Can Opioid Legislation Make a Dent in the National Epidemic?
By the end of next week, the House will have considered more than 50 bills aimed at staunching the opioid crisis. The volume “may well be a record for legislating on a single issue,” Rep. Greg Walden (R-Ore.), who chairs the House Energy and Commerce Committee, said Tuesday on the House floor.
The House’s work touches on most aspects of the crisis, aiming to better monitor opioid prescriptions, increase treatment funding, improve drug enforcement efforts, and provide additional support to families affected by the epidemic. But does quantity equal quality?
On and around Capitol Hill, it depends who you ask.
“Obviously, there are provisions in this package that we’ve been working on that will have an impact, from telemedicine to loan repayment to better coordinating care,” said Chuck Ingoglia, the vice president for public policy at the National Council for Behavioral Health. “But at the end of the day, we need to be serious about treating addiction and building a comprehensive prevention, treatment, and recovery system in this country.”
Ingoglia said he is not convinced Congress is there yet. And he has found some agreement among other drug policy and public health experts, as well as some Democrats.
“I am concerned that, collectively, the 57 bills we’ll consider do not go far enough in terms of providing the resources for millions suffering from this crisis,” Rep. Frank Pallone (N.J.), the top Democrat on Walden’s committee, said Tuesday.
Ingoglia said he and others have been troubled by two elements of the federal government’s response: an exclusive focus on opioids, to the exclusion of other substances driving rising addiction rates, including methamphetamine and cocaine; and a reliance on programs that are based on grants subject to congressional renewals instead of permanent funding streams.
Walden and other Republicans argue that the legislation could make a significant difference in a crisis that could claim 500,000 lives over the next decade. That doesn’t mean, they say, that it is perfect.
“We know there is no silver bullet,” Walden and Rep. Michael Burgess (R-Texas) wrote in an op-ed last week. “While these bills have great potential to help our communities and reduce stigma, they were not our first efforts to address the opioid crisis, and they won’t be our last.”
Leo Beletsky, a Northeastern University professor who focuses on public health policy and addiction, applauded Congress for attempting to expand treatment, but cautioned against doing so without strongly incentivizing those treatments that have been proven to be effective.
The 21st Century Cures Act of 2016, Beletsky said, did too little in that regard, and “ended up propping up a treatment sector that’s in dire need of reform.” One bipartisan bill does aim to ensure that programs funded by the Department of Health and Human Services conform to evidence-based treatment.
A bill requiring Medicare to do the same, however, attracted only Democratic support and did not advance beyond a House committee.
While data is sparse, public health officials also acknowledge that a large majority of Americans with opioid use disorder do not receive what is considered the standard of care for treatment: medication-assisted therapy coupled with psychosocial counseling.
Legislation passed in 2000 aimed to bolster addiction treatment in primary care settings, but experts believe it wasn’t as effective as it could have been. And while the package the House is considering this month expands funding and access to such treatments, it does little to better integrate them into primary care systems.
Another bill, in fact, does the opposite—establishing “Comprehensive Opioid Recovery Centers,” which will serve as a gold standard for addiction treatment facilities but, as their name suggests, are specific to opioid treatment and do not provide comprehensive health care.
“People with substance use disorders by and large have other things going on, so separating their substance use treatment from other treatment doesn’t make sense,” Beletsky said. “And it further stigmatizes and embodies this idea that addiction treatment is somehow different.”
Beletsky also noted the Medicaid programs in numerous states do not cover methadone treatment. Medicare, as a rule, does not cover methadone treatment—and a House bill to overturn that restriction has stagnated in committee.
“Isn’t it ironic that prescribers can prescribe as many opioids as they want,” Ingoglia said, “but they need special training and waivers to prescribe treatment for addiction to those same opioids?”
Leana Wen, Baltimore’s public health commissioner and a staunch advocate for expanding access to the overdose-reversal drug naloxone, released a statement encouraging Congress to consider a bill introduced by two Democrats, Sen. Elizabeth Warren (Mass.) and Rep. Elijah Cummings (Md.).
The pair’s proposal would authorize $100 billion to be spent over the next decade through a program modeled after the Ryan White HIV/AIDS Program. Authorized in 1990, that program reaches more than half of Americans living with HIV/AIDS and continues to be authorized at more than $2 billion each year.
The bill is unlikely to advance, but Wen and some other addiction experts say it is an example of the kind of policy proposal that could save lives.
“The majority of the bills currently being considered are tinkering around the edges,” Wen said in a statement. “Many present short-term or small fixes that will not allow frontline providers to address the epidemic in the way we know is necessary.”