W

ASHINGTON — The House spent much of the last two weeks passing dozens of bills aimed at addressing the opioid crisis, an effort top lawmakers from both parties have long identified as a priority.

Many are consensus proposals, though a few have generated controversy. Some are substantial in their scope, though many fund pilot programs or studies, or enact grants for which funding will expire within years.

Outside experts, while applauding Congress for its focus on the issue, say they believe the current package fails to match the scope of the current crisis.

advertisement

Politics, too, have played a role, with midterms looming this November. Republicans have been criticized for dividing the package into 57 bills with, accordingly, 57 or more GOP lawmakers who can claim credit for working to address the epidemic.

It also remains unclear exactly how and when the Senate will craft its own legislation. A spokesman for Senate Majority Leader Mitch McConnell (R-Ky.) said the legislation was a priority but acknowledged the Senate does not have a specific timeline for opioids legislation.

Lobbyists and Democratic congressional staffers have predicted that McConnell will wait until November — so that the roughly one dozen vulnerable Democrats in hard-hit states like West Virginia can’t advertise a “yes” vote on opioids legislation.

The House is expected to finish its opioids work this week. Here’s a look at some of the most impactful bills, and which proposals or policy ideas didn’t make the cut.

What’s in the package:

1. Evidence-based treatment: One bill, lawmakers and outside experts have said, is a common-sense proposal that has never formally been enacted: a requirement that any addiction treatment program funded by the Substance Abuse and Mental Health Services Administration exclusively fund evidence-based treatment. Such legislation is likely to shift federally funded treatment toward addiction medicines coupled with counseling and away from abstinence-based programs. A large majority of Americans with opioid addiction do not receive medication-based treatment, which is shown to substantially reduce overdose deaths.

2. Waiving the IMD exclusion — kind of: Many behavioral health advocates have long pushed to waive a restriction known as the institutions for mental diseases (IMD) exclusion, which prevents Medicaid from reimbursing for inpatient mental health or addiction treatment at facilities with more than 16 beds. Many believe the restriction has proven a bottleneck to addiction treatment; others have expressed concern that care delivered in many such facilities is not effective and that appropriate addiction treatment, more often than not, takes place in outpatient settings.

The House package makes it easier for states to waive the IMD exclusion, but the bill expires in five years.

Newsletters

Sign up for our D.C. Diagnosis newsletter

Please enter a valid email address.

3. Expanded access to buprenorphine: A controversial House bill would preserve the right of nurse practitioners and physician assistants to prescribe buprenorphine. Buprenorphine is a controlled substance, meaning it requires special permission to prescribe, and the bill also allows doctors to prescribe the drug to up to 100 patients immediately after they obtain a waiver.

4. A movement away from opioids for pain treatment: A bill passed by the House Ways and Means Committee aims to ensure there are no “misaligned financial incentives” to prescribe opioids via Medicare — a challenge for physicians, given the low cost of generic opioids and the many pricier options for medical devices or non-opioid medicines to treat pain.

5. Changes to medical privacy laws: After intense debate that had little to do with partisan politics, the House voted to authorize the disclosure of a patient’s history with a substance use disorder without the patient’s consent — a policy change specific to addiction treatment. The legislation’s backers say it could prevent doctors from prescribing opioids to patients with a history of addiction. Groups that favor stricter privacy standards have expressed concern that the change could prevent some individuals from seeking treatment.

What’s not:

1. Harm reduction: The package does little to further some of the most progressive ideas championed by some cities in the United States and Canada.

Namely, it does not expand syringe exchange services, which have been shown to reduce infectious disease transmission among injection drug users. It also does not change laws prohibiting supervised injection sites, though cities including San Francisco, New York, and Denver have expressed interest in pilot programs aimed at reducing overdoses. And the bill does not include a requirement that the overdose-reversal drug naloxone be co-prescribed with opioids, an increasingly popular concept for pain patients viewed as at high overdose risk.

2. Methadone treatment expansion for Medicare and Medicaid: A recent study found methadone to be the most effective drug in reducing mortality related to opioid addiction, followed by buprenorphine. Medicare programs as a whole historically have not covered methadone treatment for opioid use disorder, and a number of state Medicaid programs similarly cover buprenorphine but not methadone. The bills passed by the House allow more flexibility for Medicare, but do not fully address the Medicaid gap.

3. More parity enforcement: A proposal endorsed by Labor Secretary Alex Acosta would have given the federal government the authority to fine insurers who violate parity law — which requires equivalent coverage for physical and behavioral health conditions. An effort in the Senate to introduce such a provision fizzled, and the House did not address the issue.

4. Mandatory prescriber education: A House committee at one point had discussed the prospect of stricter limits on first-time opioid prescriptions and mandatory prescriber training for doctors. Neither policy is included among the House bills, though some legislation would create stricter oversight for opioid prescriptions and better monitoring for at-risk patients.

Leave a Comment

Please enter your name.
Please enter a comment.

  • As a 68 yr old on pain management at an unchanged dosage for over 20 yrs, this insanity has cost me my medications that I needed to; 1. Have a quality of life and 2. Control of my short bowel syndrome and continual weight loss. You are in effect killing me and I’m not an addict but in 24/7 pain now bedbound in what was suppose to be an enjoyable retirement.

  • My personal exerience and stories from friends having to do with the new opioid law, in particular Florida HB21 has been entirely negative. As a result of the sweeping bill, which wasnt thought out very well, there are increasing numbers of people actually turning to the streets for pain relief. The treatments drugs such as Suboxone are are being sold at a SHOCKING rate and Heroin is now more common than Ive seen in a lifetime. There are drug dealers out here feeding on what lawmakers think is the answer, not to mention that death from Heroin is increasing as well as the fortunes of the drug dealers!
    The new opioid laws are going to cause yet even more deaths.
    Another, not very well thought out part of the completly ignoranant law makers is that MOST PEOPLE WHO NEED PAIN MEDICINE ARE BEING UNDERTREATED OF PAIN THAT IS NOTHING SHORT OF BARBARIC!
    Lawmakers! WHAT? ARE? YOU? DOING?
    DONT WAIT ANOTHER MINUTE TO ALTER THESE LAWS REGARDING THINGS YOU KNOW NOTHING ABOUT!

  • What can I do to help chronic pain patients suffering not allowed their medication….I took care of a veteran for years who got in a car wreck . He was denied pain medication and took his life because of the pain….God help us….our freedoms are at stake

  • I am a 63 yr. old male that is widowed. I have degenerative disc disease, spinal stenosis and inflammatory joint disease throughout, it everywhere. I have been on opioid therapy for 12 yrs. without incident. Have our politicians lost their minds? They are actually trying to take the one thing that works for 99.9% of chronic care patients. If these morons are successful in illuminating opioids from chronic care, they will create the biggest illicit drug problem the world has ever seen. None of us will have any use for these pain doctors. I for one will formulate my own care whether it be illegal or not. Don’t care, desperation will set in and many people will find their pain control where ever it may be. There is not enough law enforcement in this country to control something of this magnitude. Not only will these illicit means not be controlled but, think of the increased risk to our law enforcement personnel.
    Mr. President, if this insanity is allowed to continue your administration will be responsible for one of the greatest gaffe’s in medical\social history. Suicides are on the rise due to recent developments. I shutter to think of what will happen if some of this useless legislation is passed. The chronic pain community is gain ground and participation is growing in leaps and bounds. Human rights organizations are taking notice and investigating.
    Let the critics say what they want, in short people are experiencing a hell of a lot more pain since the government and their agencies have been involved. They spout these numbers of overdoses, one should give thought as to how these drugs were obtained and I would bet 99.999% were gotten through illicit means. Focus on these street drugs and wealthy cartels and stay away from chronically sick people who live a life of pain. I can’t believe I even have to make this statement, this is so horrible and barbaric.

  • am a 69 yr old person who suffers from two medical cIonditions that require opioids to help me live.
    I took OTCs until it affected my liver an my heart. In 1992 I sought medical help as I could no longer tolerate NSAIDS, ASAs, or anything else that had these compounds. My doctor started me on Ultram, took it 6 months then they no longer worked. I tried oxycontin, extended morphine, for 6 months each without relief. We, my doctor and I, settled on Duragesuc 75 mcgs every 48hrs. This allowed me to continue working, taking care of family, do scouting, camping, just living life. I continued this dosage for years. It even continued as I moved to various states. I always used the same pharmacy even prior to it being a requirement. Doctors an I worked together to establish good relationships.
    Starting in 2010 I noticed additional changes. I always signed those pain contracts, did all the screening, even had to do all the procedures at various pain clinics in the states I lived. The procedures are an understood part of receiving any pain medications.
    I also had to decrease my methadone, which I was put on when Aetna refused to pay for Duragesic or any fentanyl. After each procedure, a cut back. I started with 90 mags of methadone, down to 30 mg in 2016. I was very unhappy, in pain an becoming unable to maintain a somewhat productive life. I was told that I had to wait 1 year to see if these various procedures worked.
    In 2007 I had an emergency surgery an removal of 8 ft. of small bowel, with an ileostomy. Six months later a reversal for failure to thrive. A 2 month hospitalization for finding the right combination of medications to control my diarrhea. One of those is an opioid.
    So here I am in 2016 with another move to now Virginia. There is no doctor here that will order any opioid for the conditions that require them.
    I have short bowel syndrome that require 2 medications together to control my diarrhea, as 1 will not work without the other.
    I also have scoliosis, sciatica, osteoporosis, osteoarthritis, DDD, severe muscle cramps in my back, an migraines. I am in constant pain, in the bathroom constantly. I am slowly dying. I am in 24/7 pain. I can hardly eat, can’t have any quality of life, an most of all, no doctor anywhere will order pain medications, no the codeine needed to control my diarrhea.
    As one of many who rely on pain medications, opioids an other medications to live, without them I am dying.
    Cppers are not addicts, we take these much needed medications just to be able to do routine every day things that others take for granted.
    The government has no place in healthcare. You do not review medical records, talk to patients, or treat. One size has no place in chronic pain or anywhere else. The DEA, using PROPS is now targeting patients as well as doctors.
    Your issue is ILLEGAL DRUGS, IMPORTED FENTANYL, cartels, street drugs and improving rehab through lifelong help and medication.
    What is happening now is increased suicides from chronic pain people unable to receive meds or have cut back so severely that there is no QOL.
    Tell CDC TO BOW OUR OF HEALTHCARE. TELL DEA TO REDIRECT THEIR EFFORTS ELSEWHERE, NOT TO OUR DOCTORS WHO ARE BASICALLY SITTING DUCKS.

    • This is so true for many patients. In the government’s knee-jerk response to the heroine, illicit drug crisis, patients who need doctor-approved opioid treatment are being left to suffer and die. Where are their human rights? Where are the rights of doctors to competently manage their patients with chronic, intractable pain?

  • How about they draft some laws about illegal spying, fake dossiers and the whole smelly mess. This just makes me sick…as an RN who works with pain patients I know that sometimes pain pills are the only thing that works. You also cannot take a random number and say “That’s it, no one can have more than that per day!” They aren’t even medically trained; what are they doing proposing laws about it?

    • @Shar53 – I’m not a nurse, but a Surgical Assistant Practioner. What you said…SPOT ON! THE IGNORANCE OF IT ALL! I know they get panelists on board, for advising purposes, consisting of Doctors in related fields, Healthcare PhD ‘s, etc. However, the whole thing is so screwed. Taking the CDC “guidelines” for PCP. What a joke that was, let us count the ways in which very intelligent people took those, “guidelines” as LAW. SERIOUSLY? Placating arises from fear, and people who educate for years and years, are EXTREMELY afraid of loosing the piece of paper and licensure numbers ehich give them the honor to help people with issues both superficial and life threatening. Again, the fearful will placate to the high level of scrutiny by the powers that be, in which we trust. (not too much anymore, if ever so).

      However, you hit the nail on the head. The coffin nail that’s created a bucket load of pain, malpractice, violation of, ‘patient’s bill of rights’, the right to be pain-free ‘for one.

      Denying that which is the most powerful thing to have. QUALITY OF LIFE, if at all possible. Which, of course, it is. However, for most people in chronic pain, 90mg MME daily cap is NOTHING.

      The MME is different from one official organization to the next. Any MME fails to include, generally, height|weight|tolerance threshold|Pharmacogenomics (metabilization) my lord, the majority of ALL drugs rely on these basic physiological processes. Ok, sorry. I’m getting on my high horse. All apologies, please.

      Good for you, most people don’t bother to take a stand for matters of important debate. However, we all know someone who is or was a chronic suffering individual, whose life had/has been stripped away.

      Yet, with technology at our fingertips, most people definitely are unaware or ignorant about online campains or official Federal dockets that they are allowed to open and to provide themselves with information on how our country’s government agencies are looking to change, suggest and notify employees and the public population. Then, if request for public opinion are asked for…you can post it online. Your little piece of the prize, whichever one you’re going for.

      Power to and by the people! Take a break from Twitter or Facebook, and check out your future people. Our voices truly ARE heard, but statically ONLY in numbers.

  • I am not an addict! I am in pain all day, all night. #3,4….not addressing the 1miilion + people suffering with chronic pain who know from years of trial an error, and medical supervision that pain medications are the ONLY thing that has helped. Never pain free, but reduced enough to be able to have some quality of life. If you do not suffer from CP, do not walk in my shoes and tell me what works for my particular situation as you are not me. Addicts need lifelong treatment, Cppers need lifelong treatment and yes, sometimes the only thing that works is pain medication. How dare you presume!

  • Just one question? Who benefits from these so called solutions? Makers of suboxone, which, btw, is not only controlled, but, an OPIOID , shhh. Also? Owners , operators, of rehab centers? Oh, my bad, second question plz? Where does all this leave the chronic pain patients, post ops, after cancer patients who just have to, according to sessions, go home take aspirin , and go to bed? Hmm, mr seessions, and what would you take after surgery, or accident that leaves you in intractable pain? Oh, my bad, you guys have yer own private pharmacy in dc, shhh.

    • The Crusade Jeff Sessions has targeting Opioids, in the name of Saving Lives, is a hypocritical crock! The CDC website reported 33000 deaths from Opioids Abuse. In the same year there were 88000 deaths from Alcohol Abuse, yet that is ignored. So much for Sessions Moral Credibility.

      Wondering how, and this became Sessions obsessions is very curious. His reason to the public of saving lives is a bold faced Lie, when stood up against deaths from Alcohol. So what’s really behind it. Follow the Money.

      Most don’t know why the US Military are Guardians of Afghanistan Poppy Fields. The only obvious reason is to Control Supply! The Money from Illegal Opioids is astronomical. Where does the Money go when gov busts dealers. Where is the Accounting of all that Money? It’s not in the Congressional Budget, but it Should be! It’s Money, and a lot of it! The CIA is reportedly known to have been involved in distributing illegal drugs.

      Turn to Sessions working to cut off the Supply of Legal Prescription Opioids, and ask What will those who rely on them for pain relief do, and for that matter, those who don’t suffer pain, but use them just to get high, which is called abuse. You can rest assured people will turn to the black market illegal Supply, to attain them.

      All cutting off the Supply will do is create Demand! Sessions is creating a giant size illegal Blackmarket for Opioids. In turn this creates an ever greater source of revenue of Money through, and from the Blackmarket, the Gov Controls. More Money going UnAccounted for, that goes into the black hole of Shadow Gov.

      Absent Any Valid Cause for Sessions Crusade Targeting Legal Opioids, already knowing the so called Mission of Saving lives is a Lie, leaves no valid cause but more Money flowing into the Shadow Gov coffers!

      Money of the magnitude of illegal Opioid trade, is in competition against the purpose of having a valid Congressional Budget, when the illegal Money goes to the Gov., yet is Not Publicly Accounted for, that is Funding Shadow Gov doing who knows what. It’s virtually two Govmts operating at the same time, which is about as Anti-American can possibly be when Americans expect transparency, and openness, that is what America is about, and stands for, which is why there is a Congressional Budget, that Americans Know where their money comes from, and is spent. Yet the subject of where all the illegal money goes is rarely mentioned, if at all. You read about spectacular sums of money captured by law enforcement, but never its Trail of Accounting.

      If anyone can present a better reason for Jeff Sessions Crusade Against Legal Opioids, it would be well worth hearing, but the reason put forth as Gov cares about saving lives drowns in all the deaths from Alcohol Abuse.

      Turn

  • Keep government from sticking there nose in where it don’t belong ! Pain meds is our personal business- not theirs !

    • Im disabled.handicapped.failed surgery. Opioids allow me to do my laundry dishes with out it takeing all day.now they are reducing what i have been takingSAFELY for 16years.by 70 percent i guess my next move is suicide on Facebook. I have nobody to do these things for me plus the main reason my CONSTANT COMPANION PAIN.IM 56and have tried everything opioids is the last stop for millions of chronic pain patients like myself now there reducing what EVERYONE GETS ACross the board. .All people are different my life is getting to where its not worth living in CONSTANT agony

    • Couldnt agree moree more!!!! The new laws are like prohibition! The more laws=More crime!!=more death

  • RE: “A recent study found methadone to be the most effective drug in reducing mortality related to opioid addiction, followed by buprenorphine.”

    This statement is misleading in my opinion. This was an observational cohort study, not a head-to-head randomized trial comparing the efficacy for methadone and buprenorphine. Additionally, the study results show an overlap in the confidence intervals for mortality reduction for the two drugs. This makes it even less appropriate to extrapolate that methadone is more effective. A more accurate interpretation of the study would be that there was an association of reduced mortality with buprenorphine and methadone. Why do I point this out? Methadone has safety concerns that buprenorphine does not have. It can be dangerous drug in the hands of clinicians who are inexperienced or careless, or if patients overuse it. This was well-documented in the early phase of the opiate epidemic. In some state programs, preferential use of methadone to manage chronic pain was linked to an uptick in mortality.

    The other aspect of this study which is probably even more important is that there was no benefit of naltrexone on mortality. Granted, the numbers were too small to make conclusions based on this study. But looking at all the data, the take-home message is that buprenorphine and methadone likely have a mortality benefit that I have not yet seen for naltrexone. As a pharmacist, I am concerned that policy makers will gravitate to funding naltrexone programs because of pharma lobbying. Additionally, they find it easy to buy into the old 12-step program belief that using an opiate to manage opiate dependence or addiction is bad because it trades one dependence for another. That’s a belief, not evidence. The public programs we fund to combat the opiate epidemic should be evidence-based.

Sign up for our Morning Rounds newsletter

Your daily dose of what’s new in health and medicine.

Privacy Policy