Senate Approves Historic Drug Addiction Legislation

Senate Approves Historic Drug Addiction Legislation

Passed in a sweeping bipartisan 92-to-2 vote, the "Opioids Bill" is the first ever drug addiction legislation to support long-term treatment and recovery. But there's no funding in the bill to pay for any of the forward-looking measures.

The U.S. Senate has approved a new "opioids bill" which addresses the nation's rampant prescription painkiller and heroin addiction crisis with some history-making provisions. The bill intends to transform the way America's health care and law enforcement systems approach drug use disorder by framing it as a health problem, not as a primarily legal situation or as a personal failure.

Thanks to the special efforts of many congressman and senators, the Comprehensive Addiction and Recovery Act (CARA) is a "compromise amalgamation" of more than a dozen measures proposed throughout the year. It includes much of a similar bill passed in March by the Senate and of another passed in May by Congress. "This is a bipartisan bill to reform important programs and give a substantial boost to those fighting on the front lines of the opioid epidemic -- which in my state is taking more lives annually than gun shots or car wrecks," said Sen. Lamar Alexander (R-Tenn) in a press release. NPR reports that Sen. Oren Hatch (R-Utah) "helped win additions to the bill that encourage pain research, expand access to medication-assisted treatment, and limit Medicare Part D beneficiaries to one pharmacy and one physician for prescriptions." Among its many recommendations, the bill calls for all states to finish implementing their prescription drug monitoring programs (PDMP).

The last time we checked, Missouri was the only state still without a PDMP, but it's in the works and could be approved soon. Meanwhile, several other states with approved PDMPS don't have them up and running efficiently yet. The new bill also recommends creating a special task force to study the best ways to treat pain to help reduce knee-jerk reliance on and use of dangerous opioids. There have been several initiatives in this direction recently and research continues to search for safer alternatives to opioids.

Insufficient funding to achieve its goals

One of the main problems with the CARA bill is that it was supposed to provide grants to the states so they could undertake the actions it calls for. But few if any states can actually afford to do so. Earlier this year the president requested $1.1 billion to help states combat addiction. During its trip through Congress in May, the CARA bill suffered from political wrangling along party lines and was passed with severely inadequate funding. Although the new bill doesn't allocate enough money to put all its lofty goals in place, the White House indicates that President Obama will sign it. It's expected that the White House will call again for substantial increases in funding.

On July 12, just before the bill's final passing in the Senate, the New York Times published an editorial saying the bill does contain "some good ideas. It will also be far less effective at saving lives than it should be." "It would authorize addiction treatment and prevention programs to stem what has become a scourge and a disgrace - more than 28,600 overdose deaths in 2014. But it contains not a penny to support those initiatives," the Times said. "House Republicans say they will appropriate $581 million when Congress returns in September. That's too stingy given the scope of the problems," the Times added. Critics are saying there's no need to wait until September to discuss and approve the necessary funding. And in fact, many say, the Republican's decision to delay while they recess for six weeks will cost hundreds of American lives.

The buprenorphine expansion

Meanwhile, the bill does include a provision recently approved by federal regulators that could make it easier for some people to get help even without the needed funding. The federal Department of Health and Human Services recently tripled the number of patients - from 100 to 275 - that authorized doctors will be allowed to treat with buprenorphine. The new CARA bill augments this by adding physician assistants and nurse practitioners to those approved to prescribe buprenorphine provided they complete special training. Buprenorphine is used to help manage dependence on opioids by reducing withdrawal symptoms, while hopefully the patient pursues the goal of becoming drug free. But like methadone, another drug used to alleviate opioid withdrawal symptoms, buprenorphine is itself an addictive narcotic. It therefore also runs the risk, like methadone, of becoming simply another addiction - a switch to a legal drug from illegal opioids, that can go on for months or years or a lifetime.

The only value in "substitute drugs" like methadone and buprenorphine used in this fashion lies in helping people who are struggling with dependence to benefit from the drug for a short term, with the stated goal of becoming entirely drug free as soon as possible.

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