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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  • Yes the U.S. Government already has people tortured Medically as they play doctor, and none of them in the U.S. Government care, neither Democrats, nor Republicans, or anyone in the U.S. Federal and State Government. They do NOT care at all about how they make us people with a Severe Chronic Pain Sickness, who did everything responsibly, who have done nothing wrong, to once again have to suffer daily torturous Pain for nothing we have done wrong, are related to in any way, or that we deserve in any way.
    The U.S. People need to know and realize what is happening, what the U.S. Government has been doing to us U.S. Citizens- torturing us freely in the United States.
    They just lie to the United States People, yes tell lies to lead the U.S. People to think that they are not torturing innocent U.S. Citizens. Even though they are torturing us U.S. Citizens. Such is exactly what the Federal and State U.S. Government is actually doing to us U.S. Citizens, which is torturing us innocent U.S. Citizens with a Severe Chronic Pain Sickness freely, intentionally, once again, just like they have already done before to us U.S. Citizens with a Severe Chronic Pain Sickness- back in the 1980’s and prior to the 1980’s, and now again! Back when they lied about Morphine Medicine, kept it from us and just left us to suffer in daily constant Pain. They said Morphine Medicine was bad, that it would not work, that we’d just have to keep taking a higher dosage of it, we’d just kill ourselves as we’d be drug addicts from it. Which all of it is total 100% proven total lies, Bull Shit, about Morphine Medicine. Yes I have proven it my self that it is complete absolute lies!
    Where actually the truth is about Morphine Medicine- is for a lot of us people with Severe Chronic Pain Sickness- where the Morphine Medicine is the only Medicine that works well to ease our Pain and with NO problems at all from the Morphine Medicine (also that Morphine Medicine is to many of us people who suffer daily constant long term Pain- Morphine Medicine is actually to us a literal G-d Send, a Miracle Medicine, a Life Saver) (also I’ll let you in on a big secret they don’t want you to know and do NOT tell anyone about- which is that a person using Morphine Medicine responsibly and who has NO reason why they should not be using it, and is prescribed by a Doctor, that such a person will have absolutely NO death defying problem from the Morphine Medicine if they always use it responsibly like all Medicine should be used, and again big secret they do NOT tell or want people to know ……………… like as if all the people over dosing have done nothing wrong, and my name is Gunga Din, and what would I know about Morphine Medicines, I’ve only been using it daily for almost 28 years with NOT one measly problem from the Morphine Medicine that save my life, gave me a life I do NOT have without it thanks to severe injuries, I did NOT cause, that ruined my life- for what it’s worth for those who can factor the facts). But yes a correct working dosage needed for my daily Pain in many areas of my neck, eyes, face, head, upper body, arms and hands is once again kept from me for nothing but other people’s wrongs I have nothing to do with, the same old Morphine Medicine lies I have proven wrong, and that the U.S. Federal and State Government care more about solving their drug addict problem that has nothing to do with me- wow I don’t even know these drug addicts for whom the U.S. Government ruins and punishes my life, takes my life, ruins my life again I had to fight for, while going through a long more than decade of daily constant suffering torturous Pain. Yet the U.S. Federal and State Government care more for their drug addict problem, than the lives of us people with a Severe Chronic Pain Sickness, yes us whom they do NOT care at all about our lives at all!
    Nothing else worked to ease my Pain, and there is nothing new that has changed anything for me to even stand in the same room with how well Morphine Medicine works for my broken body and the Pain, that I have used so long and I am use to. For them to force me to look again for an answer to my Pain, which I already found an answer that works well and had no problem, yet they punish me for other people’s wrongs I have nothing to do with, no trial, nothing, just tortured to suffer in Pain and they do NOT care! I have had to endure for almost 39 years now every dam day Pain!
    It is stupid and evil to take away the Morphine Medicine that saved my life and gave me at least somewhat of a life, especially considering for how long I have used it. I know how Morphine Medicine works for my Pain and the Pain does NOT always stay at one level- and I have used Morphine Medicine well accordingly to my Pain and not one problem- though I know you people have NO idea how bad my Pain gets- nor do you care, I use Morphine Medicine responsibly, I have no problem of being tested whenever they want as I have nothing to hide, I just have a hard time with the fact that drug addicts lives mean more to you people than my life does (drug addicts are none of my business, I just do NOT like the U.S. Federal and State Government punishing me for other peoples actions I have nothing to do with), and yes it does trouble me greatly that they have ruined my life here in the so called United States Country. They also treat me like I am a fool, which also bothers me greatly.
    Interestingly the U.S. Government, people of society too, didn’t give a dam about the illegally plastered drunk in an 18 wheeler truck who caused a head on collision one night when I was 18 years old, killed two friends 19 and 20 years old, and ruined my life, and we did nothing wrong. NOT my problem, it’s their problem.
    But here I am still having to pay for strangers wrongs, but now paying for drug addicts wrongs this time. So much for this so called land of the free, land with supposed Rights, all I see is the exact opposite! Never mind all the lies I get thrown in my face continuously! Plus they expect me to just be a fool and accept this cut throat crap and ruined life once again!
    The same lies once again about Morphine Medicine, and that too troubles me greatly, as I know the truth about Morphine Medicine- and I know it well. They are NOT going to fool me. But of course the just leaving us to suffer with torturous Pain daily once again for nothing, with Morphine Medicine that eased the Pain well just taken to a useless working dosage, I can NOT even get an appointment with a Pain Doctor who treats people with serious injury Pain with Morphine Medicine- NOT one appointment anywhere. They ruin my life and leave me high and dry suffering torturous Pain- yah go figure! I am having great trouble with that too (dah); never mind all the other lies I’ve had to lay out on the table too and digest- as in NOT good.
    But I have more than proved well from simple fact of life necessity due to a smashed in upper regions, that everything they told us about Morphine Medicine- the idea that it does not work, that it is bad, you have to keep upping the dose, etc., is nothing but total absolute LIES, LIES LIES, AND MORE LIES!
    The United States Government already tortured many other people and my self for nothing, and for years, I was tortured for more than a decade with daily non-stop Pain and NO exaggeration (give me a lie detector test if you wish), worse though than me- was those people before the 1980’s- where people were tortured with Pain for life till they died, they turned to the streets for Narcotic drugs, or till they killed their self from the Hell they were intentionally, purposely put through- to suffer through for nothing, and the U.S. Federal and State Government are doing the same thing again though to us people from the 1980’s with a Severe Chronic Pain Sickness and they do NOT care.
    The 100mg limit does NOT work for everyone (an understatement!). I did NOT use the dosage I used, due to drawing some lucky number out of a hat. NO sorry- it was just the opposite, I was very unlucky, with a scenario of Hell thrown in my lap- till I finally found Doctors and was allowed to used the only Medicine that worked for my Pain from my severe injuries that nothing can be done for and things done properly/responsibly.
    I am a witness to this being true, that what I have said has happened and is happening again, and all I have said is the truth. Yeah and being done again to us people with a Severe Chronic Pain Sickness. Other people will be next, yes you innocent people will be next, you too will be punished for nothing, but they’ll find some reason to frig you over too, if this lunacy is not stopped. To let people who practice Medicine do their job as they see things, not some person in Government who has NOT been through Medical School. Pretty simple it is. But if things are not corrected, they will greatly possibly torture you other people too for nothing, and do it to you for who knows how long- possibly even life- or to be even slaughtered instead of tortured. Such is possible, for lunacy left to bear is very dangerous!
    Our lives mean nothing to these people in the U.S. Government.
    I had to fight for my life, I had to go through a literal torturous Hell for more than ten years to finally get an answer, a correct working dosage of Morphine Medicine took another ten years, and finally found the Pain Doctor and two other Doctors who each played a part for saving my life, and giving me at least somewhat of a life finally, as I was literally finally losing my mind from ten years of every day day after day constant Pain that just escalated all the time, would get so bad and at times bring me to vomit. Yeah I found the answer, but these so called people just take it from me, based on nothing to do with my Morphine Medicine, nor anything to do with my self at all. It’s all due to people I have nothing to do with, their illegal wrongs I have nothing to do with, and I do NOT even know these people for whom my life is once again ruined! My life is now over, it sucks and none of these politicians care about how they have wronged me for nothing! How they have ruined my life, they do NOT care! As I type my neck is killing me, my eyes, my face, my shoulders, my head, but they do NOT care at all! The 100mg limit is a joke, a dark evil joke.
    They are purposely doing this to us, they want to ruin us physically and mentally. As they torture us.
    I don’t get it, why do they do this to us, because they do make us suffer for nothing- and they do NOT care at all about what they’ve done or about us as a person. They talk like what they did is some great success story, which burns in the pit of my stomach with words I best not type. Yeah there is NO answer that they have, it’s all based on evil, it comes straight from evil.
    The thanks I get for being responsible and doing right in this fake United States Country. Stabbed in the back and kicked in the teeth, and repeated on me. I am tired of suffering, and these people in the United States Government do NOT even care. Yeah go factor that truth- yeah go figure?

  • Sometimes the devil is in the details. The Senate bill includes the following section:

    501. Study on prescribing limits

    Not later than 2 years after the date of enactment of this Act, the Secretary, in consultation with the Attorney General, shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report on the impact of Federal and State laws and regulations that limit the length, quantity, or dosage of opioid prescriptions. Such report shall address—

    (1) the impact of such limits on—
    (A) the incidence and prevalence of overdose related to prescription opioids;
    (B) the incidence and prevalence of overdose related to illicit opioids;
    (C) the prevalence of opioid use disorders;
    (D) medically appropriate use of, and access to, opioids, including any impact on travel expenses and pain management outcomes for patients, whether such limits are associated with significantly higher rates of negative health outcomes, including suicide, and whether the impact of such limits differs based on clinical indication for which opioids are prescribed;

    (2) whether such limits lead to a significant increase in burden for prescribers of opioids or prescribers of treatments for opioid use disorder, including any impact on patient access to treatment, and whether any such burden is mitigated by any factors such as electronic prescribing or telemedicine; and

    (3) the impact of such limits on diversion or misuse of any controlled substance in schedule II, III, or IV of section 202(c) of the Controlled Substances Act (21 U.S.C. 812(c)).

    =======================
    The main question here is “why take two years?” This sounds to me like a get out of jail free card for the CDC. We already know that unjustified restrictions on opioid therapy are killing patients and destroying lives. It is time to outright withdraw the CDC opioid prescription guidelines for a major re-write.

    Call your Senators and demand that they rewrite Section 501 to be accomplished in 90 days.

  • Please “ Say it sin t so” that the Senate is not going to allow Medicare to pay for methdone treatment! Methadone is the only reason I’m alive and productive today! I am 70 yrs old and have been in methadone treatment at the same clinic for 23 yrs. it now costs me $600 per mo and I only receive $1200 a month of SS benefits. I guess I should have not worked all my life and then Medicaid would have paid for my treatment, as they re doing for 75-80% of the addicts here. I don t want to be forcibly detoxed from here , but that is becoming an option that will probably kill me. Senators; please help me!!!

    • Hey!!! Get your facts straight!!!!!! Medicaid dies NOT pay for methadone. Not in Arkansas anyway. They want pretty authorization and then they deny the coverage wanting you to use ultram, mscontin,(morphine) etc. What a joke the CDC AND OUR GOVERNMENT IS!!!! CAN WE SAY: DICTATORSHIP?
      SMH

  • The response so far has been unscientific and nearly Genocidal. A lot of those funds will be sent to faith based treatment, instead of programs that work. At least this article mentioned chronic pain patients, they have been kept out of the discussion. This debacle was started by Pharma Greed, and they are still allowing the creators of the so called opiate epidemic, profit from their so called cures. These are the same ghouls that took money from Pharma to allow them to peddle get around federal laws and illegally distribute opiates.

    What we have here is the best lackluster, half baked solution, a bunch of industry funded, amoral, willfully ignorant, and misinformed ghouls can create. We have witnessed the end of science and reason, while these people profited from the deaths. We are in Post Fact America, where nonsense, propaganda, and lies have replaced facts. They even gamed the death toll, and used it to market more deadly pharma products.

    • I was injured at 16. Wasn’t supposed to reach 35. I have, but kniw I’m on borrowed time. I had a short leg cast put on too tight and it killed the nerves, and cut off the circulation. My leg was allowed to remain on too long and the damage went to my spine. 4 sympathectomies ( 2 lumbar, 2 brachial), my sympathetic nervous system is not properly functional. My organs are being shut down, one by one and it will eventually kill me. Every single second, of every minute, hour, day month and year, for 39 years now- my body feels like somebody is holding a torch to it. Sharp shooting electrical jolts that shoot through my limbs and make them jerk uncontrollably.
      My limbs are so deep down cold that nothing warms them. I have been on my deathbed far more times than I like to think about.
      I have had 200+ surgeries, sepsis, blood clots, pulmonary embolisms, osteomyletis (10 times), my bones are so brittle that nothing can be done to prevent my spine from collapsing more than it has already. 3 amputations. 1 artificial hip and need a replacement of the other side, as well as my right knee. But, its too risky for the surgery.
      I know self hypnosis, biofeedback, and have had years upon years of therapy (physical and psychological).
      I know other methods of trying to deal with the CRPS, TRIGEMINAL NEURALGIA, (Full body w/ complications due to earlier procedures).
      10 + years bedridden, to where I cannot take care of myself.
      And those are my good days!
      During a flare up, I am in excruciating pain with all symptoms greatly intensified.
      Any breeze, clothes, sheets, change in the weather, sets it off
      A touch of a loved one, someone trying to help.. And I feel like I am being electrocuted from the inside out from the inside out.

      I was on a maintenance dose of opiates, for ~ 30 years. Never failing to jump through the required hoops, pass the tests, or pill counts. IN FACT, it was a constant struggle within me when it came time to take my medicine. I DID NOT WANT TO HAVE TO TAKE ANY MEDICINE!
      I want MY RIGHT TO CHOOSE!
      IT’S MY LIFE, MY BODY.
      My medications were stopped cold turkey by pain management, due to the CDC “guidelines ” that are being acted upon as if they are law.

      I am terminal, just not a terminal cancer patient. ALL NON TERMINAL CANCER PATIENTS, WERE TURNED AWAY! NO WARNING. NO TAPERING. NO DISCUSSION.
      CDC GUIDELINES SAY,” FIND OTHER METHODS… OVER 5 MILLION PEOPLE HAVE DONE JUST THAT- NOW THIS IS BEING THREATENED AS WELL, AS BIG PHARMA ISN’T PROFITING.
      SINCE WHEN HAS IT BECOME AN AMERICAN WAY TO PURPOSEFULLY TORTURE AND COMMIT GENOCIDE OF THE AMERICAN PEOPLE?

      THE fordruggingamericans collection of future big pharma workers of america, do NOT have our BEST INTEREST OR HEALTH IN MIND!
      #FollowtheScience!
      #LeafItBe
      #ticktockticktock…

  • Politics! It’s the people who need help not politicians who want to advance their personal political schemes. I see this problem from two sides of the coin.
    Side #1: I am a stage 3 breast cancer survivor. I had very aggressive chemotherapy. I am blessed to be 71 years old now. But the chemo did quite a bit of physical damage to my body that can’t be fixed and leave me in chronic pain 24/7. Excruciating bone pain, muscle pain and nerve pain. Until my doctor was able to get my pain under control to help me I wondered which was worse, the cancer or the pain I now face..not saying anything about the depression and no quality of life. He has managed this severe pain with an opioid medication for the past 10 years. Now it’s old age creeping in that limits some of my activities, not that horrible pain. For anyone or any government to deny or in any way interfere with a patients comfort and quality of life is not acceptable.
    Side #2: People addicted to drugs need a full range of help to become sober, not just detox! The reason many don’t go for rehab is because no matter how badly they want to quit there’s no help! Oh sure if you’re fortunate enough to have insurance or rich family it can be done. There’s a real reason people become addicted in the first place that was never treated. So the drugs take the place of that void that develops. Our people need to have HELP to become sober and live a productive life. There’s so many that want help, yet it’s no where to be found. And for the few that do get a state grant for rehab they get booted when a bed is needed for someone with insurance!
    Instead of spending millions of dollars on “special” agencies or groups to look into this or that, just do it. Use those millions and millions to help these neglected human beings. They’re our people. Our brothers, sisters, sons, daughters, parents, friends! Yes, Medicaid and Medicare need to step up and help.
    For those of us who suffer chronic pain, leave us alone. We’re not bothering anyone.
    My son was an addict for 10 years and has been clean for 7 months now. He uses methadone treatment and must go to get his med in person by bus and walking. He’s committed to not using whether walking in rain, sleet, hail or 100 degree temperature. These addicts suffer everyday of their lives..they can’t find a way out. They need everyone’s honest help. They are desperate to live life but just can’t do it alone. Some people just need help. Not some self glorified politicians playing them like a game of chess! I could go on and on but I think I’ve dumped enough on you all. Thanks for listening.

  • Facts are rolling in that the CDC, FDA, DEA have miscalculated that fentanyl and heroin are the actual issue, and not opiate perscriptions for Chronic Pain patients. They are off by 50% on the percentages of fentanyl overdoses, and chronic pain sufferers. Horrible suffering is exactly what is happening right now, all over our country as doctors, pain centers, and most of all patients, are being bullied and threatened into compliance, to taper down or off of medicine that has helped patients have some quality of life. All in anticipation of a bill passing. It hasn’t even passed yet, and it has already raised the suicide rate, instead of helping. What is going on is inhumane, and against the oath that doctors take.

  • I m a 70 yr old methadone client with a monthly SS benefit of $1200. Of this I must pay $600 per month for my methadone. I’ve been clean and productive for 23 yrs. why is it that a lot of these addicts at the clinic , who have barely worked in their lives are covered by Medicaid? Why can’t the senators see the damage they re doing by denying Medicare coverage for methadone treatment?

  • Stage 4 Cancer should not have ANY of these rules! I need my Fentanyl patch and Dilaudid to manage my bone pain caused by stage 4 terminal cancer.

  • This government makes me SICK!!!! First they blame doctors for “over prescribing” when it’s clearly not happening, now they are blaming the most of this “opioid crisis” on illegal fentanyl…(which I totally believe is true). So leave our prescribing physicians ALONE!!!!!!! THEY ARE NOT THE CAUSE OF YOUR SUPPOSED “OPIOID CRISIS” !!!!!!! CDC, RETRACT YOUR STATEMENT THAT BREWED THIS DISASTOR ON CRONIC PAIN PATIENTS IN THE FIRST PLACE!!!!!!!!!!OUR FEDERAL GOVERNMENT HAS NO BUSINESS PUSHING MY LAW ABIDING DOCTOR’S RX WRITING PEN!!!!!
    #FEDUPWITHLIES

    • Yes people with chronic pain are being treated like felons and same with dr.s who try to help us its an outrage ,they will drive more pain patients to their deaths because they will pull them from a dr. To a street dealer, this is an outrage im totally disgusted with our government.

  • Again why is the goverment involved in medical decisions .How well did the prohibition go for alcohol ? And alcohol is far more deadly than people in chronic pain.get real folks

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