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ASHINGTON — 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.

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“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?”

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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.”

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  • The photo op is hilarious, all pointing blame on anyone but themselves. Whats not funny? People are committing suicide in greater numbers as even our vets are being played , and care withdrawn. But whats of import is that the powers that be gain financially , states given more money for supposed treatment centers, suboxone given , paid for by? My question, why take opioids away from patients , left with no alternatives , make up new disorder , to use said drug on. While the cdc , dea, fda, are all playing , and making money, patients treatments stopped for no reason other than , guess who, says so? Then we have drs operating, but, tell patients to take aspirin? The supposed reason? Oh, maybe you will have a few left over, drug cartel steals them, makes 4 crisis? Hey! Btw! Its heroin and fentanyl, that causin od’s, not legal drugs like rx’s! Duh! Politicians can ruin a one car funeral and cause confusion and delusion.

  • As a normal patient consumer, I find that it is insurance companies themselves that have become the opioid pushers.

    As an example: I have used an effective, prescription cough medicine since the first time I got pneumonia in the mid 1980s. Tessalon Perles (benzoate) is effective, relatively inexpensive, doesn’t dull your brain, non addictive, non narcotic, and has been removed from formularies this year.

    Now, all of the cough medicines on formularies contain codeine, which is addictive. Please tell me, who is the opioid pusher now?

    I’m finding that physicians are reluctant to write prescriptions for pain relief because they feel that they are being scrutinized for how many such prescriptions they write. As a result, I end up with a prescription for 5 tablets of the only pain med to which I am not allergic. I’ve even run into some doctors who are unwilling to write for that specific drug.

    One consequence of my allergies to nearly all opioids and some physicians who are unwilling to write for anything other than percoset or Vicodin is that I went through a total knee replacement with NO prescription pain relief. I wouldn’t recommend it.

    I honestly don’t know what these doctors are thinking. At my age, and being a child of the sixties, I’ve had plenty of opportunities to become addicted if I’d had any inclination to do so.

    Selling drugs on the street doesn’t seem particularly safe, although I might be influenced by episodic television plots. If I wanted to sell opioids, my best market might be the local senior center, except we’re talking fixed income there.

    This all or nothing approach must be tempered with allowing physicians who know and understand the needs of their patients (for the most part) to write the prescriptions they feel will best help those patients, and if that sometimes includes a non opioid medicine instead of the alternative opioid, that should be covered, too.

    • I am author of the article which WriterMera has recommended. “Thanks” for the reference.

      I would also direct readers attention to a 15 minute video interview between award winning television journalist George Knapp, and Dr Dan Laird. In this interview, Knapp and Laird discuss the active campaign of misinformation and medical fraud to which the CDC, major health insurance companies, and financially self-interested addiction treatment centers have contributed. Our US public health problem with opioids is real — but it isn’t caused by over-prescribing, and for the most part never was.

      See https://www.youtube.com/watch?v=Pou87CV5onw&feature=youtu.be

    • Three blind mice all trying to get the cheese , but, keep going around in circles to cause distraction and confusion, as well as appear to be working for the people , when , in fact, the opposite true.

  • So all of us that are suffering from chronic pain are treated as tho we are the criminal. We do what is required of us, take as prescribed (which the prescribed amount does not stop the excruciating pain). Most of us CPP have been taking these meds for 10+ years with NO deaths from overdosing. We get up take our meds and go to work, without them we are unable to get out of bed and lead a fairly normal productive life.

    It hae been my experience that the people who are selljng theirs are the ones that are young, never worked a day in their life , but are on disability and medicaid. They pay 2.00 for a prescription and sell them for 6 -10.00.

    I am amazed! I truly believe that if our (CPP) meds are taken from us there will be more deaths from suicide due to the fact that we just could not live in pain any longer.
    Please think about us the chronic suffers before anymore stupid crap happens. Karma will getcha!

  • I really hope some of the things that are being addressed are the victims all these laws are creating, specifically the patients that are not receiving medical care , they often have multiple health issues that prevent them from using the recommended medications that people who have NO idea what the medical history of the suffering patient is are recommending. They are not Drs and should have no access to medical records even assuming they could understand them.These decisions that should be made by Dr and their patients who know what the diseases and pain they have are causing. The Drs who are afraid to treat patients and should not be afraid of losing their licenses for doing their job. These bills need to be focusing on the real problem of illegal drugs being brought into this country to prey on the patients suffering with no place else to turn. You are creating the perfect storm for a massive amount of overdoses and suicides by denying legal use of a useful type of medication. There are already many safeguards in place to prevent the few who get prescriptions for illegal use. Please stop this typical government overcorrection that causes more harm than good.

  • As a patient who suffers intractable pain from my 25 year battle with CRPS, and as a pain patient advocate I find these bills abhorrent. The 20 plus million Americans who suffer from unrelenting and intractable pain are being hung out to dry, or tossed under the proverbial bus, or run over by this out of control freight train something must be done to help us. We are ostracized and treated like illicit drug users. Many have their opioid pain medication greatly reduced or stopped, are forced into drug rehab when we did nothing wrong.

    It’s pretty pathetic when our elected officials, people one would think are educated and willing to have the research done on this issue. Sadly they do not. If only we could mobilize to form a non partisan voting group and vote these offending officials out, only then can we possibly get our side understood. Our voices are finally getting louder. Plus sadly the restrictions being placed on opioid manufacturing, prescribing and the too invasive Prescription Drug Monitoring Programs that now not only track opioid prescriptions but muscle relaxants, sedatives and any that may give us some energy to function. We are now red flagged and often incorrectly diagnosed with Substance Use Disorder. Really? Who does that? This nonsense must stop.

  • Yes, I want to thank Lev Facher and STAT for providing the important insight that the most important treatment in the opioid epidemic is MAT, medicaitons like methadone and suboxone. These need to be free for anyone who wants them, which also means easy access.

    What the article didn’t say is that one of the key problems involved with many of the drug bills is that the most expensive bills, Prohibitionists bills that call for greater rates of incarceration, not only cost trillions, and destroy families, they also do not seem to do anything to drub drug abuse/overuse.

    If they have any postiive effect at all, it is just to give those punishing drug users a sense of relief or satisfaction. As a gross understatement, this is not a valid justification.

    Also the article didn’t address that 12 Step rehab and 12 Step support groups (Alcoholics Anonymous and its many branches such as Narcotics Anonymous) are still the most widely used but are horrifically ineffective for opioids, even if some note that they seem to have moderate success with alcohol. The success rates for 12 Step rehab are so low that someone is more likely to OD immediately after release than if they continued to use on their own. The rehabs that use MAT are clearly going to have higher success rates as long as MAT is maintained after release than those that don’t. However, most rehabs, and 12-Step based rehabs in particular, frown on the use of MAT because they feel interferres with turning “one’s will and life” over to the Higher Power of 12 Step, which can be a lamp. That the Higher Power of 12 Step can be a lamp is how 12 Step defends itself from accusations that it is a religion. But the defense makes less sense than praying to an actual God who does have the power to remove cravings. However, since it is a miracle (which means it is something that does not usually happen) it is probably Far SOUNDER to use medical treatment. Other self-help groups that are not religions, include HAMS, SMART, LifeRing and Women for Sobriety.

    Yale researchers also have impressive findings on computer programs that help teach people to make better snap judgments. These computer programs seem to be more effective than traditional therapy or 12 Step and would save trillions.

  • This is not the only epidemic we are facing, there are those of us who suffer from long-term debilitating pain who cannot get the pain medication and interventional pain management treatments that we need to allow us to have some semblance of quality of life! We take our medications as prescribed, we follow all the rules as outlined and yet we still cannot get the help we need! There are people out there easily getting pain medication, still, who do not need them but sell them to make a buck. This problem needs to be addressed & stopped by the physicians & followed up by law enforcement if necessary! Not every one who takes pain medication abuses it, however, I have been treated as if I do by pharmacists & physicians alike, which is humiliating. I suffer from Complex Regional Pain Syndrome Type 1, RSD (CRPS/RSD) & Fibromyalgia as well as a myriad of other problems caused by this disease which for the most part is an “invisible” disease. Just because you do not see me suffering does not make it so. Most physicians have never heard of this disease & it took me 3-4 yrs for an accurate diagnosis, during that time I was told “it was all in [my] head” where had I been diagnosed within the first 6-12 months instead of years later, I would not be suffering as I am now. Most physicians I am referred to have never even heard of this disease nor do they know how to treat it. I do since I have been dealing with this since 2006, but the surgeries & pain medications I need are not covered by the insurance I have. Please do not forget about those of us who need the relief provided by pain medication & interventional pain management. There are a lot of us out there who follow the rules & regulations & desperately need help to just get through the day & get out of bed!

    • For Bruce: the study you reference is a literature review reflecting as much the opinions of the authors as any real research knowledge in the papers they hand-picked for inclusion in their finding. The Mayp recommendation on opioids is an unqualified editorial opinion not backed by medical research. The assertion that our current drug crisis comes from over-prescribing is a dead giveaway for uncritical anti-opioid bias or fear of censure by government authorities, on the part of the writers.

      Fibromyalgia is a very complex disorder. In 20 years of supporting chronic pain patients with literature research and analysis, I’ve met several who were helped by opioids. But there is no gold standard that works for everybody. Just about all of the medications now used with this disorder are “off label” adaptations of meds originally developed for other purposes.

    • Bruce, the primary disease I suffer from is listed first, Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy aka CRPS/RSD as well as Fibromyalgia etc. If you do not know what CRPS/RSD is perhaps you should look it up before commenting. You did just exactly what other people including physicians do, jump to a conclusion because they never heard of the disease. I had 7 surgeries in 1 year not including nerve root injections,epidural steroid injections,facet injections and trigger point injections. I have had 2 sympathectomies & 3 denervations (carterizations of the nerves in my neck from C2-C7) as well as a Spinal Cord Stimulator Implant in my back in an attempt to control the pain.
      So, until you know what the big words are & read only the words you know, perhaps you should refrain from judging someone else. Unless, of course, you are one of the ones I referred to as receiving pain meds and using them as income instead.

  • I believe it may not be going too far to suggest that Congress is merely trying to create the “appearance” of doing something constructive — but without addressing the real basis of our ongoing drug crisis, and without threatening the bread baskets of powerful vested interests which contribute to political campaigns. Our pubic health problem isn’t over-exposure to medically managed opioids and it never was. Our opioid crisis is driven by illegal street drugs and socio-economic despair in the hollowing-out of inner cities, rural and Rust Belt communities.

    The Trump administration is even now congratulating itself on a new PR campaign that has the Surgeon General telling outright lies about the nature of addiction from prescription drugs. It’s “Just Say No” all over again, with equally unlikely probability of success. The recently signed “Veterans Administration Mission” bill will reliably result in the deaths of even more Veterans as they are cut off from the only pain therapy that works for millions of people: opioid analgesics.

    There is a core message that all chronic pain patients should be giving their doctors and their legislators: Data published by the CDC itself proves beyond any reasonable contradiction that rates of opioid prescribing from doctors to their patients have no relationship to opioid related overdose deaths. NONE! The contribution of medical opioids is so small that it gets lost in the noise. This finding was recently briefed to the HHS Task Force on Best Practices in Pain Management. And the noses of your legislators need to be rubbed in reality. Call their offices and demand that they stop punishing pain patients!

    • If we honestly look at the overdoses, combined with age groups and socioeconomic class and the state of the economy plus the fact that families have gotten away from the God of the Holy Bible we will see a direct link to poor parenting, the increased influx of NPF (non prescription fentanyl) and heroin. Even our Government has gotten away from good moral ethics. This country is failing its sick citizens, especially those with painful organic diseases, The proposed reduction in medications merely “skirt the issue” and penalize every person in grave need of opioid medications just to shower, and go to the mail box. Disability claims will rise, DME equipment sales will increase i.e. wheel chairs and rollators etc.
      Our employers, including decision making people in the medical are promoted to positions of authority in which they do not have a working knowledge. Gone are the days of the Personnel Office. We are now a Human Resource. Decision makers are poorly vetted. Decisions were made by people with a poor working knowledge of Excel or used it to deceive the CDC. Thank God the FDA did not approve the guidelines that were proposed.
      The Truth will stand when the whole world is falling apart.

    • Exactly! It is illegal street heroin and fentanyl analogues that are causing the VAST majority of opioid deaths, not Grandma’s Vicodin prescription. Politicians and the media are focusing on legitimate patients with legal prescriptions and ignoring this out of control, unregulated street opioid crisis that is being driven by sophisticated crime syndicates run from other countries. I fear that this plague will get much worse before it gets better thanks to our venal, incompetent politicians and their media enablers.

  • Is it feasible to require the manufacturers and/or the distribution network to set aside a percentage of sales profits to be applied directly to opioid/meth/heroin treatment? Similar to contractors’ set asides (10% in Denver) for luxury condos to have low/modest purchases for those who qualify/may have been displaced? This would be an ongoing source of revenue for those who so desperately need it.

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