Is Azar the antidote to the opioid crisis?

At a peak of the Durham heroin crisis last year, and as part of my EMS continuing education, we reviewed our protocol for delivering naloxone—a drug intended for emergency opioid overdose reversal. In Naloxone, and as with many antidotes, the problem is part of the solution. The agent’s active ingredient is a deactivated piece of the opioid, which fits snugly into the patient’s receptors and shuts out the problematic drug. But delivering naloxone is sensitive. As one paramedic explained, if you deliver too much of the antidote at once, patients will shoot straight out of their slumber “and punch you in the face!”

One of the possible antidotes for America’s opioid crisis is much like naloxone: derived from the problem’s source and at risk of bludgeoning America in the face. President Trump nominated former pharmaceutical company CEO Alex Azar for secretary of the US Department of Health and Human Services. If confirmed, Azar would be tasked with implementing many of the public health solutions to the opioid crisis in the short and long term.

But this widespread power could be uniquely dangerous in the hands of an ex-industry executive. Pharmaceutical companies started and are fueling the opioid crisis through exaggerated advertising, overly addictive recipes and subversion of oversight through targeted lobbying. In 2016 alone, the pharmaceutical industry spent $152 million influencing legislation. And industry-funded groups like the Pain Care Forum spent $740 million over the last 10 years opposing legislation aimed at curbing opioid overprescription. Confirming a former executive into a position of unwieldy jurisdiction over pharmaceutical regulation might be leading another fox to the hen house.

Of course, it is possible that Azar’s insider knowledge could provide him with unparalleled insight into the more sinister strategies that pharmaceutical industries might use to keep their pain management drugs profitable. It could also make him privy to other targets of long-term changes, like physician prescribing patterns or non-addictive recipes for pain relief medications. Furthermore, his lock-and-key fit within the pharma industry might predispose current executives and other stakeholders to trust that Azar will take their interests into account.

But perhaps the most compelling argument for confirming Azar as HHS Secretary is the same one medics use for shoving an antidote into an overdosing patient’s nose (at their own risk): America needs an emergency withdrawal from opioids—now. The staggering death count due to opioid overdose has risen to 90 a day (that’s more than guns or car accidents), prompting President Trump to promise an emergency declaration in August. In spite of this, the acting HHS secretary did not officially declare a public health emergency until late October. This change enabled the department to take more urgent measures, from freeing providers to prescribe emergency treatments to ramping up first responder training. Yet even the HHS’s latent response is still superficial. In fact, the Trump administration has still not yet agreed to yield federal funds toward HHS’s efforts. 

Moving from an interim Secretary to one who was appointed by the president himself might open much-needed funding channels between the federal government and HHS’s crisis programming. Furthermore, having a stable department head might help streamline the HHS to become more efficient and effective in implementing its 5-point strategy. Naming an HHS head like Azar, who has an understanding of how to distribute these services, could at least help resuscitate America out of its sedated stupor and save thousands of lives.

But even if the HHS under Azar does curb our emergent problem, instating Azar could bring negative consequences for America's opioid crisis in the long run. The HHS secretary oversees one of the largest power networks affecting American health. Azar would take charge on policies and agencies like Medicaid, Medicare, the Food and Drug Administration (FDA), the Centers for Disease Control (CDC) and the National Institutes for Health (NIH). Programs like these provide the foundation for understanding and treating the opioid crisis. Medicaid alone has played a critical role in curbing the opioid epidemic by providing key inpatient hospital services and therapies to opioid abusers, covering three in 10 non-elderly adults with opioid addiction.

All things considered, the scope of Azar’s influence over drug prices would be unnerving, especially given his experience leading a pharmaceutical company whose insulin prices doubled dramatically during his tenure. His history raises additional questions about his motivation to help suffering Americans access much-needed treatment. As a result, Wednesday’s confirmation hearing called into question Azar’s entanglement in the subject of his large potential jurisdiction and his intentions to lower health care barriers for Americans. The Senate Finance Committee, which has yet to schedule a confirmation hearing, must question Azar’s conflicts of interest further before the full Senate can vote on his nomination. If he recuses himself of his pharma industry investments before entering the secretary position, his role as an antidote to the opioid crisis might be more convincing.