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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  • In the year 2010 I fell and hurt my back, at first my primary gave me 10 Percocet and sent me to a pain management Dr for shots, the shots helped in beginning but then didn’t help. My primary Dr at this point said I had to find a pain management Dr who did shots and dispensed pain medication also, I went to a few different ones but didn’t feel comfortable with them ,then I found one that worked out of a hospital in which I felt comfortable with, they had no idea what was causing my pain so I was sent to an orthopedic Dr and he wanted to do a laminectomy. I agreed was going to be out of work for at most a week ,when they did xrays prior to operation Dr told me I had a broken vertebrae and I had to get both laminectomy and fusion so now Iam out of work at least 3 – 6 months I was upset but agreed.My pain Dr just kept raising my opiates and I was afraid of getting addicted I asked him about addiction he told me as long as I was talking them for pain I wouldn’t get addicted I was on 320 mgs a day, now prior the most I ever took was 10 Percocet I know was taking 3 80 mgs of oxycodone every 8 hrs and 15 mgs of roxicodone every 6 hours also oxyfast 5 ml as needed for pain so now 7 years later I’m being told I have to get off it and try medical marijuana which insurance doesn’t pay for . Iam now on Disabilty so of course I cannot afford medical marijuana. I have written to the governor Wolf with no response and needless to say Iam petrified and anxious I don’t know what to do my dr has been rude and ignorant towards me cause my back is worse then ever I broke another vertebrae in November and much worse my right leg gives out on me when I walk to long and even fell in hospital.Why are they not looking for solutions to us people with chronic pain and have had it for years why didn’t our Dr weans us down,and after more than 7 years now cutting you off opiates?There has to be someone out there who can help the ones taking the meds right there has to be something that we can do . It has to be illegal or A Dr oath to prevent this to happen for us who have been in chronic pain for years.You know the worse thing about all this is people are dying from heroine not managed people on pains meds for chronic pain,I wish I was never put on such a high dose of opiates .

  • I swore I’d never vote for another Democrat but now I will never vote for another dumbass Republican. Getting between patients and the doctors is going to leave us in a place where we can get help. It took him 20 years to decide we’re in a crisis. Close the damn border stop the Chinese I’m sending the crap over here stop hurting pain patients and yes I am pissed off

  • I have chronic pain and I also have major panic attacks my pain will be the rest of my life a lots of metal of my leg herniated discs fibromyalgia major panic attacks everything else I was managing just fine on my pain meds and my Clozapine until the CDC want to mess with me now I’m not doing well I’m having major panic attacks since they kept me way down almost to nothing I’m in pain all the time this is just ridiculous what are we supposed to do I am 59 years old I started working full-time at 14 years old I’ve paid my social security I first got injured I was workman’s comp and then I busted my leg metal all through it cannot take it out doctor said they would have to cut my leg off why oh why are you trying to take things that help us survive mentally and physically and be happy in this world

  • I have cancer and my husband has a severe neck injury three ruptured disc’s in his neck bone on bone he is in severe pain and quality of life is horrible since doctor has had to decrease his medication not quite fair that people with legitimate pain with documented medical records should be penalized because some abuse. I agree tighter regulations are in order but don’t punish the ones that don’t abuse it and need it.

  • I’m jhst curious, is there any legislation in the proposal or a newer revised proposal for addiction treatment? For those who have chosen to let themselves become enslaved to that Evil Evil drug “Heroin” or opiates? Some form of inpatient treatment in lieu of medicated “Methadone” (worse than Heroin) treatments, it is not something that people should act as though they are entitled to it, but Methadone is worse than Heroin and right now Gov’t hethcare will pay for it but not pay for a thirty day treatment program for instance. People stay on Methadone for YEARS & at rougly $80 per week it would add up over five or ten years of Methadone treatment “which is the norm” not the exception. Anyhow I went way off but do you know an answer to my question? If so please let me know at patrickhutchinson66@gmail.com thank you.

  • I AM A 58 AND A ARMY VET. I HAVE PTSD,AM A PARANOID SCHITZSOPHRENIC,MANNIC DEPRESSANT,BIPOLAR,HAVE A SPLIT PERSONALITY,HAVE TITANIUM RODS AND PEDICLE SCREWS AT L4-L5 ,WITH FUSION OF BONE FROM LEFT HIP.BOTH SHOULDERS ARE BONE ON BONE WITH ROTATOR CUPS GONE,RHEUMATOID ARTHRITIS,OSTEOPOROSIS,RESTLESS LEG SYNDROME,PARTIAL REMOVAL OF RIGHT SIDE OF MY BRAIN DUE TO BRUISED BRAIN ACC.,WAS SHOT IN ABDOMIN BY A 12 GAUGE SHOTGUN IN HUNTING ACC.IN 98,IN A COMA 6 MONTHS ,HAD APPROXIMATELY 60 SURGERIES ON MY STOMACH ,LOST ALL MY SMALL INTESTINES BUT 16 INCHES,2/3MY COLON GONE DUE TO MESH INFECTIONS ,STOMACH REBUILT,SPLEEN DAMAGED ,LEFT LUNG COLLAPSED,GRAFTS TO BELLY UNKNOWN,FISTULAS-2,DRAIN WHEN THEY GET INFECTED,HAVE 14 TITANIUM CLIPS IN STOMACH TRY TO STOP DRAINAGE OF FISTULAS,HAD COLOSTOMY FOR 2 YRS.,THANK GOD IT WAS REVERSED ,NOW HAVE HERNIA IN THAT PART OF COLON,WEIGHT LOSS OF 50 LBS. FROM245 TO 195 VARIES,AM 6’2″AND SUFFER FROM SEVERE CHRONIC PAIN AND HAVE ANXIETY ATTACKS,SOMETIMES I HALLUCINATE AND SEE THINGS THAT ARE NOT THERE AND NOW THE VA IS TAKING MINE AND OTHER VETS LIKE ME ,OUR MEDS.I THINK OF SUICIDE EVERYDAY OF MY LIFE NOW BUT,I LOVE LIVING TO ,IT IS MY RELIGION THAT KEEPS ME FROM KILLING MYSELF AND MY WIFE AND 2 GREAT KIDS ,ONE GIRL 29,A SON 36 .I SIMPLY WANT TO LIVE SOME KIND OF A DECENT LIFE WHICH WITHOUT MY MEDS FOR PAIN AND ANXIETY AND PTSD ,SCHITZOPHRENIA,ETC IS NOT POSSIBLE .EVERY DAY IS A CHALLENGE TO JUST SURVIVE AND RISE TO SEE ANOTHER SUN RISE .PAIN DOES FUNNY THINGS TO THE MIND AND MAKES THE BRAIN AND NERVES ACT DIFFERENTLY.I DON’T DRINK DO ILLICIT DRUGS ,DON’T SMOKE NEITHER KIND BUT BECAUSE OF THE HEROIN AND METH PROBLEMS WE ARE PAYING THE PRICE .I HAVE BEEN ORDERED TO STOP TAKING MY ANXIETY MEDS WHATS NEXT MY PAIN MEDS .AND THEN WHAT?I WILL LIVE TO BE 80 YEARS OLD IF I LIKE OTHER VETS ARE HELPED INSTEAD OF PENALIZED FOR OTHERS MISTAKES .WE SHOULD HAVE THE RIGHT TO CHOSE HOW WE WANT TO LIVE NOT BE TOLD ,AFTER ALL THIS IS AMERICA THE UNITED STATES OF AMERICA OR AM I STILL IN A COMA AND HAVE NOT AWAKENED FROM THAT HORRIBLE GUNSHOT TO MY STOMACH,IF NOT PLEASE SOMEONE ,”DON’T WAKE ME UP.”

  • Am i the only one that finds how strange it is that NOW these marjauna CBD joints are poping up on every block in my town,at lighting speed. I remember friends that went to prison for that stuff. And now it is every where. IT dont make sense But we have this huge epidemic of opioids!!!

  • I should say I am SORRY, for my triple rant, BUT I won’t! I am sorry for the people that lost loved ones from whatever actual caused it. My oldest brother died from a herion overdose when he was 50, he was very aware of his choice.IT WAS THE STREET drugs given to him that killed him. He had been doing herion since 1965.To the lawmakers give an answer before you so swiftly take away these (DANGEROUS OPIODS) You can die from drinking too much water! or look at the car wreck deaths just from accidents not to mention intoxication of achohol! YOU old FART lawmakers can get you pain meds anytime you snap your fingers! THINK about the folks who truly need it. It was bad enough when you made us go beg and pay a pain mang. doctor for a few pills.

  • This is so stupid, I’ve fallen of a roof twice as a roofing contractor . My back is so terrible hurt, I can only work 2hr a day, iam 55,and have a house and famliy,my medication is the only way I can work,the only way or loose everything, please dont limit our pain medication for people who really need it to work,

  • I think the government is going too far on opioid control. I have been on pain Killers 18 years. I am 79 years 0ld and have had MRI’s that indicate my lower back is destroyed and no surgery can be performed I just have to live with the pain that is reduced but not completely gone. It just lets me live a life with reduced pain. I used to get a prescription for a three month supply of pain killers. Now I can only get a one month supply. I live 50 miles from my pain Doctor and have to travel that distance monthly. I do not know what is going to happen when I can no longer travel there. Some thing should for the old people that have no medical solution to be able to get the drugs they need to live a half decent life. We are not a threat we only want to live what years we have left with a half decent life. The government needs to do something for the old needy.

    • There are legal substances that address severe pain that I won’t mention because the FDA wants to shut them down. Go to any forum on pain and dig around. You’ll eventually find it out.

    • People like Deb expose their ignorance and lack of empathy when they post this kind of nonsense on here. She is either severely misinformed and she really thinks she is helping, or repeating some nonsense she saw in the Internet or read in mass media.

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