The Health 202: Senators will vote for a package of opioids. But there are still big obstacles.

WASHINGTON – As the Senate prepares to vote Monday night on its response to the opioid crisis, a federal government drug abuse study released on Friday highlights how desperate the situation remains.

The Senate bill is far-reaching, creating and expanding programs in many organizations. But public health advocates and experts see the latest statistics from the administration of addiction and mental health services as another indication of the government's lack of work and even seem ready to do so.

The National Annual Survey of Drug Use and Health (NSDUH) found that 11.4 million Americans over the age of 12 had used opioids last year and 2.1 million Americans had opioid disorders.

Here's the good news: these numbers have dropped slightly from the previous two years and the number of new heroin users has been cut in half.

Here is the bad news: the number of Americans dying from a heroin overdose continues to increase, which is in line with figures released by the Centers for Disease Control and Prevention last month.

Even if a few people consume heroin, the drug is more fatal because it is increasingly associated with fentanyl, an incredibly powerful opioid, inexpensive and synthetic. The CDC estimates that of the 72,000 overdose deaths in 2017, 30,000 were due to synthetic opioids.

"The reason why the overdose deaths soar is not because of a sudden increase in the number of people passing from prescription to heroin, the reason why these deaths have increased is due to a sudden increase of dangerousness. "Andrew Kolodny, co-director of opioid policy research at Brandeis University, told me.

The Senate bill deals with the ease with which synthetic opioids are shipped from overseas, usually from China. A provision by Senator Rob Portman, R-Ohio, requires the US Postal Service to filter parcels from overseas and to receive electronic data on package content – something that only commercial operators must do now.

"Because of its extreme power, lethal doses can be shipped in small packages that are virtually impossible to identify without the necessary information and screening devices," said Portman in a speech last week.

Here's another good news: More than 100,000 more Americans received treatment for opioid-related disorders last year.

But the bad news: out of nearly 20 million people in need of treatment, 94% did not receive it.

When asked why, 30% of them said they did not have health coverage and could not afford it, and 10% did not know where to go for treatment.

The Senate bill, which largely reflects a version of the House passed in June, aims to increase access to treatment, including through a grant for rehabilitation centers. But this too is perceived as a small answer to a huge problem.

Public health experts say more doctors should be allowed to prescribe buprenorphine and methadone, two medications that can be used by a health professional to help addicts to wean themselves off. Doctors must obtain a waiver to administer buprenorphine and even then, they are limited to the number of patients they can give. The Senate bill addresses this issue, but closely. For example, the measure increases the number of patients that doctors can prescribe from 100 to 275 drugs.

Sarah Wakeman, medical director of the Mass General Hospital's Addictions Initiative, said "the proposed opioid legislation does not go far enough".

"Historically, we do not think of addiction as a medical problem and, as a result, our health system and our public health system are unfortunately not prepared to respond in a robust way," said Wakeman. "We could significantly reduce or stop overdose deaths, we have the tools and the science, but we do not have the will yet." Opioid overdose is a reversible disease and the underlying disease of the disease. addiction is highly treatable, treatments or interventions to keep people alive widely available. "

For Wakeman, reaching the depth of the opioid epidemic would require an injection of federal funding of more than $ 20 billion per year into HIV / AIDS. So far, despite the fact that President Donald Trump has declared that the use of opioids constituted a public health emergency and that a bipartisan consensus had been reached on the fact that something had to be in fact, there was no such financial implication.

In addition, the White House's amendments to the Affordable Care Act may limit access to treatment. The shorter-term, cheaper term plans that the Trump administration will allow Americans to buy for 2019 do not include the essential benefits of ACA, including coverage for business problems. substance addiction. And the work demands that many states wish to add to their Medicaid programs could result in a loss of health coverage for low-income people with addictions.

According to the Kaiser Family Foundation, Medicaid recipients with opioid addiction are three times more likely to receive treatment than those with private insurance.

But Kolodny said President Obama was also responsible for the crisis. The problem, 20 years in preparation, has worsened around 2010, but Obama has not talked about it until the last year of his presidency.

"Obama was not better on opioids than Reagan was not doing it," he said. "The Obama administration, the president, has really neglected the epidemic and its situation has worsened."

"Overall, it's very little, very late," added Kolodny. "We have not seen an appropriate answer yet."