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An addict is injecting heroin, even as a fentanyl test strip was recording a positive result on Wednesday, Aug. 22, 2018, in New York. (AP Photo / Bebeto Matthews)
In a rare moment of bipartisanship, the Senate passed a package of bills last Monday to combat Canada's deadly opioid epidemic.
The vote was 99-1, with only Senator Mike Lee (R-Utah) dissenting.
President Trump and Congress have promised a federal response to a crisis that affects millions of Americans and is responsible for the deaths of nearly 50,000 people last year. Asset declared the epidemic a public health emergency. This is one of the only important pieces of legislation that Congress is expected to adopt this year, as lawmakers prepare for the mid-term elections in November.
All 70 Senate bills cost $ 8.4 billion and create, expand and renew programs in several organizations. It is an ambitious project to prevent fentanyl, a deadly synthetic drug, from being shipped through the US Postal Service, while allowing doctors to prescribe more drugs to wean opioids, such as buprenorphine.
"It does not include everything we all want to see, but important new initiatives and a step in the right direction," said Senator Rob Portman (R-Ohio), who advocated several measures as part of the strategy. package.
"Congress is committed to putting politics aside. It's not just bipartite – I think it's non-partisan. "
Yet many advocates and public health experts say it does not offer the only thing we really need: the huge amount of funding needed to fully combat a crisis that deeply affects rural and urban communities across America.
Sarah Wakeman, medical director of the Mass General Hospital's Addictions Initiative, said targeting the depth of the opioid epidemic would require an injection of federal funding of more than $ 20 billion per year. year.
"Historically, we do not think of addiction as a medical issue and our health system and our public health system are totally unprepared to respond robustly," she said.
The House passed a similar measure in June and both houses will have to negotiate some differences before sending the package to Trump's office.
The biggest difference between House and Senate measures is an obscure, decades-old rule known as "Mentally Ill Institutional Exclusion" or "MDI Exclusion", banning federal drug rehabs in centers. more than 16 beds. patients mainly suffer from a serious mental illness. Many people with substance abuse problems also suffer from mental illness, and this rule means that they can not be treated for their addiction when they are in a large mental health facility.
The House bill partially reverses the exclusion of IMD for mental health patients who also suffer from an opioid-related disorder that would cost nearly $ 1 billion during next 10 years. The Senate bill makes some changes to the MDI rule, including ensuring that pregnant and postpartum women continue to receive services covered by Medicaid and administered outside these facilities, such as prenatal care. But this does not allow Medicaid to pay for the treatment of addiction in large facilities.
While opioid addictions are decreasing, deaths from heroin overdose are increasing. This is not because more people are consuming heroin, but because the drug contains fentanyl – an incredibly powerful, inexpensive and synthetic opioid. The Centers for Disease Control estimates that of the 72,000 overdose deaths in 2017, 30,000 were due to synthetic opioids.
The Senate bill deals with the ease with which synthetic opioids are shipped overseas, usually from China. A provision in Portman requires the postal service to filter parcels from abroad and receive electronic data on package contents, which only commercial operators can now do. Legislation in the House contains similar language.
In addition, the Senate bill aims to increase access to treatment for drug addicts, in particular through a grant for rehabilitation centers where people with addictions can find temporary housing, vocational training or otherwise.
It provides loan repayments to behavioral health service providers who practice in addiction treatment centers in areas of the country where there is a shortage of mental health professionals; Expands a program that gives first responders the opportunity to administer naloxone, the life-saving antidote to overdose of opioids; and allow the Federal Drug Administration and the administration to ask drug manufacturers to create blister packs when opioids are administered within a limited period of three to seven days.
Jessica Nichols, Chair of the Drug Policy Forum, is an advocate for the bill.
"I think this is an important moment for new resources and better policies to deal with the opioid epidemic," she said. "It's a historic bill that treats addiction as illness."
But others in the industry are less impressed.
Daniel Raymond, of Harm Reduction Coalition, said that it was hard to tell a city that is losing its citizens to a drug overdose that help comes in the form of a pilot program of competitive subsidy that it may or may not receive.
"This is an election year to show that they are doing something. It's not always badIng, but I think to a certain extent that it's a political document, "said Raymond last week. "When you explore deeply, it's not that the ideas are not good, but they do not reach the level, that's what our country needs now."
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