U.S. Rep. Suzanne Bonamici got an earful about how young people are affected by opioid use during a panel discussion that followed up five sessions she has conducted in the 1st Congressional District of northwest Oregon.
The Oregon Democrat sits on the House Committee on Education and the Workforce, a subcommittee of which held a hearing on the issue in mid-February.
"I know the president has made some sort of commitment to tackle this and there is bipartisan support for doing something about the opioid crisis," Bonamici told a panel of educators and treatment experts who met Feb. 20 at The Round in Beaverton.
"But there are going to be some challenges about where those dollars go.
"If they just go to ramped-up law enforcement, that is not the right answer. We should not treat this as another war on drugs. It's not going to be addressed by arresting people."
Bonamici also conducted a roundtable Friday, Feb. 23, at Portland's Old Town Recovery Center, which is run by Central City Concern. She was joined by Sen. Ron Wyden, D-Ore.
At the session in Beaverton, Bonamici said about 20 percent of high school seniors have received prescriptions for opioids as pain medication.
"We need to know more about how opioids affect young brains," she said.
"I see a disproportionate effect on young people in ways that will affect them throughout their lives. We have to treat this as a disease, not as a moral failing. There is a stigma issue that must be addressed."
Bonamici recounted a meeting with someone in Clatsop County whose son struggled with addiction and died after being prescribed opioids for a sports injury while in high school.
"When we talk about changes in policy, it helps to put a face on the issue and to make it about people," she said.
In line with previous proposals she outlined after a Jan. 25 roundtable in Beaverton, Bonamici added these points:
• Federal policy should encourage doctors to manage with minimal or no use of opioids, although current insurance policies often fail to cover alternatives.
• More research is needed about how opioids affect still-developing adolescent brains.
• Money is needed for evidence-based education and treatment. "It's not simply a matter of just saying no," she said.
• Alternatives to police stations — or treated wastewater from toilets that ends up in rivers — should be offered for disposal of surplus medications.
Experts speak out
Bonamici heard from:
Sarah Feldstein Ewing, a professor in the School of Medicine at Oregon Health & Science University, who said adolescent users are likely to face fewer economic and social consequences than adults, who stand to lose jobs, families and housing.
She said research indicates that like the brains of adults, who can abuse drugs and alcohol for years, those of adolescents are altered, although in different ways. But she also said unlike other drugs and alcohol, they can obtain them almost openly because opioids are medications.
"We would never think to give adolescents cannabis, even medical cannabis, or alcohol," she said. "But we routinely expose them to this drug. For any other substances, kids have to go out of their way to violate norms to obtain them. That is not the case with opioids."
Dr. Dana Nason, a Hillsboro pediatrician, who said school-based health clinics are useful for screening teenagers with potential abuse problems. As of January, there are high school clinics in Beaverton, Century (Hillsboro), Forest Grove, Merlo Station (Beaverton), Tigard and Tualatin.
"But once you identify somebody, treatment is the issue," he said. "There is a huge funding issue once we find somebody."
Kathy Wilson, care coordinator for the Hillsboro School District, who said addiction treatment must go hand in hand with mental health.
"Their addiction is rooted in some form of self-medicating for the emotional pain they are in," she said. "Sometimes the issue is getting the youth identified … and to motivate the family to get the person into treatment."
But she said schools can play a role in that critical intervention.
Don Grotting, Beaverton schools superintendent, who said that unlike other drugs, opioids can be obtained through parents, neighbors, other students — or students' own prescriptions.
Abuse of alcohol or other drugs "is a lot easier for them to recognize than opioids," he said. "We're seeing more people who are far into it before we are able to intervene."
Still, he said, parents have to be part of the solution: "We are finding out that unless we get the parents in with counseling, and to help parents as well as students, it's a no-win situation."
Andy Cartmill, senior program educator in addiction services for Washington County, who said there is a linkage between the mental state of children and teenagers and drug use.
Cartmill said he makes about 160 presentations, which include parents, on various aspects of addiction.
"When (young people) are asked the No. 1 reason why they do not use, they list parents," he said. "So every time we get a chance to talk with parents, we do.
"But the bottom line is that I can tell kids not to do drugs. Yet they go home and watch commercials that tell them to use drugs all day long."
Pam Pearce, cofounder of Oregon Recovery High School Initiative, and someone who has experienced recovery herself, who said people often fail to draw a difference between teenage experimentation and use. Results of many surveys often highlight greater shares of students who have tried alcohol and other drugs, in contrast to smaller shares who use monthly or daily.
Still, Pearce said she experienced alcohol abuse, similar to that leading to the death of her father, before she recovered.
"Prevention is key," she said. "It needs to start at the beginning."
Wyden, Bonamici raise questions about future funding
Sen. Ron Wyden joined Rep. Suzanne Bonamici in raising questions about how federal dollars can be spent effectively to deal with opioid addiction.
Both are Oregon Democrats who sat in on a roundtable discussion Friday, Feb. 23, at Portland's Old Town Recovery Center, which is run by Central City Concern.
Wyden is the top Democrat on the Senate Finance Committee — which has broad authority over federal health spending — and on Feb. 5, he and Republican Chairman Orrin Hatch of Utah invited public comment.
"When you are talking about more than $1 trillion in overall (annual) health care spending, this is where we have to make the best possible use of funds in terms of the opioid epidemic," Wyden said.
In their letter, Wyden and Hatch said that one of every three recipients in 2016 under Medicare Part D — which helps pay for medications for people 65 and older — obtained prescriptions for opioids at a cost of $4 billion.
In 2015, they said, three of every 10 people with opioid disorders were covered by Medicaid — the joint federal-state program of insurance for low-income people — at a cost of $9 billion.
President Donald Trump declared opioid addiction a "public health emergency" back on Oct. 26, but he proposed no new money for programs. Congress, in a massive two-year budget deal that Trump signed on Feb. 9, boosted spending by $6 billion.
Still, Trump's proposed federal budget for the 2019 cycle would reduce spending for both Medicare and Medicaid — although Congress is likely to go its own way.
"There is no question that this (Trump) budget proposal would turn back the clock," Wyden said. "It would be especially harmful for rural Oregon, older people and veterans."
Medicaid — which operates here as the Oregon Health Plan — helps pay for identification and treatment of drug and alcohol abuse that recipients cannot afford on their own.
Bonamici said that because Republican congressional majorities approved a tax-code overhaul that will swell the national debt by an estimated $1.5 trillion over a decade, their next step will be to cut future spending — even though so far, Congress has resisted Trump's approach.
"We are bracing ourselves against attempts to cut safety-net programs such as Medicare and Medicaid," she said. "There will be an effort to cut, rather than boost, existing programs."
— Peter Wong
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