The House passed bipartisan legislation on September 28 to provide resources for fighting the U.S. opioid crisis. President Trump will soon have a chance to sign legislation that increases access to addiction treatment, provides for less-addictive alternatives for pain treatment and cracks down on the ordering of opioid drugs through the mail. Medicaid restrictions on substance abuse treatment will also be eased, including access to inpatient treatment.
While the legislation has been hailed as an important step forward in combatting the opioid epidemic, Sen. Elizabeth Warren has proposed spending up to $100 billion over the next ten years. Funding for the current year is set at $3.8 billion, an improvement from the $1 billion allotted in last year’s budget. But Democrats like Rep. Frank Pallone have criticized the legislation as not going far enough despite the increase in funding.
The Senate is expected to make changes to the legislation based on committee work in progress, including the provision of adequate funding. It’s expected that both House and Senate will be able to agree on final legislation by the end of the year and send it to the president for approval. Senate work on the bill mirrors the House legislation in many areas, making it more plausible for the two chambers to agree on the measure.
A crucial component of the legislation is the loosening of restrictions on the prescription of buprenorphine, a drug used to treat addiction. Nurse practitioners and physician’s assistants will now be able to write prescriptions for buprenorphine, which could help patients avoid dangerous drugs like heroin and fentanyl.
One of the loopholes fueling the opioid crisis is the loose enforcement of laws against mail-order opioid purchases. The legislation package, which combines 58 separate bills, classifies fentanyl as a controlled substance, giving more teeth to efforts to prosecute illicit drug providers. Another issue is a lack of access to a patient’s drug treatment and addiction history by a treating physician. Until now, privacy concerns have left it up to patients to let physicians know about any drug abuse problems. The new legislation requires full access to this information.
Synthetic opioids like fentanyl and tramadol require minuscule amounts to take effect according to the Centers for Disease Control and Prevention. This makes it easier to accidentally overdose. The death rate from synthetic drug overdoses doubled in 2016. These drugs can be produced in illegal labs and are sold on the street to unsuspecting buyers. Strength can vary from one batch to another, and a dosage that was safe one time can be a death sentence the next.
Research and training are also included in the ambitious House proposal, including funding for research into non-addictive alternatives to commonly prescribed painkillers. This could make a dent in the need for opioids, but it’s a long-term solution that doesn’t address the immediate crisis. Critics point to the need for immediate intervention for opioid drug addiction.
The Helping to End Addiction Long-term (HEAL) initiative sponsored by the National Institutes of Health (NIH) has nearly doubled research funding to $1.1 billion for 2018. It appears that the current legislation being worked on by Congress is also a significant beginning in combating opioid addiction in the U.S. The multi-pronged approach includes research, education, treatment and enforcement. It’s just a start, however, and to make inroads on the scourge of opioid addiction, more funding will be needed in the future.