Distinguished Members of Congress, thank you for the opportunity to address you today. My name is Parle Chetver, and I serve as an osteopathic physician dedicated to advancing patient-centered, evidence-based health care. I appreciate your commitment to addressing the opioid epidemic, a public health crisis that continues to devastate families, communities, and our health care system. The title of my presentation today is Actionable Advocacy, Combating the Opioid Epidemic with Evidence-Based Public Health and Policy Solutions, Empowering Osteopathic Physicians to Lead Change. Again, my name is Parle Chetver, and I have no relevant financial relationships to disclose. Managing pain while minimizing the risk of substance misuse presents a complex clinical challenge. Physicians are tasked with the dual responsibility of alleviating suffering and preventing addiction. This requires diligent risk assessment, careful monitoring, and the use of treatment agreements that establish clear guidelines for opioid use. Importantly, our approach must be free from stigma. Consider this, would we shame a patient with diabetes for needing insulin? Would we blame a person with high blood pressure for requiring long-term medication? And if so, then we should not treat the opioid addiction epidemic any differently. Today I will discuss the challenges we face in confronting this epidemic, present evidence-based strategies that have proven effective, and outline legislative actions that can significantly bolster our national response. I approach this topic not only as a physician, but as a representative of the osteopathic profession, a profession that emphasizes preventive medicine, holistic care, and the integration of mental and physical health. Over the next hour, I will guide you through an overview of the current crisis, examine the unique role that osteopathic physicians can play, and propose targeted policy recommendations. My objective is to demonstrate that with your support and the incorporation of these strategies, we can forge a more resilient and compassionate healthcare system that protects our citizens and treats the underlying causes of opioid misuse. I would like to begin by underscoring the gravity of this crisis. According to the CDC, opioid-related fatalities continue to claim tens of thousands of lives each year. In 2022, there were 82,000 opioid-related overdose deaths. This equates to one opioid-related death every 6.4 minutes. Overall, opioid-related deaths accounted for about 76% of all overdose fatalities. A 2022 analysis by the Congressional Joint Economic Committee estimated that the opioid crisis cost the United States nearly $1.5 trillion in 2020, reflecting the escalating impact of the epidemic. This economic toll includes healthcare costs, lost productivity, and criminal justice expenses. Synthetic opioids, particularly fentanyl, have emerged as a leading cause of these deaths, placing unprecedented strain on our healthcare infrastructure. Beyond the tragic loss of life, the opioid epidemic inflicts profound social and economic damage. Each statistic represents not merely a number, but a human being. A family member lost, a child placed in foster care, and a community burdened by increased healthcare costs, diminished workforce productivity, and an overtaxed criminal justice system. Importantly, the crisis affects all segments of society. Social areas face the highest overdose rates due to limited access to treatment facilities, as are certain urban areas where socioeconomic disparities intensify the risk of substance misuse. It is imperative that any legislative solution address these impacts. Over the past several years, Congress has taken meaningful and bipartisan action to address the opioid crisis. Congress has funded key initiatives such as the Prescription Drug Monitoring Program, or PDMP, which has been instrumental in tracking opioid prescriptions and reducing misuse. PDMPs are state-run electronic databases that monitor the prescribing and dispensing of controlled substances, including opioids. By providing real-time data, they help healthcare providers and pharmacists identify potential misuse, prevent doctor shopping, and ensure that patients receive appropriate medications while reducing the risk of addiction and overdose. The passage of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities, or the SUPPORT Act of 2018, was also a landmark step. This legislation, which received overwhelming approval in both the House and the Senate, provided a comprehensive framework to combat opioid misuse. It included measures to expand access to treatment, enhance prevention efforts, strengthen recovery programs, and improve enforcement against illicit opioids. However, despite these significant efforts, major challenges persist. The implementation of federal policies varies greatly from state to state, leading to disparities in access to treatment and inconsistencies in enforcement. In some cases, well-intentioned regulations have had unintended consequences. For example, strict prescribing limits meant to curb misuse have sometimes left patients with chronic pain struggling to access necessary medications. This has resulted in a complex patchwork of policies, where a mix of federal, state, and local regulations has created an uneven landscape for both health care providers and patients. Some states have successfully expanded treatment programs, while others face barriers, funding limitations, administrative hurdles, and workforce shortages. These overlapping and sometimes conflicting policies have made it difficult to establish a consistent national approach to opioid use disorder treatment and pain management. Moving forward, I would respectfully request Congress to harmonize these policies. This includes ensuring that federal guidelines provide clear evidence-based recommendations that balance opioid misuse prevention with the need for legitimate pain management. Additional funding can be directed towards expanding the addiction treatment workforce, increasing access to medication-assisted treatment, or MAT, and ensuring that every state has the resources to implement effective and coordinated policies. By taking a unified approach, Congress can build on the success of past legislation while addressing ongoing gaps in the system. Safeguarding public health requires not only continued investment, but also greater coordination among federal, state, and local agencies to ensure that no patient is left behind. Despite some positive outcomes from federal and state interventions, the opioid crisis continues to evolve, presenting new and increasingly complex challenges. Overdose rates remain alarmingly high, particularly due to fentanyl, which I mentioned earlier. Fentanyl is up to 50 times stronger than heroin and 100 times more potent than morphine, making even small doses lethal. Illicitly manufactured fentanyl has flooded the drug supply, often mixed with other substances such as heroin, cocaine, and counterfeit prescription pills, without the user's knowledge. This has led to a dramatic increase in fatal overdoses, making fentanyl the primary driver of opioid-related deaths in the United States. Additionally, poly drug use has further complicated treatment protocols. Many individuals struggling with addiction are unknowingly exposed to fentanyl, increasing the risk of overdose even for those who do not intentionally seek opioids. The growing presence of xylosine, which is a dangerous sedative that is often mixed with fentanyl, has exacerbated the crisis, leading to more severe overdoses in cases that are resistant to standard naloxone or Narcan reversal treatments. Beyond these medical challenges, stigma remains one of the greatest barriers to effective treatment. Addiction is a chronic disease, it's not a moral failing, yet individuals with opioid use disorder continue to face discrimination in healthcare settings, workplaces, and even within their own communities. Fear of judgment discourages many from seeking treatment, while outdated policies continue to punish rather than support those who are battling addiction. As healthcare providers, we are committed to treating every patient with the dignity and respect that they deserve. This ethical imperative must be reflected in the policies that govern opioid prescribing and addiction treatment. Addiction is a chronic, treatable disease, not a moral failing. By ensuring that patients receive both appropriate analgesia and comprehensive support services, we can reduce the likelihood of misuse while upholding the highest standards of clinical care. In light of these challenges, a piecemeal approach is no longer sufficient. We do need a comprehensive, coordinated national strategy that integrates robust prevention efforts, expanded treatment access, and long-term recovery support. This includes strengthening fentanyl interdiction efforts, expanding access to harm reduction like fentanyl test strips and naloxone, and investing in research for innovative treatments that address fentanyl dependence. It also means breaking down stigma through education, policy, reform, and ensuring that addiction treatment is treated as a fundamental part of healthcare, not a criminal issue. With your leadership, we can implement policies that not only reduce overdose rates, but also strengthen the healthcare system's ability to respond to this evolving crisis. By taking evidence-based action, we can develop a sustainable, long-term response that saves lives. The opioid crisis is a complicated issue, and it requires a comprehensive response. Before I go into detail on each category, I want to provide a brief overview of four key strategies that are essential to addressing this crisis effectively. First, medication-assisted treatment, or MAT, is one of the most effective approaches for treating opioid use disorder. By combining FDA-approved medications with counseling and behavioral therapies, MAT helps individuals manage withdrawal symptoms, reduce cravings, and sustain long-term recovery. However, MAT is often misunderstood and stigmatized, with some perceiving it as merely replacing one drug with another. This misconception persists, although there is overwhelming evidence that demonstrates the effectiveness of MAT in reducing cravings, lowering relapse rates, and preventing overdose deaths. Second, mental health care must be a priority. Many individuals who are struggling with opioid addiction also face co-occurring mental health disorders, such as depression, anxiety, and PTSD. Without proper mental health services, we cannot fully address the root causes of substance use. Third, non-opioid pain management provides safer alternatives for treating pain. Expanding access to physical therapy, interventional pain procedures, and other integrative treatments can reduce reliance on opioids, while still ensuring that patients receive effective pain relief. Finally, addressing the social determinants of health is critical. Factors such as housing instability, unemployment, and lack of access to health care contribute to substance use and relapse. By tackling these broader social issues, we can create environments that support recovery and prevent addiction before it starts. Each of these strategies plays a crucial role in combating the opioid crisis. One of the most significant advancements in treating opioid use disorder is medication-assisted treatment, or MAT. Unlike traditional detoxification methods, MAT addresses both the physical and psychological aspects of addiction. This makes MAT one of the most effective tools available for long-term recovery. The three most commonly used medications in MAT are methadone, buprenorphine, and naltrexone. Methadone and buprenorphine alleviate withdrawal symptoms and reduce cravings, while naltrexone blocks the effects of opioids to help prevent relapse. When combined with counseling and behavioral therapies, MAT has been shown to significantly reduce opioid cravings, lower relapse rates, and prevent overdose deaths. Research consistently demonstrates that individuals receiving MAT are more likely to remain in treatment and achieve long-term sobriety compared to those who rely on abstinence-based approaches alone. It is also a critical tool in reducing the spread of infectious diseases such as HIV and hepatitis C, which are commonly associated with injection drug use. Despite its proven efficacy, MAT remains severely underutilized. Regulatory restrictions, a shortage of trained providers, and pervasive stigma continues to create unnecessary barriers for patients who desperately need this treatment. Many health care providers are still required to obtain additional certification to prescribe buprenorphine, while methadone can only be dispensed at specialized opioid treatment programs and that forces patients to travel long distances for care. And these limitations disproportionately affect rural and underserved communities where addiction treatment services are already scarce. I respectfully request that Congress take decisive action to expand access to MAT. First, if we may support initiatives that fund MAT training programs for physicians, nurse practitioners, and physician assistants, ensuring that more providers are equipped to offer this treatment. Second, increasing Medicaid coverage for MAT services will help eliminate financial barriers for low-income individuals who otherwise might not be able to afford treatment. And finally, reducing administrative burdens on clinics that provide comprehensive addiction treatment will allow more facilities to offer MAT, particularly in regions where access is currently limited. These measures are not just policy changes, they are life-saving interventions. By expanding access to MAT, we can break down barriers to care, reduce opioid-related deaths, and help individuals who are struggling with addiction to reclaim their lives. With your leadership, we can ensure that this proven, evidence-based treatment reaches those who need it most. It is also well established that substance misuse is frequently accompanied by depression, anxiety, and PTSD. Addressing these co-occurring conditions is essential for a successful recovery. While I commend Congress for recent appropriations aimed at bolstering mental health services, additional funding is needed to create a robust, integrated system of care. Specifically, I request your support for legislation that integrates behavioral health services into primary care settings, that expands the mental health workforce in both rural and urban communities, and that supports evidence-based counseling and therapy programs along with MAT. We think about this in terms of long-term impact. A well-funded mental health infrastructure not only facilitates recovery for those already affected by opioid misuse, but also serves as a preventative measure to reduce the incidence of substance use disorder in the future. As we focus on improving mental health services to support recovery and prevent substance use disorder, we must also address another critical factor in the opioid crisis, which is pain management. For many patients, effective pain management does not require opioids. We have a range of proven non-opioid therapies including physical therapy, acupuncture, and cognitive behavioral therapy that can successfully address both acute and chronic pain without the risk of addiction. However, these options remain out of reach because of insurance and reimbursement gaps. When non-opioid therapies are not covered by insurance or when they are reimbursed at lower rates, patients might be steered towards opioids by default, even though safe and equally effective alternatives exist. To overcome this barrier, we must advocate for policies that encourage insurers, both public and private, to cover evidence-based treatment beyond opioids. Doing so not only expands patient choice, but also helps reduce the potential for opioid misuse and addiction. Another key step is embracing a multi-modal approach to pain management. Because no single therapy works for everyone, we should integrate physical, behavioral, and interventional treatments under one cohesive plan. This approach addresses the root causes of pain while limiting exposure to high-risk medications. By combining multiple therapies, we can provide personalized care that genuinely meets each patient's needs. Furthermore, we must invest in ongoing research into emerging pain management modalities. Pain science evolves rapidly and innovative treatments continue to appear. Supporting research ensures that we remain at the forefront of new techniques, improving our ability to offer safe and effective options that reduce reliance on opioids. Finally, we should support multidisciplinary pain clinics, which bring together specialists including pain physicians, physical therapists, mental health professionals, and others to collaborate on a comprehensive treatment plan. These pain clinics have demonstrated success in reducing opioid prescriptions and improving patient outcomes. By fostering the growth of such pain clinics nationwide, we can give more patients access to truly integrated pain management. Taken together, these measures of addressing reimbursement gaps, encouraging a multi-modal approach, funding research, and expanding multidisciplinary pain clinics will transform our approach to pain management. Patients deserve access to a broad spectrum of safe and effective treatments that address pain at its source, rather than simply masking symptoms. With your support, we can provide these better options, reduce our reliance on opioids, and ultimately protect more Americans from the devastating impact of opioid misuse. Any comprehensive discussion of non-opioid pain management must also include osteopathic manipulative treatment. As osteopathic physicians, we not only provide clinical care, but also serve as influential leaders in our communities. Many of us contribute our expertise beyond our practices by serving on hospital committees, community health boards, and advisory panels, thereby informing public health decisions at the local, state, and national levels. Our direct experience with the intricacies of pain management and addiction uniquely qualifies us to guide policymakers. We are trained to deliver medical care while recognizing the interconnections among physical, emotional, and social factors. This is a holistic approach that is critical in addressing the opioid crisis, where pain and addiction are frequently compounded by the mental health challenges which I discussed, as well as socioeconomic challenges. It is my hope that policymakers will view osteopathic professionals not merely as service providers, but also as strategic partners in policy formulation. We have valuable insights into effective practices, unmet needs, and areas that are ripe for improvement. A cornerstone of osteopathic medicine is our approach to chronic pain management, which includes the use of OMT. By targeting musculoskeletal imbalances, OMT addresses the root cause of pain, potentially reducing the reliance on opioid medications, and offering patients long-term relief. Our commitment to treating the whole person aligns with the need for a comprehensive strategy to combat opioid misuse. An effective approach will integrate non-pharmacological therapies, behavioral health support, and community resources to create a compassionate and robust care model. Through these holistic methods, we can provide recovery pathways that prioritize the long-term quality of life over mere symptom alleviation. By forging strong partnerships between the medical community and legislative bodies, we can develop pragmatic solutions that encompass the full spectrum of human health, addressing both the biological underpinnings of addiction and the associated social and mental health challenges. A thorough approach to addressing the opioid epidemic must consider the profound influence of social determinants, such as unstable housing, poverty, and limited educational opportunities. These factors create conditions where addiction is more likely to take hold and persist. For instance, individuals experiencing housing instability often face chronic stress, social isolation, and reduced access to health care, all of which heighten their risk of opioid misuse. Similarly, financial hardship and economic instability can lead to despair, making substance use seem like a temporary escape. Lack of educational opportunities further compounds these challenges because it restricts access to stable employment and vital resources, and that reinforces the cycles of poverty and addiction. Consider a patient who must travel long distances to reach a methadone clinic, or a veteran who has chronic pain and post-traumatic stress disorder and cannot afford an integrative pain management program. These are all the barriers that exemplify the systemic gaps which contribute to substance misuse. Beyond the human impact, there's also a strong economic incentive to address these social determinants. Strengthening the social safety net can lead to significant cost savings by reducing reliance on emergency room visits and improving treatment outcomes. Individuals with stable housing, employment opportunities, and comprehensive health care are less likely to depend on costly crisis interventions and more likely to achieve long-term recovery. Proactive investment in these areas not only alleviates the burden on health care systems, but also fosters stronger and more resilient communities which can better support individuals in overcoming addiction. To create lasting change, our efforts must focus on sustainable solutions. Policies that expand access to affordable housing will provide a stable foundation for individuals, enabling them to maintain employment, enabling them to manage their health and engage in recovery more effectively. Investing in job training programs equips vulnerable populations with skills that lead to meaningful employment and economic mobility and that reduces one of the key risk factors for substance misuse. Strengthening public health infrastructure is equally critical, ensuring that communities have access to mental health services, addiction treatment programs, and preventive care. These investments establish a framework for early intervention, addressing both the immediate symptoms of addiction and the deeper systemic causes that sustain it. I strongly urge you to consider targeted funding initiatives that reinforce the social safety net. By directing resources to community-based programs that address housing, employment, and health care disparities, we can provide individuals with the stability and support they need for long-term recovery. This strategy requires both immediate relief measures and sustained investments in education, economic opportunity, and health care access. Expanding programs that offer counseling, job placement assistance, and housing support fosters a more equitable environment where individuals are empowered to break free from the cycle of addiction. Addressing these fundamental issues is the most effective way to achieve lasting reductions in opioid-related harm. By confronting the social determinants of health head-on, we can build a healthier and more resilient society, one where individuals have the resources and opportunities needed to overcome addiction and reclaim their future. So where do we go from here? In conclusion, we've examined the opioid epidemic from multiple perspectives, its ongoing severity, the legislative efforts to date, and the remaining gaps in our national response. We have discussed evidence-based interventions such as medication-assisted treatment, enhanced mental health funding, and non-opioid pain management, and we've underscored the critical importance of addressing the social determinants of health. Health care professionals possess invaluable insights into the real-world effects of regulatory and funding decisions. I hope that we can cultivate a dynamic, informed dialogue that strengthens this alliance between the medical community and policymakers. By fostering these relationships, together we can help ensure that legislative initiatives are both targeted and effective. I respectfully urge consideration of the following legislative priorities. First, increasing funding for medication-assisted treatment and behavioral health services by expanding grants and appropriations for community clinics that offer integrated addiction services. Second, supporting non-opioid therapies by encouraging both public and private insurers to broaden reimbursement for evidence-based alternatives such as physical therapy, cognitive behavioral therapy, and osteopathic manipulative treatment. Thirdly, strengthening the rural health infrastructure by allocating resources to telemedicine and mobile clinics to ensure that underserved communities have access to both pain management and addiction treatment. And finally, promoting education advocacy by investing in programs that provide clinicians with ongoing training in safe prescribing practices and comprehensive care models. These measures will not only save lives and reduce health care costs, but will also lay the foundation for a more resilient and equitable health care system. Distinguished members of Congress, your leadership is instrumental in transforming our national response to the opioid crisis. Together with the medical community, we can develop policies that not only treat the symptoms of addiction, but address its underlying causes. Your commitment to this issue is vital, and I know that with your continued partnership, we can forge a path towards a safe and healthier future for all Americans. Thank you so much for your time and your dedication to public service. I appreciate the opportunity to present these recommendations, and I look forward to our continued collaboration. Thank you again.

opioid crisis

patient-centered solutions

medication-assisted treatment

non-opioid pain management

social determinants

osteopathic professionals