidemic. It expands and reauthorizes programs ranging from prevention to treatment, funds the research of less addictive drugs for pain management, and expands treatment to individuals with substance use disorders including pregnant women. Passing the STOP Act in this package is particularly important to us and our law enforcement partners as it will help stop the influx of drugs from being imported from overseas.
The array of initiatives in this law must be implemented efficiently and evaluated to ensure that the funding is being utilized. This is especially important for the prevention measures in the legislation, which ultimately are much more cost-effective than treatment. We hope these efforts do not end with this law but will continue. The opioid epidemic is complex and this law will not magically fix the problem.
The opioid epidemic is the deadliest drug epidemic to-date and warrants an immediate and comprehensive response. However, more needs to be done to address and treat all substance use disorders, not just opioids. Broader measures should be considered by Congress that address the disease, not just the substance.
Feel free to begin a discussion, offer a comment, or request more information about our consulting services by emailing Sven Bergmann at SBergmann@Ventureglobal.com.
Bergmann is a Managing Partner at Venture Global and advises brand owners, technology providers and governments on anti-counterfeit strategies, programs, and technologies.