The country just moved one step closer to comprehensively addressing the opioid epidemic that’s killing thousands of Americans each month, following Congressional action last week. But some critics say the gesture is hollow and we’re merely standing in place without the needed billion-plus dollars attached to these ambitious plans.
The U.S. House on Friday wrapped up approving a package of 18 different bills to address the scourge of prescription painkiller and heroin abuse, now responsible for more American deaths each year than car accidents. Congress’ approval paves the way for everything from providing more stringent review of new opioids by the Food and Drug Administration, to establishing an interagency task force to update how providers manage patients’ pain in this new reality.
Last week’s approval comes two months after the Senate itself passed the Comprehensive Addiction and Recovery Act by a vote of 94–1. The two sides of the legislative aisle will conference in the coming weeks to try and reconcile the two bills, House Speaker Paul Ryan wrote on his blog last week. “Then we intend to send a bill to the president’s desk and I hope each and every one of you will come back when we sign that bill,” Ryan wrote. “Because this is about people’s lives. It is about whole communities being torn apart. We can win this fight and we must.”
Some in health care welcomed this latest step. The American Hospital Association, for one, is pleased with the inclusion of hospitals as part of the new interagency task force to hammer out new best practices for pain management, Erik Rasmussen, AHA vice president of legislative affairs said in a statement.
The association also welcomes help in the struggle to treat those addicted to opioids — including expanded access to the overdose reversal drug naloxone, added treatment for pregnant and postpartum women who are addicted, and more means to treat infants who are dependent on opioids.
“Hospitals’ experiences have shown that only a multifaceted approach that invests in education, prevention, treatment and rehabilitation can stem this epidemic,” Rasmussen said. “Recognizing that more can be done to increase access to medication-assisted treatment and inpatient and outpatient rehabilitation services, we look forward to productive negotiations between the House and Senate, and to comprehensive legislation being signed into law.”
Meanwhile, the AHA plans to keep fighting on Capitol Hill for the $1.1 billion that the White House, addiction treatment advocates and others in Washington are pushing for to fund all of these new opioid programs. Among them, Daniel Raymond, policy director for the New York-based Harm Reduction Coalition, told me Friday that the bills contain many of the ingredients it will take to stem the tide of addiction and death — such as expanded access to naloxone and medication-assisted treatments like methadone or buprenorphine.
However, Raymond said, the “flurry of legislative activity” doesn’t hide the House’s “failure” to provide necessary funding. Congress’ approach in previous years of modest funding increases through appropriations has done little to “keep pace with the scope and scale of the overdose epidemic,” he said. Based on 2014 estimates, 10,000 lives have already been lost this year, and each day without funding could spell dozens more, Raymond noted.
“We shouldn’t be having waiting lists to get into treatment to see a doctor who can prescribe you buprenorphine in this country, but in state after state, we do,” Raymond says. “What the president wants is a version of an infrastructure bill — to build bridges, to build roads, to build highways — but for opioid treatment. If we don’t have the resources to modernize our opioid treatment system, then we’re just going to see the overdose rates go up and up. We have not seen the worst of this yet.”
The White House urged Congress last week to act quickly on funding to help head off the loss of more lives. At the same time, a group of House members representing the areas hardest hit by the epidemic — including New Mexico, Massachusetts and New Hampshire — just introduced legislation calling for that $1.1 billion in funding.
“Every single day, an average of three families in Massachusetts lose a father, mother, brother, sister or child to addiction,” Congressman Joe Kennedy III said in a statement. “Without providing the necessary funding, our response to the opioid crisis gripping communities across our country is a half-step at best.”
While addiction advocates like the Harm Reduction Coalition’s Raymond appreciate the “thrust” and contents of what was approved last week — funding issues aside — one missing element is the call to mandate education for prescribers of opioids. That’s something doc groups have pushed back against, for fear that it could further tax already overburdened docs, among other concerns.
Raymond notes, however, that more than 10 states have already made such training mandatory and hopes others will follow. “Something still needs to happen on the prescribing side,” he said. The FDA and White House, too, have supported such mandatory education, according to the New York Times.
All across the country, states are taking their own measures to try and better control the prescribing side of the equation, no longer comfy with letting clinicians use their best judgment when helping patients manage pain. Just last week, Delaware proposed a list of stricter prescribing regulations. If approved, docs in the First State would only be allowed to prescribe a seven-day supply of opioids following an acute injury or procedure.
To go beyond that first week, the prescriber must first check the patient’s drug history in the state’s electronic prescription monitoring program, and discuss the dangers of such treatment. For those suffering from chronic pain in Delaware, on the other hand, prescribers must also administer a drug screening at least twice a year to such patients, and discuss alternatives to opioid painkillers.
Like many others, Delaware has been hit hard by the epidemic, Rita Landgraf, secretary of the state’s department of health and social services, told me. Nestled between heroin hotbeds in New York City and Baltimore, the state’s New Castle County last year was designated as a “high intensity drug trafficking” area by the feds. Delaware saw 204 individuals die of drug overdoses in 2014, which is a 19 percent uptick compared with the previous year.
Overprescribing has been a huge concern in Delaware, with patients taking home weeks worth of pills when really they only need a few days’ doses. The Centers for Disease Control and Prevention notes that about 2 million Americans each year abused or became dependent on prescription painkillers. Every day, more than 1,000 people spill into hospital emergency departments after misusing such pills. And often, that addiction snowballs toward illegal heroin, as about 90 percent of those addicted to the street drug say their habit started with pills.
Delaware had been considering such steps for years, but the CDC’s new prescription guidelines gave officials the added impetus to move forward with regulation. Landgraf expects some resistance from physicians, but believes it’s obvious that a lighter legislative touch on prescribing has not served patients well in years past.
“The intent is not to blame or shame the medical industry,” she told me. “But, to allow the market to govern itself does not seem to be working, clearly. We’re at a spot now that we need to use regulatory authority.”