Congress approves 650-page bill to attack opioid crisis, as doubts abound

drugs-300x179Congress has approved a major new push to deal with the opioid crisis that kills tens of thousands of Americans annually. Voters can expect President Trump to sign the big bill, passed easily and with rare bipartisan support in the House and Senate, just in time for politicians in the mid-term elections to campaign on their drug-fighting initiatives. But critics say it won’t be enough.

The opioids legislation covers 650 pages, and, in brief, the Washington Post reported, would:

  • Require the U.S. Postal Service to screen packages for fentanyl shipped from overseas, mainly China. Synthetic opioids that are difficult to detect are increasingly being found in pills and heroin and are responsible for an increase in overdose deaths.
  • Increase attention to treatment, a key component, mental health advocates say, to overcoming addiction. The legislation creates a grant program for comprehensive recovery centers that include housing and job training, as well as mental and physical health care.
  • Boosts access to medication-assisted treatment that helps people with substance abuse disorders safely wean themselves.
  • Changes a decades-old arcane rule that prohibited Medicaid from covering patients with substance abuse disorders who were receiving treatment in a mental health facility with more than 16 beds. The bill lifts that rule to allow for 30 days of residential treatment coverage.

USA Today reported that the congressionally approved legislation, which the Washington Post said consolidated dozens of proposals from hundreds of lawmakers, also would:

  • Require the Centers for Medicare and Medicaid Services to put in place programs for prevention and treatment, including drug management for at-risk beneficiaries to avoid over-prescribing opioids, medical assistance for incarcerated juveniles who need substance abuse treatment, and limits on e-prescribing prescription drugs that are controlled substances.
  • Order the Food and Drug Administration to update information on nonaddictive treatments for chronic pain and addiction. In January, the FDA released its strategic policy roadmap, which included bolstering efforts to prevent and treat opioid addiction.

Although these all are good steps, including allowing emergency responders to carry and use naloxone, an overdose antidote, critics say that Congress and the White House fell short, again, in two key ways in battling opioids: failing to provide sufficient money and sustained leadership. As the online information site Vox reported of the opioids measure:

[T]he bill would not provide a significant increase in spending for the opioid crisis at all. Even though it authorizes some relatively small grant programs, the actual funding for those will be decided later on by Congress’s appropriations process. Previous estimates by the Congressional Budget Office suggested earlier versions of the bill would add around $8 billion over five years if fully appropriated — which is still far from the tens of billions a year that some experts say is necessary.

Vox also interviewed Keith Humphreys, a Stanford University drug policy expert, who said the legislation contains “many ‘small sanities’ … that will make a difference,” but Republicans and Democrats could not agree on a comprehensive plan they could get behind, so,  “a fundamental disagreement [remained] between the parties over whether the government should appropriate the large sums a massive response would require. Lacking that, Congress did the next best thing — which is to find agreement on as many second-tier issues as they could.”

In my practice, I see the harms that patients suffer while seeking medical care, and the havoc that has been wreaked on too many lives by dangerous drugs, notably the unacceptable, profit-seeking prescribing of prescription opioids. They have torn open a path to debilitating and deadly abuse of even more powerful synthetic drugs like fentanyl and illicit street substances like heroin. Big Pharma, doctors, hospitals, and insurers all have played their ugly parts in creating a menace that has made overdoses the leading cause of death now for Americans 50 and younger.

The Washington Examiner, in its story on the opioids bill, summarized well how the crisis has grown — and why even more response is demanded:

The issue has bled into other areas of health and the economy. People who use drugs are unable to pass drug tests to secure jobs, and the spread of HIV and hepatitis C has increased in communities where sharing infected needles is common. Patients with severe pain have said they do not have an alternative allowing them to find relief, and patients who seek treatment for addiction often make several attempts and cycle through the criminal justice system. Drug users report that they have been revived with the drug naloxone during an overdose but then did not receive treatment for addiction, causing them to return to drug use and overdose again at a later time. In large part because widespread drug use started with doctor prescriptions, lawmakers have approached the issue with a public health focus rather than drug wars of the past that stressed law enforcement.

As politicians campaign in the shrinking time before the crucial elections, please consider letting them know that they’ve made a start in combating opioids but more — much more — needs to be done.

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