WASHINGTON — The Senate on Monday passed a wide-ranging opioids bill, one that aims to prevent illicit fentanyl trafficking, account for drug diversion in opioid manufacturing quotas, and improve access to addiction treatments via telemedicine.

Many senators, soon to campaign for re-election in states hard-hit by the epidemic, say the bill is enough. Many advocates for better addiction treatment beg to differ.

And, perhaps as importantly, many key policy differences remain between Senate and House versions of legislation to address the epidemic, leaving Congress plenty of work to do before the bill reaches President Trump’s desk. That effort is expected to begin in earnest after Election Day.

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The Opioid Crisis Response Act, authored largely by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), contained dozens of proposals that are viewed as limited but commonsense steps toward a better nationwide system for preventing and treating addiction. As a result, the bill enjoyed bipartisan support and has been marred by relatively few controversies, especially compared to the House version.

The sole brief snag centered on a provision written by Sen. John Cornyn (R-Texas), the chamber’s No. 2 Republican, which would have awarded $10 million in yearly grants to advocacy organizations, largely to provide training and literature about improving treatment services.

Democrats protested that the language was so narrowly tailored that only the Addiction Policy Forum, a group run by a longtime lobbyist for the drug company Alkermes and funded largely by PhRMA, would be eligible for the funds. After multiple outlets reported on the controversy last week, Republicans agreed to remove the language.

Here’s a look at what else was in the bill, what policy ideas didn’t make the cut, and what ideas might be added back in the coming weeks and months.

What’s in the bill

Reduced quotas: The Senate bill gives the Drug Enforcement Administration more authority to reduce manufacturing quotas for controlled substances, including prescription opioids when the agency suspects diversion, building on a rule the agency issued itself earlier this year. The quotas spell out the volume of specific controlled substance classes manufacturers can produce in a given year.

Chronic pain patients, however, have expressed the concern that reduced quotas could make it more difficult for patients in need to access their medications, without reducing addiction and overdose rates. As the county’s addiction crisis has become more of a focus in Washington, chronic pain patients have increasingly warned policymakers about the pitfalls of otherwise well-intentioned efforts to reduce opioid oversupply.

Telemedicine: The bill instructs the Department of Health and Human Services to issue regulations allowing doctors to remotely prescribe medication-assisted treatments. Buprenorphine and methadone are both controlled substances, meaning in-person prescriptions and referral requirements can pose an obstacle to patients seeking treatment in rural areas.

Mail security: The “STOP Act,” penned by Sen. Rob Portman (R-Ohio) and included in the Senate bill, aims to prevent the illegal importation of illicit fentanyl via the international mail system. The bill will bolster digital tracking data on 70 percent of international packages arriving in the U.S. by the end of 2018 and 100 percent by 2020.

As Portman and other backers point out, the entry of illicit fentanyl into the county’s drug supply has resulted in an explosion of overdose deaths. In 2016, illicit synthetics including fentanyl were involved in more overdose deaths than prescription opioids.

What’s not

More methadone treatment: The House’s opioids bill included language to close a coverage gap for methadone-based addiction treatment in state Medicaid plans, beginning in 2020. The Senate bill did not include such language.

Prescription limits: Some versions of the legislation, including one authored by Sens. Portman and Sheldon Whitehouse (R-R.I.), included hard limits on first-time opioid prescriptions for acute pain. Numerous states have already enacted such legislation, but groups including the American Medical Association have resisted efforts to legislate prescribing practices at the federal level. Other advocates opposed to the limits decried those versions of the legislation as messaging tactics.

Parity enforcement: Like the House bill, the Senate’s package does little to improve enforcement of parity laws mandating that employers and insurers comprehensively cover treatment for behavioral health conditions, including addiction. Parity was a key focus of a Trump White House commission that issued a sweeping list of recommendations last November.

What might get added back in conference

A controversial patient privacy law: Advocacy groups that normally agree on addiction treatment policy are split on a House provision that gives health providers more freedom to share information about a patient’s history with substance use and non-fatal overdose with families, caregivers, and other health professionals

The Senate package, however, does not extend the same authority to providers. Sources familiar with the House legislation said Rep. Greg Walden (R-Ore.), the chairman of the House Energy and Commerce Committee, is unlikely to walk away from a conference process without ensuring the House version, which he helped author, makes it into the final package.

IMD exclusion: Trump’s commission also recommended that the federal government waive the so-called “IMD exclusion,” which prohibits Medicaid payments to addiction treatment facilities with more than 16 beds. Advocates say the exclusion limits the nationwide capacity for inpatient addiction treatment.

The House version included a limited version of the provision, which could greatly expand treatment options but which could also cost the Medicaid program billions of dollars. The Senate included no version at all. Nonetheless, Portman has said he hopes the House version can be improved upon in negotiations following the Senate vote.

This story was updated to reflect passage of the bill.

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  • After 3 years of surviving a motorcycle accident that crushed pelvis arm n foot n longterm med needs 3 years later the meds i noticed i been hurting and sick and pain is all back .thanks a holes for cutting all the helpful part of the meds out of my scripts .its so messed up .i feel like being uthenized then dealing with what i been dealing with now .starting a day in pain and whatever they put in these damn meds is making my stomach hurt n no more help from meds .how in the hell can this crap continue something has to change or i might as well give up .bad enough i cant work ,have sex,lift anything heavy , barely walk .i hope something changes soon .or their probably going be dealing with people taking their lives from pain .pain is a bad thing to deal with and since 3 months i been in the worse since i heard this change .its total horsecrap .i hope the a holes that sign the bill has to deal with pain real soon and need relievers and in same boat as me .cancer patients has to be feeling it as well .

  • I am a 44 yr old single father from Maine. In 1996, i was very reckless with drinking and the occasional designer drug use (i.e. Cocaine,acid, mushrooms ect.) admittedly not the brightest decisions i made throughout my life. Regardless on Oct 16th 1996 at 1am eastern time, i crashed my car at over 120 mph! Nearly missing a police car as it was taking place. Thank god i didn’t hurt him! However I suffered tremendous facial injuries, as well as a few minor ones. But the amount of damage that was done, was as my surgeon put it ” I have seen hundreds of injuries similar to yours Mr. Mott, none of whom were even remotely close to as severe as yours.” Then he asked me something that I will never forget. He then asked,”Mr. Mott, Adam how many do you think we could talk to today? Being the wise ass i could sometimes be, I answered ” I’d say most if i’m talking to ya” with a smart ass grin less smile cause my jaw was wired shut. He got real serious, and said ” out of over 400 individual cases, not half as bad as you. Died mins. into getting in the er!”. See this was just before i left the hospital to go home. 4 months earlier i was me. I was 21 Handsome with a future signed up for Marine Corps leaving to boot camp in a week. I went out to celebrate had a bit too good of a time. I woke up 3 months later to me it was like over night. I had no use of my face, like when you get a numb limb, you know arm or leg. To the point it feels as though it feels like it isn’t there at all you know is its there! You can see it touch it and when the blood comes back it hurts like the dickens huh! Pins and needles on steroids, very unpleasant but goes away. I am 44 now. I have willingly and had to have 10 re constructive surgeries. Last one was in 2014. While having to prove i had done all i can to co operate in all other options of treatment before i could be given a palliative exemption. Now remember the numbness i spoke about. Here is where it becomes relevant, when i woke up when the feeling started to come back like a week later. The Pins and neddles type pain plus almost the entire right side of my eye socket , check bone upper and lower mandibles both broken directly on center with all the nerves you know them deep ones. The bridge of my nose wasnt there. My right eye as i was flung out the sunroof of my 84 IRock-Z not! It was a Camaro but not a Z. The roof was a back yard guy diy thing but it still popped my eye like a California wine grape.
    Now i cant tell the whole story but i think anyone who reads this will be able to relate I would go through a solid year sometimes. The whole numb for a while, then pain for a year that comes and goes as it pleases as well as a plethora of other issues causing me constant tremendous pain sessions during the beginning, you know the first 5. But then i did something so incredibly stupid one Friday night just days after what was to be my last surgery, if it didnt work i was going to be dealing with this type of acute chronic permanent both steady at times and sporadically like mind numbing painful s*%#! For the rest of my life. Well, to Celebrate i went out with a friend on his birthday to the bars. Me for pity him for drinks. I was getting woosy due to my meds and my friend said he only had a couple. I fell asleep right after we got in the car the asshole, crashes my face at 40mph into a boulder! Broke everything he spent 2 years trying to put me back together, lucky to be here! And i just destroyed for the 2nd time in 2 years everything was just fubar man, fubar.
    The pain was one that would just make my body pass out cause the human mind can only width stand . As you can imagine the pain pills we went through! OH MY GOD, in the beginning morphine drip, or Demerol, then vic’s perc’s were the norm till Oxycontin was first introduced to main stream america. I personally didnt like em at first. Too strong, so i was the first patient the clinic ever had that brought back a nearly full script of the 40 mil tabs! And asked for vic’s again. I decided to go out west and im doing so gave up the pills and decided to tough it out on asprin in the desert. I moved to Los Vegas NV for a number of years. When i couldn’t find a doctor who would even begin to help finish fixing my face to try to stop the pain. So I came Home! In short order i was ivin another script of the 40mil tabs by the same doc. He told me to just give them time they will work. And they did. For the first time in years my pain was down enough to strt to eat more things and talk, sneeze without the nightmarish agony i have endured hoping it would go away. It did Not! In Fact it was getting really bad before the Oxycontin. This was in the year 2005, from 98′ to 05′ i prayed every day it would go away for good. I gave it my all during what was suppose to be the best years of my life for ever changed, can never get that time back. In a away i felt it was the penitent one and this was to be my fate for choosing so poorly at such a young age but i did.
    Now after 22 years of this annoying yet unyielding pain, I still take oxycontin, and oxycodone, at what some would argue an obscene amount at times. In 2014 after my last surgery, once again i went in with high hopes. Came out looking a little more symmetrical, but that numb face was back almost 7 years after the last one. But this time the pain brought new meaning. I was trying to win my children out of foster care following a rough divorce. That was the reason for the surgery! Dhhs was claiming i was an addict and that i could in no way tend to my then 2 year old and 5 year old with autism. Then told me had i done surgery i said 9 of them. They asked when the last one was i told the around 03′, they asked me why i hadn’t tried again ? It had been a decade maybe it could help. Now you just cant tell your pc to go ripping your face apart. So we scheduled a cheekbone replacement and nasal rebuild as well as explore to see what may be the source of the pain. Where else Boston Generals Top Plastio team. If these cats cant do it then i give up. Well it didn’t it got way worse.
    My point is after 18 years of taking this medication and others. These are a life saver, My Doc is a saint, when the law changed we started early on the weaning I had been taking 2 30 mil oxycodone 2/4per and 2 Oxycontin 80mil 2 per 8 for a total of 6 a day. This is what i was taking and winning my kids back from the same dhhs who were glorifying my ability to function so well on so much. These types of meds cannot be the problem anymore. I know a 89 year old woman who is in pin and dying. 3-4 months cancer. refused radiation the refused her pain meds. I had friends from support groups i had to say good bye to due to being pushed to heroin due to being pill shy on a months worth of pills. You cannot get a script here in Maine unless like me or a few others, thanks to a couple rowdy Maine Lobster man. Who stood up for us , good men, men with families and jobs. When i pick up my script in the local hannafords in my small town i feel so ashamed i were a hood and glasses to go in, and hope there wont be an issue. I didn’t know why i wrote this or if anyone will read it and relate but Those two drugs i have had to increase dosage and decrease more then once but i should have access to the amount i need not what someone who knows nothing outside the house circus. What i know and has been seen to work is theses drugs continuosly for the last 18 years they do work long time so stop saying they dont.

  • The people with chronic pain are being hurt the worse. When you changed law telling drs they have a limt amount that they can give a patient a day. Amount np higher than 180 a day of opiods. This is not what all chronic patients worked all there life for. To have to live in severe pain.when you are in 60s and 70s your health gets bad. And so what what if you are addicted to opiods. We will not live much longer. The government should not be able to play God. And tell our doctors how much opiods they can give. Our drs went to school for 8 to 10yrs. They what to give a patient. From what they see on a MRI or cat scan. Most patients today can get out of bed. And not do shopping and keep there homes up. This is so unfair. Chronic pain patients do not abuse there opiods. Ya lock up all the people on the streets selling opiods. And all the huge drug lords. America use to care about there seniors health. Please return control to drs. Each patient is different. And takes a different amount for each patient. Please don’t make seniors suffer. The drs are so scared that when they do surgery on you they want to give a asprin. Thank you

  • I just recently had a triple bypass and after surgery they would not give me pain medication I went into a panic attack I thought I was going to stroke out because the pain was so severe so if you are plAnning to have surgery I would advise you to wait until this so called opioid crisis epedimic bullshit is over it’s just another way for medicaid system to get more money funded from the government at the pain recipients expense and furthermore my wife is a cancer patient who needs her pain medication but they are consistantly taking her dosage down further and further she is not sleeping anymore because of the pain is so severe I think that its inhumane for people in chronic pain to have to suffer there should be a legal way for the ones in pain to not have to suffer

  • And patients with chronic severe pain are treated exactly like the criminals. They do not separate actual treatment needs with abusers.

    I was recently left without pain management due to these laws. I was stopped on a dime and suffered pain levels at 7 -10. Now most doctors will not treat anyone with treatment like mine due to the DEA and FBi abusrb oversight.

    My doctor did routine drug testing for illicit drugs, he made us sign a contract not to doctor shop, all scripts were dated with the earliest date to fill which allowed for one day of medication left prior to filling the last script.

    He served West Texas and Eastern New Mexico. Had 5000 patients over time and was targeted by the government due to the number of pills given but not divided by the number and needs of the patients.

    It was strictly bases on the abuser side of the war on opioids just like all of the regulations. None address our needs as patients.

    So I am without pain medication. I had a spinal cord stimulator place in my spine but worry about infection. In 1997 a unknown caused infection destroy my back and left my nerves and spinal cord permanently damaged.

    So I must be treated or live a life with no quality of life. Just pain.

  • I am an acute/chronic/fatal patient. I was thrown in this mess of political jargin called the 2018 opioid epidemic act. The first 5 months they (doctor) took 3-30mg extended release morphines per day away! The new level of pain I am forced to live with is unbearable. Now he is about to start on my 30mg oxy. I told him there was no way I would be able to live with the pain.
    He said that it was really a bummer how many people were committing suicide. A bummer? Are you kidding me? Suddenly doctors have forgotten the hippocratic oath they took to become a doctor, they are showing no compassion toward patients.
    All I see as far as change is people waiting at the pharmacies offering to buy my rx! I now look in my rearview mirror to make sure no one is following me home. I use a cane, I have people coming up to me in stores asking me if I want to buy pills. Is this what the government wanted? It should have been obvious to them this would happen, it does not take a rocket scientist to see that the new legislation promotes the black market and the use of medical marijuana. So what was the intention? Mass suicides? Promoting the new government controlled marijuana? What? Please help me understand before I die – what good has come out of this, not to mention the Vietnam Vets and what they are going through, it is shameful just shameful and to think OUR GOVERNMENT did this on purpose! They actually sat down and wrote all of this on paper and passed it! Seriously???

  • Another pitiful attempt to waste time on problems that are not a true crisis while the countrys major problems never get fixed,immigration,ecomony,health insurance improvements

  • Another pathetic attempt to legislate a health issue , politicians only care about image and votes. It’s sad that legitimate pain patients must venture into the dangerous, dirty, illegal market because politicians thinking they are answering the cries of parents of dead dumb kids, should have raised a better kid, all about choices and consequences.

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