WASHINGTON — Rahul Gupta, MD, MPH, director of the White House Office of National Drug Control Policy, got hit from all sides Monday at 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, committee Republicans focused on the issue of border control. “One [outstanding question] is how President Biden’s border crisis and this administration’s open border policies have aided and abetted trafficking of illicit drugs, such as fentanyl, in our country,” said Rep. James Comer (R-Ky.), the committee’s ranking member. “Fentanyl is being smuggled across the southwest 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 that the southern border of the US was secure but the administration is continuing to work with Mexico on the drug issue, Fallon called that response “shockingly inadequate” adding “it shows just gross negligence .. . the Mexican drug cartels are controlling the southern border, not the federal government. It’s a gross dereliction of duty that’s putting Americans at risk.”
Medication-Assisted Treatment Questioned
But Republicans weren’t the only ones showing their displeasure. Rep. Stephen Lynch (D-Mass.) described the use of medication-assisted treatment as a strategy for helping those with substance use disorder. “We allow doctors to have hundreds of patients and just give them Suboxone [buprenorphine/naloxone] and not really deliver any behavioral health services that would get at the underlying addictive activity,” he said. “We’ve got a couple of clinics that hand out Suboxone — the patients go out the door and then they either trade that or they buy fentanyl or methamphetamines, which is even a worse problem. They can’t get high with the Suboxone, so they’re going to harder drugs,” which leads to more stabbings and other violence.
“We’re actually seeing much more violent activity because an individual on methamphetamines might be up for days, and we’re seeing a lot of stabbings,” he said. Gupta noted that “people have different ways of getting at the treatment … Some may do OK cold turkey, while others may need medication for varying amounts of time … We’ve got to help people when they need it and where they need it.”
Lynch seemed unimpressed with that answer. “It’s not working 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, that are shooting up … I think we’re pushing more of this stuff out, and it’s not helping. So I think we’ve got to reassess.”
Should Cannabis Be Reclassified?
Rep. Ro Khanna (D-Calif.) wanted to know why cannabis — which he said could sometimes be a useful alternative to opioids for pain management — was classified by the Drug Enforcement Administration (DEA) as a Schedule I drug — a class with the most restrictions — while opioids were classified as Schedule II. Classifying cannabis as Schedule I also means that researchers are barred from conducting rigorous, large-scale 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. Clearly, the policies that we’ve had in this country with regard to marijuana have not worked, and the president has said so.” Khanna reminded Gupta that “the president has the executive authority to direct DEA, HHS, and FDA to consider administratively rescheduling marijuana, which would facilitate research, which would facilitate patient access … At least make sure it’s rescheduled so it’s not more restricted than opioids themselves.”
Congresswoman Eleanor Holmes Norton (DD.C.) said that she was “extremely disappointed that the Biden administration’s two budgets have proposed maintaining the rider that prohibits the District of Columbia from spending its local funds on commercializing recreational marijuana.” Gupta responded that “in the matter of the DC rider, I understand it’s with Congress, and I’ll leave it at that. And having said that, the president has been very clear that he supports decisions regarding legalization of marijuana to be left up to individual states, but at the federal level, he has supported decriminalization of marijuana use and automatic expungement of records.”
An Equity Lens
Norton wasn’t entirely negative about the administration’s response to the issue so far, however. “Since assuming office, the Biden administration has shown a robust commitment to advancing equity and centering recovery over punishment in federal response to the overdose crisis,” she noted, and gave Gupta a chance to further explain the administration’s policy in this area.
Gupta said that with his office’s recently released drug control strategy, “one of the things we are doing is looking at all of the metrics that are available to us … We were able to put forward a state model for nonviolent crimes; if someone has a mental health disorder, or addiction, let’s get the person help; let’s get them treatment; let’s get them housing — instead of incarcerating them. It’s not only a good thing to do and prevents recidivism, but it’s also cost-effective for the communities. It is these types of things that the strategy looks at, figuring out how to solve problems at a community level and making sure that we’re doing that with the lens of equity.”
Rep. Debbie Wasserman Schultz (D-Fla.) was also supportive of Gupta, praising his understanding of the issue. She saved her wrath for Florida Governor Ron DeSantis (R) and other Republican governors who are opposed to expanding Medicaid in their states. “Research shows that overdose rates are lower in states that 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, when compared against states that haven’t expanded Medicaid.”
“Sadly, because Governor DeSantis is immune to facts, science, and even the shame that families must endure because of his callous inaction, he is not likely to be moved to act,” Wasserman Schultz concluded. “But that doesn’t mean we stop calling out his and other Republican governors’ cruel indifference and how it compounds this crisis and adds to the pain that millions of American families will suffer.”