Latest Congressional Opioid Bill Will Not Resolve Crisis

The Congress's latest efforts to address the opioid crisis will not be enough to end the continuing plague of overdose deaths across the country.

Public health experts and first responders say the massive bipartite HR 6 (115), approved by the 99-1 Senate on Monday, is taking important steps to improve access to treatment, but lacks funding to crack down on it. 39 urgency that takes 115 lives in the United States a day.

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"We need to stop putting people in bags," said Jonathan Thompson, executive director of the National Sheriffs Association. He said Congress was reacting to a crisis instead of taking a comprehensive approach to preventing drug abuse. And it must happen faster.

The House passed its package in June and House and Senate negotiators have already begun to resolve their differences. Senate Speaker, HELP, Lamar Alexander, said he hoped to unveil a final deal on Friday. The House is likely to vote on the final package next week in order to send it to President Donald Trump's office before the mid-term elections.

The new legislation would crack down on mailings of illicit drugs such as fentanyl and encourage the development of non-addictive pain therapies – which is necessary, but will take time.

But this only marginally limits the severe shortage of treatment beds for rehabilitation at the national level, and this encourages little more doctors to prescribe drugs to treat drug addiction, which requires training and a specific permit. The bills create new grants and demonstrations to test new treatment programs, but there is no guarantee of long-term funding to keep them in good working order.

"The data shows us constantly that more and more people are dying. What is the reluctance to spend money and do something? "Said Chuck Ingoglia, vice president of public policy at the National Council for Behavioral Health.

Trump, who campaigned in 2016 to end opioid addiction, has often talked about strengthening law enforcement, and even supporting the execution of drug traffickers. House and Senate bills have generally put more emphasis on a public health and treatment approach, though critics do not think they go far enough.

The latest CDC data shows that the devastation is worsening: about 72,000 overdose deaths last year, an increase of 10% over 2016. Most of these deaths came from opioids, whether legal or illegal. And although states began to limit opioid prescriptions, the increase in deaths was largely due to illegal drugs like fentanyl.

Trump said the opioid epidemic was a national public health emergency last year and pledged to cut opioid prescriptions by one-third over the next three years.

He signed a presidential proclamation this week stating that Prescription Opioid Epidemic Awareness Week and heroin would bring attention to the crisis.

The latest congressional efforts will mark the second legislative response to the epidemic of opioids in two years. President Barack Obama signed the first article, the 524 (114) or Comprehensive Addiction and Recovery Act, in 2016, which created grants for states to work in the field of prevention and rehabilitation.

Lawmakers say the legislation they will send to Trump is the next step, not the last word. They know that the crisis is evolving and that voters are well aware of the consequences and expect more.

"It is not one and it is done. We have taken the lead and we will have to continue working on this topic, "said Senator Shelley Moore Capito (RW.Va.), whose home country of West Virginia has the overdose death rate the highest in the country. .

Health groups are encouraged by some parts of the legislation, including a measure approved by the House that allows states to partially lift a decades-old Medicaid restriction on the treatment of opioid and cocaine addiction in some facilities. Legislators claim that this provision will allow states to develop inpatient treatment faster than the current Medicaid waiver system. Another bill allows doctors to share more medical information for addicted patients. The Senate bill contains neither and it is difficult to know if they will enter into the final agreement.

Both chambers include proposals to help families affected by drug addiction and opioid-dependent babies. They also include extensions of Medicare coverage for certain drug-assisted therapies and wider use of telemedicine to treat substance abuse, which can be particularly useful for rural residents.

"The difficulty we're seeing is that we do not have the infrastructure to solve this problem," said former Mary Bono, co-founder of the Collaborative for Effective Prescription Opioid Policies. "A lot of these bills are trying to fix it and try to help, but it will take a long time and the federal government can not do everything."

An idea that was not included in this package but could be discussed in the future is to allow the federal government to negotiate the price of naloxone. The idea of ​​making the antidote more affordable was approved by the president's opioid commission, headed by former New Jersey governor Chris Christie, but did not gain ground for political reasons.

Many public health officials and experts warn against any attempt to repeal the Affordable Care Act or reduce Medicaid coverage, which would undermine the work done to control the drug crisis.

"The Medicaid Enlargement is one of the ways we have been expanding the treatment of access," said Pennsylvania Health Secretary Rachel Levine, adding that the repeal of the law would be " extremely counterproductive ".

Earlier this year, Congress injected more than $ 4 billion into the fight against the opioid crisis. This money has gone to law enforcement, as well as to treatment and prevention programs, and legislators should appropriate about $ 3 billion more in future spending programs. State health groups, who appreciate the new dollars, say that long-term guaranteed funding will be needed to build and equip more treatment centers. It is difficult to plan or build capacity with short-term grants that can or can be renewed.

"They are very anxious about recruiting staff," said Ingoglia, of the National Council of Behavioral Health.

"The question does not have many new laws, although there are things to fix, but we need to make sure everyone has the resources to do the work they need," said Mike Fraser. Executive Director of the Association of State and Territorial Health Officials.

Some have complained that money does not reach states and local communities fast enough.

POLITICO reported earlier this year that millions of dollars had been spent by Congress last year to fight the crisis, due to the sluggish federal grant system.

"This epidemic is going to be stopped community by community, not the federal level, not the state level, it's going to happen at the local level because every community is different," said Eli Briggs, director of government affairs for National Association of Health Authorities of Counties and Cities, NACCHO. "As long as the funding has not reached the local level, we will not turn the page."

However, many are encouraged by congressional efforts and attention to the issue, which has long been separated from the health care system as a whole.

"This crisis will require sustained attention and funding for years to come," said Jeremiah Gardner of the Minnesota-based Hazelden Betty Ford Foundation. "But the opioid crisis has taken years and it will not end overnight."

Gardner and others say it is crucial that policy makers focus on addiction in general. Alcoholism, for example, kills about 80,000 people each year, according to federal estimates. The legislation currently under study is specifically about opioids, but deaths from drugs and cocaine and methamphetamine are also increasing across the country.

"We have had a crisis of dependence for generations in this country. It tends to change from one drug to another, "he said.

"People in this field are still talking about day stuff," said Regina LaBelle, who was chief of staff of Obama's Office of National Drug Control Policy. "The Congress must think about it and not tie the hands of states."