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US Congress’ latest opioid bill welcome but won’t solve the crisis

US Congress’ latest efforts to address the opioid crisis are welcome but won’t be enough to stop the unrelenting scourge of overdose deaths across the United States, writes Brianna Ehley for Politico.

Public health experts and first responders say the massive bipartisan legislation, H.R. 6 (115), which the Senate approved 99-1 in mid-September, takes some important steps toward better access to treatment but lacks the urgency, breadth and steady long-term funding required to quell the emergency that takes 115 lives in the United States a day.

"We’ve got to stop putting people in body bags,” said Jonathan Thompson, executive director of the National Sheriffs Association. He says Congress is being reactive to a crisis instead of taking a comprehensive approach to prevent drug addiction in the first place. And it’s got to happen faster.

The House passed its package in June, and House and Senate negotiators have already started working out differences. Senate HELP Chairman Lamar Alexander said he hoped to unveil a final deal soon. The House would likely vote on the final package within a week with a goal of getting it to President Donald Trump’s desk before the midterm elections.

The new legislation would crack down on mailed shipments of illegal drugs like fentanyl and encourage the development of non-addictive pain therapies — which is necessary, but will take time.

But only marginally does it tackle the severe nationwide shortage of treatment beds for rehab, and it does little to encourage more doctors to prescribe medication to treat addiction, which requires special training and licensing. The bills create new grants and demonstrations to test out new treatment programs but there's no long-term funding guarantees to keep them up and running.

“The data keeps showing us we have more and more people dying, so what’s the reluctance to actually spend money and actually do something?” said Chuck Ingoglia, senior vice president of public policy at the National Council for Behavioral Health.

Trump, who campaigned on ending opioid addiction in 2016, has often talked about stepping up law enforcement, even endorsing execution for drug dealers. The House and Senate bills have generally stressed more of a public health and treatment approach, even if critics don’t think they go far enough.

The latest CDC data shows the devastation getting worse — roughly 72,000 overdose deaths last year, a 10 percent increase from 2016. Most of these deaths were from opioids, whether legal or illegal. And though states have begun limiting opioid prescriptions, the increase in deaths was largely driven by illegal drugs like fentanyl.

Trump declared the opioid epidemic a national public health emergency last year, and vowed to reduce opioid prescriptions by one third over the next three years.

He signed a presidential proclamation this week declaring it Prescription Opioid and Heroin Epidemic Awareness Week to draw attention to the crisis.

Congress' latest efforts will mark the second legislative response to the opioid epidemic in two years. President Barack Obama signed the first one, S. 524 (114) or the Comprehensive Addiction and Recovery Act, in 2016, which created grants for states to work on prevention and rehab.

Lawmakers say the legislation they will send to Trump is the next step, not the last word. They know the crisis is evolving — and that voters are well aware of the toll and expect more.

“It’s not one and done. We’ve stepped up to the plate and we’re going to have to keep working at this,” said Sen. Shelley Moore Capito (R-W.Va.), whose home state of West Virginia has the highest overdose death rate in the country.

Health groups are encouraged by some parts of the legislation, including a House-passed measure that allows states to partially lift a decades-old Medicaid restriction on payments for opioid and cocaine addiction treatment at certain inpatient facilities. Lawmakers say that provision will let states move faster to expand inpatient treatment than the current Medicaid waiver system.

Another House bill allows doctors to share more medical information for patients with addiction. Neither are included in the Senate’s bill and it’s unclear if they will make it into the final agreement.

Both chambers include proposals to support families affected by addiction and babies born dependent on opioids. They also include expansions of Medicare coverage for certain medication assisted therapies and for broader use of telemedicine to treat addiction, which can be especially helpful for people in rural areas.

“The difficulty we’re seeing is we don’t have the infrastructure to address this,” said former Rep Mary Bono, co-founder of the Collaborative for Effective Prescription Opioid Policies. “A lot of these bills try to address that and try to help but this is going to be a long slog and the federal government can’t do it all.”

One idea that didn’t get in this package but could be discussed in the future includes allowing the federal government to negotiate the price of naloxone. The idea of making the overdose antidote more affordable was endorsed by the president’s opioid commission, led by former New Jersey Gov. Chris Christie, but has not gained traction on the Hill for political reasons.

Many public health officials and experts warn any efforts to repeal the Affordable Care Act or reduce Medicaid coverage would undermine work being done to get the drug crisis under control.

“Expanding Medicaid is one of the ways we were allowed to expand access treatment,” said Pennsylvania’s Health Secretary Rachel Levine, adding that repealing the law would be “extremely counterproductive.”

Congress earlier this year injected more than $4 billion dollars into fighting the opioid crisis. That money went to law enforcement, as well as treatment and prevention programs, and lawmakers are expected to appropriate around $3 billion more in forthcoming spending packages. State health groups, appreciative of the new dollars, say more guaranteed long-term funding will be needed to build and staff more treatment centers. It’s hard to plan or build capacity when relying on short-term grants that may or may get renewed.

“They get very skittish about hiring staff,” the National Council for Behavioral Health’s Ingoglia said.

“The issue now isn’t a lot of new legislation, although there are things that need to be fixed, but rather making sure everyone is appropriately resourced to do that work that is needed,” said Mike Fraser, executive director for the Association of State and Territorial Health Officials.

Some have complained that money isn’t getting to states and local communities quick enough.

POLITICO reported earlier this year that millions of dollars Congress sent states last year to fight the crisis had not been spent, due to the slow-moving nature of the federal grant system.

“This epidemic is going to be stopped community by community, not from the federal level, not the state level, it’s going to happen at the local level because every community is different,” said Eli Briggs, government affairs director for the National Association of County and City Health Officials, NACCHO. “Until the funding gets down all the way to the local level, we’re not going to turn the corner.”

Still, many are encouraged by Congress’s efforts and attention to the issue, that has long been siloed from the broader health care system.

“This crisis is going to take sustained attention and funding for years to come,” said Jeremiah Gardner, of the Minnesota-based Hazelden Betty Ford Foundation. “But the opioid crisis was years in the making and it’s not going to end overnight.”

Gardner and others say it’s crucial that policymakers focus on addiction more generally. Alcoholism, for example, kills roughly 80,000 people every year, according to federal estimates. The legislation currently under consideration focuses specifically on opioids, but drug deaths from cocaine and methamphetamine are rising across the country as well.

“We have had an addiction crisis for generations in this country. It tends to morph from one drug to another,” he said.

“People in this field are always talking about substance de jour,” said Regina LaBelle, who served as chief of staff of the Office of National Drug Control Policy under Obama. “Congress needs to think about that and not tie states hands.”

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