Senate opioids bill misses target, experts say

Drug addiction experts are concerned that laws passed by the Senate to address the opioid crisis will have limited impact because they lack the kind of funding they need.

While drug addiction experts welcomed some of the provisions of the Opioid Crisis Response Act, many felt that the content of the bill represented another missed opportunity to fight an epidemic responsible for the death of the drug. more than 47,000 people in 2017..

"The federal government, and especially when you look at this bill, is focusing on the continued reduction of opioid prescribing," said Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center and former director from the White House office. national drug control policy. "The biggest deficit I see is not bridging the large funding gap we have to provide states and local communities with the resources they need to dramatically expand access to treatment."

Among the bill's major proposals is the reauthorization of 21st Century Cures Act grants that provided $ 1 billion over two years to states and gave the National Institutes of Health greater flexibility to approve high-impact projects. new non-addictive analgesic as an alternative to opioids.

Provisions to expand access to drug-assisted treatment by making permanent rule changes in 2016 under the authority of the Obama administration allowed nurse practitioners and PAs to prescribe ART and allowed physicians to prescribe up to 275 patients.

The bill also expands a program that assists first responders to administer naloxone, a medication designed to reverse the risk of overdose, to provide services in schools in areas most affected by the opioid crisis. additional resources to help educate providers on improving the management of pain treatment.

Most of the funding proposals included in the bill help expand or continue existing grant programs, but offer little new funding. The Congressional Budget Office estimated that the legislation would add $ 7.9 billion in spending over the next five years.

Dr. Andrew Kolodny, director of opioid policy research at Brandeis University, said a more robust, long-term funding commitment was needed to meet the demand for treatment. It is estimated that only 10% of the approximately two million patients with a substance use disorder have access to treatment.

Kolodny estimated that a commitment of about $ 6 billion a year over the next 10 years would be required, devoted solely to expanding access to treatment to make significant progress.

"Without adequate funding and a commitment to long-term funding, it does not make sense," Kolodny said of the Senate bill. "The money that we earn here and there does not work for a state when it comes to developing new treatment programs."

Botticelli said lawmakers should discuss ways to create the kind of appropriate annual funding mechanism to combat the spread of HIV / AIDS through the Ryan White program. Since 1990, the program has provided more than $ 2 billion annually to support medical care and support services for economically vulnerable people living with HIV.

"Short-term grant programs and short-term resources – even if we have to dramatically increase them – these efforts need to be sustained over time," Botticelli said.

A similar bill was passed in the House in June and a final version of the bill will have to be negotiated between the two chambers before being sent to President Donald Trump for signature.

The bill on the House contains provisions that address issues that Dr. Kelly Clark, president of the American Society for Addiction Medicine, said to be essential to any serious effort to deal with the opioid crisis.

She said she hoped that a final version of the bill would seek to modernize the rule of institutional exclusion for mental illnesses, which prohibits the reimbursement of medical expenses for mental health problems or addiction in psychiatric institutions with more than 16 beds. Clark said legislators needed to amend a substance abuse privacy law that many addiction experts cited as a barrier to providing more coordinated care to these patients.

"We have an absolutely flawed base of outdated legal restrictions that prevent doctors from taking care of their patients and their patients to help them recover," Clark said.