Ep. 79 Sen. Maggie Hassan: the SUPPORT Act

NICIE PANETTA: Hi there, and welcome to the second to last edition of the MidPod, the Midterms Podcast. I’m Nicie Panetta, with Heather Atwood. We’ve spent so much time in the last year with candidates running for congress, with their staff and with committed volunteers. And we wanted to devote one episode to reason for all those coffee hours, all those rallies, all that fundraising and all that door-knocking in the rain: making laws to help people. Today we want you to hear from one legislator about one law focused on one pressing problem. Senator Maggie Hassan, Democrat of New Hampshire, is going to tell us about the SUPPORT Act, which provides $6 billion dollars in federal funding to fight the opioid epidemic. You probably know -- especially if you’ve been listening to the MidPod -- that the opioid epidemic is a national health emergency. It spawns tragedy every day in our cities and towns. About 50 thousand people will die of an overdose this year, almost as many Americans as died in the whole Vietnam War. Wherever we traveled, we found families struggling with this crisis. Remember Talley Sergent, running for Congress in West Virginia?

TALLEY SERGENT: So for me this isn't a talking point. My sister is an addict and she has three kids. One's 18, one's 16, and one's 11. And it's something that I've had to live with with her for the last 20 years and it's really ripped my family apart to be quite honest. And it's ripping people's family apart right now. I mean the new West Virginia family consists of grandparents and grandkids. I mean, no state is immune to this and if we sit back and wait for someone else to take the reins it will never happen. Number one I think we've got to hold the pharmaceutical companies accountable. They're dumping down in this small town called Kermit in southern West Virginia is like 438 people. They dumped over a million five pills. What? You kidding me? Like, no. You know, people who write the prescriptions - it's not every doctor it's, you know, a few bad apples out there. And that's not OK. And people need to go to jail for that. So, you know, addiction is a disease. For the addicts who continue to use, we've got to find ways to help make them better from this disease. But for me personally it's about breaking that cycle. It's about getting into the schools, because that's the one safe place these kids in this state have every single day for 180 days a year.

NICIE: Remember Dr. Don Burke in Pittsburgh?

DR. DON BURKE: I'm really worried about this epidemic at a national level because this exponential growth process doesn't show any signs of letting up to the extent that I have gone on record now in public to take this highly predictable pattern of growth that is highly predictable pattern of growth and say well what's likely to happen in the next five years because we're on a pattern that is as highly predictable. And if you do that then the total number of deaths that we will have just in the next five years from overdoses will be somewhere on the order of 300 to 500,000 deaths in the United States.

NICIE: And here’s Vicky Dwelle who attended our potluck in Michigan 11.

VICKY DWELLE: And that’s why I'm raising my grandchildren. My oldest daughter is a heroin addict. From what I understand she got hooked on Oxycontin.  It's the story she had her wisdom teeth pulled and it went from bad from worse there. And we took our first grandson 10 years ago and then she had another baby and we got him and then we've lost her for years. We would hear from her I kept track of her through the court system but we would not hear from her for years and her time funny thing is we've adopted the boys and she was finally picked up this April the first time I heard from her was this April in almost three years. And as I said through the Maricopa County I knew that there were warrants out for her arrest. I knew stuff was up and I talked to I saw that she'd been arrested and I called the attorney he got permission to talk to me. He said she's a mess. So she detoxed in jail.

NICIE: SO many families. So many first responders. So many communities crying for help. Congress and the Trump Administration actually did something this year in response to these pleas for help.  The bipartisan SUPPORT Act passed both houses this fall and was signed into law on October 24th. As a side note, we recommend going to congress.gov to look at the history of the bill and see how many different bills from different members of congress in both houses got boiled down into this one bill. It’s a great way to get a glimpse of the complexity of the process. We reached out to members from both sides of the aisle to tell us about this example of Congress doing its job, and were delighted when Senator Maggie Hassan agreed to speak with us. Here’s our conversation with Senator Hassan, who spoke to us from a recording studio at the US Capitol.

NICIE: We're really so glad that you can be with us briefly today to talk through the recent bipartisan legislation on the opioid crisis here on The MidPod we spent a lot of time on campaigns and the 2018 elections. But it's great to spend some time on lawmaking and policy and particularly on an issue that has affected so many Americans we've we've interviewed in our travels.

MAGGIE HASSAN: Yeah it's really an issue that affects people from all walks of life. Everywhere you go. And so it's something that even in the midst of a particularly turbulent midterm election cycle, members of Congress really did work together on.

NICIE: That is so exciting to hear. And we should tell you that when we were traveling the country we were really first introduced to the just desperate situation across this country this epidemic has brought. And we were wondering when you were first personally aware of the scope of this epidemic.

HASSAN: It's hard for me to pinpoint a particular time. It is an epidemic that affects everybody it affects our rural communities, our urban communities, our suburban ones, it affects young people maybe who have had a sports injury and get treated with opioids and find themselves addicted. It impacts people who have had chronic pain and were treated with opioids. It affects people who try an opioid just once or twice with peers and then discover that they're particularly vulnerable to becoming addicted. So it impacts everyone it impacts not only the people who have the disorder it impacts their families, their employers it's impacting our law enforcement. So I began hearing about it while I was governor and began working on it pretty much from the get go. And New Hampshire's been one of the hardest-hit states in the country for a whole variety of reasons. We still see a large percentage of our opioid deaths in our state caused by Fentanyl overdoses. And as you know Fentanyl is much more lethal even than heroin and so it's something that I've been trying to bring resources to and develop best practices about both on the public health side of it but also on the law enforcement side of it for some years now.

NICIE: Do you want to talk through the history of the bill itself and what you see is the key provisions that will help your constituents in New Hampshire?

HASSAN: Sure. This bipartisan bill is called the Support Act which stands for substance use disorder prevention that promotes opioid recovery and treatment for patients and communities act, long name, that's why we call it the Support Act. But there are a number of critical provisions. First of all I'm just really grateful to Senator Alexander who's chair of our committee and a ranking member Senator Murray for the bipartisan work they did on it. What happens in Congress a lot is that a number of us introduce bills and then as we work them through our committees we tend to fold them all into one big comprehensive bill when there's a lot of common ground. And so among other things this bill will substantially increase the resources on the frontline for treatment. It does that in a variety of ways helping get more people licensed or certified to provide medication assisted treatment but also helping facilities that provide that kind of treatment be able to do it for more people. So that's a very important provision. That's something I worked on with Senator Portman, a Republican from Ohio. The other thing we want to make sure we do is that we're understanding best practices and really scaling them up. So Senator Capito and I have a provision in this bill that takes existing successful treatment centers and really helps scale them up to integrated prevention treatment and recovery centers so that there will be more resources on the front line for all different aspects of treatment and recovery. But again focus being on the gold standard here which is individualized medication assisted treatment and supports which we are beginning to see really does help people get into recovery and stay there.

NICIE: That's great to hear because we heard from former addicts that we interviewed that their concern is that medication assisted treatment is not widely available enough and it even has a stigma attached to it in some cases.

HASSAN: So right now you can go to medical school and when you graduate you are automatically qualified to write a prescription for an opioid. You can't at the same time write a prescription for the medication that would help somebody recover from substance use disorder. So one of the provisions of this bill the one that Senator Portman and I worked on literally says to medical schools if you develop courses in medication assisted treatment that are certified by the federal government your graduates who take those courses will be able to provide this kind of treatment anywhere they go in the country automatically so that we are beginning to get more doctors but not just doctors nurse practitioners and others on the frontlines who can prescribe this very important treatment. There are a number of other aspects of the bill too that go towards law enforcement giving them more tools not only to be safe themselves on the front lines but also making sure that we are cracking down on the importation of fentanyl into this country also making sure that we are holding pharmaceutical distributors accountable when they don't do their job in spotting and flagging diversionary shipments of illicit opioid. So there are a number of pieces in here for law enforcement as well as for the public health piece of this crisis.

HEATHER ATWOOD: We understand that the administration, the Trump administration, may have made it a priority to direct funds to pharmaceuticals for developing non-addictive painkillers. Do you want to talk about that a little?

HASSAN: Well there are certainly parts of this bill that direct our medical researchers in the Federal Government to look at how we can develop non-addictive pain treatment because obviously some of this epidemic is fueled by the use of opioids to treat pain. And there's a long history there of the pharmaceutical industries involvement in marketing opioids and frankly being deceptive about the addictive qualities of opioids. So it's a complex set of events but at the end of the day we think it's very important that our medical community turned to research how we best treat especially chronic pain with methods and or pharmaceuticals that aren't addictive.

NICIE: And then a process question: What would you say were the key sticking points and were they more between the House and the Senate, were they between the administration and Congress, and how did you work them through?

HASSAN: Well I don't know that I would say they were sticking points per se but I think one of the most important things we achieved here was, and this was something that I was grateful to the administration for was making sure that the hardest-hit states got their fair share of federal dollars to help them combat this epidemic. So New Hampshire is particularly hard-hit depending on the month we are either the second or third highest per capita death rate from this epidemic of any state in the country. And generally speaking West Virginia and Ohio are up there with us. It gets very difficult to try to get other states to give up dollars to go towards a state that is harder-hit. So the administration really helped us recalibrate the formula. And as a result New Hampshire is getting substantially more money than it was going to get under an old formula and that was a very important part of this bill. And similarly other states with high per capita death rates will get a level of support that reflects their actual experience rather than just their population. That was probably one of the most difficult things for us all to achieve together. But we did and the administration really heard us loudly and clearly on that. And I'm very appreciative of their efforts.

NICIE: And who ran point for the administration? I know the surgeon general has personal family experience with this issue. But who are your key counterparts?

HASSAN: There are any number of people in the administration. So certainly you probably all know that Kellyanne Conway was one of the people who got involved in this. Secretary Azar from the Department of Health and Human Services is the one who really I think was the point person on helping us resolve issues around the distribution of federal dollars to the hardest-hit states. At the end of the day, I remain concerned that it took as long as it did for us to get this done. When I came into the Senate I had been a governor there were had been bipartisan work by governors there was a strong blueprint for how to proceed forward but at the end of the day we were able to come together. We did get this bill done. There is still much more work to do and that's something I don't want anybody to lose sight of. The funds that we have allocated are a vast improvement from where we were but it's not nearly enough and we know that. There is still work we have to do to develop data about the effectiveness of peer to peer recovery services something that anecdotally we hear a lot about. But this was a very good start and I'm very very grateful to members of Congress on both sides of the aisle and the administration that we were able to get it done and I was excited and honored to be at the White House last month to be there when the President signed the bill.

NICIE: And that that maybe is a great way to wrap us up as it sounds like for one thing there's not a lot of new money. There's no new federal money in this bill right? Every every dollar is eventually going have to come from someplace else.

HASSAN: I want to be clear. We passed a bipartisan spending agreement and then appropriations bill that actually did increase over two years federal spending on this epidemic by six billion dollars. So it is true that this bill didn't itself appropriate new money but we did take action in our bipartisan spending agreement to significantly increase resources for the opioid epidemic. And this bill really is directing how those monies will be spent and distributed.

NICIE: Okay that's really helpful and maybe an example of what I was trying to get to which is one of the reasons we so wanted to speak with you about this is we have been struck by the lack of media coverage and the lack of public attention to the fact that this bipartisan effort did take place and what would your advice be to our listeners if they want to get involved with the next phase of federal action on this crisis?

HASSAN: First of all I will just say that you know I'm very grateful to you for covering this because I think one of the things that happens especially during election cycles is that the media tends to cover conflict not agreement. And there is agreement and common ground still in Congress. And it is important for people to know that if they want to get involved in this or any other issue contact your member of Congress or your United States senator. What's particularly helpful to us is your personal experience and ideas about how best to tackle any particular problem but when it comes to the opioid epidemic, what I continue to be incredibly grateful for is the number of people who have stood up and shared their personal stories whether it's a family member whether it's themselves whether it's a colleague they have stood up and said this disease impacts everybody. It's not a character failing, it's a disease. We need to treat it like one. And because people have stood up and shared their experiences that has allowed us to reduce the stigma of drug addiction it's also allowed members of Congress to tackle this in a practical way because we have actual examples of what works and what doesn't. And that input from people on the front lines is critically important. So I'd urge people, e-mail or call your electeds both at the federal level and at the state level and volunteering to the degree there are places like recovery programs that need volunteers. That's a great way to get involved.

NICIE: Well Senator Maggie Hassan of New Hampshire we cannot thank you enough for taking the time out of your busy schedule to speak with The MidPod today. We do appreciate it.

HASSAN: I appreciate you guys for covering this so much. Thank you very much and have a great holiday.

NICIE: Our thanks again to Senator Hassan for making the time. The terrible truth is that while you’ve been listening to this episode, someone probably died of an opioid overdose. This is why Congress matters. Why government matters. Why elections matter. If you or someone you know is struggling with addiction, there is a federal hotline number to call. It’s 1-800-662-HELP (4357) Next week, will be our final edition of the MidPod. We’ll bring you some reflections, some special guests and some holiday cheer. Thanks for listening and thanks for being active citizens.