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CDC Requests More $$ For Antibiotic Resistance, Opioid Abuse
by Shannon Firth 03.26.2015
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Director of CDC asks for more resources to manage multidrug-resistant microbes and curb opiate addiction.



The Ebola epidemic is not over yet, but the CDC is focusing much of its $6.2 billion fiscal year 2016 budget request more on domestic matters, such as antibiotic resistance and prescription drug abuse.

On Wednesday, CDC director Thomas Frieden, MD, MPH, asked the House Committee on Appropriations for $283 million -- an increase of $264 million from last year -- to fight antibiotic resistance.

According to Frieden, over two million Americans contract antibiotic-resistant illnesses each year, and 23,000 people die from them. This costs the U.S. $20 billion annually. And the problem is getting worse.

It isn't just the rare patient with a pneumonia who is impacted, said Frieden. Among cancer patients in treatment and those undergoing kidney dialysis, for example, such infections are very common.

"We just presume that we'll be able to treat them," he said. "What we're seeing really for the first time is an increasing number of people and organisms that are now resistant to every single antibiotic that we have."

He specifically highlighted Clostridium difficile, a microbe that killed 15,000 people in 2011, and carbapenem-resistant Enterobacteriaceae, (CRE), another "nightmare bacteria," which kills as many as half of the patients it infects, he said.

But Frieden is also optimistic. "We think we can turn this around," he said. With the right investment, over a 5-year period the CDC believes it can prevent 600,000 multidrug-resistant infections, 37,000 deaths, and reduce healthcare costs by $5 billion.

Most of the agency's funding in this area would be allocated to states to establish Antibiotic Resistance "Protect" programs to track outbreaks, ensure smarter prescribing practices, and curb infections. The money would also help to build the agency's "Detect" Network, a cluster of as many as seven regional labs to fight antibiotic resistance outbreaks or threats.

Prescription drug abuse is another area of focus for the CDC. In the single lecture he heard on pain in medical school, Frieden said he was taught that opiates weren't addictive. "A generation of doctors was taught that, and it's wrong," he said.

That's why, in addition to funding to fight killer microbes, Frieden also requested an increase of $54 million -- from $20 million to $74 million -- to expand the Prescription Drug Overdose Prevention for States Program to all 50 states and Washington.

These medications are dangerous, he said "[y]ou only have to take a few doses to become addicted, potentially for life."

But the harms are still not recognized by patients or by providers, Frieden said.

"This was a problem that was fundamentally created by bad prescribing practices, and it can be ameliorated greatly by improving those practices and providing additional services to patients and to physicians," he said.

In addition to educating clinicians and supporting patients, this investment would maximize the effectiveness of prescription drug monitoring programs (PDMPs) and zero in on at-risk communities, he said.

The agency's budget request also included support for programs to eradicate polio and to fight the "next Ebola outbreak" should one occur, Frieden said.

Committee chair Tom Cole (R-Okla.) responded to the budget request saying that it would like to provide resources to stave off public health threats but because of the sequester, he said, "We may not be able to do everything that this administration is proposing."

In his opening statement, Cole also warned the agency against wasting taxpayer dollars on "politically motivated" activities; the written version of his statement expanded on the meaning of that phrase by adding, "such as promoting gun control or lobbying local communities to ban the consumption of certain products."

In the wake of the shootings in Newtown, Conn. in late 2012, President Obama asked the CDC to research causes of gun violence -- something that it hasn't looked into since 1996 -- but the agency has yet to do so, citing a lack of funding, according to news reports.

Rep. Scott Rigell (R-Va.) said that gun violence was "the purview of other areas" and urged Frieden to focus on one of the CDC's other missions: antibacterial resistance. "I can't support you on [gun violence] but on everything else you have my full support."

Ranking member Rosa DeLauro (D-Conn.) said she supported the agency's budget request, but was disappointed by its decision to cut funding for immunizations as well as breast, cervical, and colorectal cancer screening, and by its decision to defund the REACH program -- an initiative that supports efforts to reduce chronic disease in minority communities.

Representatives Barbara Lee (D-Calif.) and Lucille Roybal-Allard (D-Calif.) were also frustrated by the cuts to the program. "People because of their race and background should not be subjected to disease disproportionately," Lee said.

After explaining that he would do the best he could with the resources the agency received, Frieden added, "I can only say that I agree with you."

DeLauro blamed sequestration for these tough decisions. "We know that the CDC's ability to protect the public has been hampered by what I view as a disastrous reduction in its budget." She cited a $1.35 billion drop in funding since 2010 -- a fifth of the agency's budget.

While Congress spends $1.5 trillion on tax breaks and loopholes to support the wealthy, it has reduced its investment in public health and through spending caps, jeopardizing the nation's security, she said. "I believe we can do better when it comes to our nation's health."







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