Congress has agreed on a comprehensive package to address the opioid epidemic, which includes both law-enforcement and public-health measures. President Trump is expected to sign it.
The 653-page bill has a provision to fight importation of fentanyl through the mail, one that allows more health-care providers to prescribe medication for opioid addiction, and another to make it easier for Medicaid recipients to get inpatient care for substance abuse over the next five years.
“While there is more work to be done, this bipartisan legislation takes an important step forward and will save lives,” a group of Republican and Democratic committee leaders said in a statement.
Opioid overdoses were responsible for nearly 50,000 U.S. deaths last year, 1,565 in Kentucky.
One of the most expensive items in the new law is the partial removal of a decades-old federal rule that prevented states from using federal Medicaid dollars on inpatient addiction treatment facilities with more than 16 beds, called the IMD exclusion (for “institution for mental disease”).
For the next five years, the new law allows states to amend their Medicaid programs to obtain federal funds to cover up to 30 days of residential treatment for individuals receiving substance-abuse treatment per calendar year.
Mental-health advocates have said this provision doesn’t go far enough because it doesn’t cover treatment for mental illness that isn’t related to substance use. Others have voiced concerns that the relaxation of the exclusion will divert money away from other community-based programs.
Some addiction specialist are also concerned that it will create a shift to these inpatient facilities and away from longer-term outpatient programs that focus on medication-assisted treatments, which is the gold standard for treating opioid addiction. “Many residential programs for opioid addiction still don’t offer such treatment as part of their protocol, and the bill does nothing to address that,” Abby Goodnough of the New York Times reports.
The package also will permanently allow nurse practitioners and physician assistants to prescribe buprenorphine, an anti-addiction medication that requires a special license. It also allows nurse anesthetists, nurse midwives and clinical nurse specialists to prescribe buprenorphine for a trial period of five years.
It also includes a provision to help stop the flow of illicit opioids into the country by mail, especially synthetic fentanyl. Goodnough writes, “It will require the United States Postal Service to start collecting information on international mail shipments, just as private carriers like FedEx and DHL already have to do. By the end of this year, the Postal Service will need to provide the name and address of the sender and the contents of the package, as described by the sender, for at least 70 percent of all international packages, including all of those from China. It will have to provide the information on all such shipments by the end of 2020. The Postal Service could block or destroy shipments for which the information is not provided.”
The package will provide funds for the research and development of new, non-addictive painkillers and allow the U.S. Food and Drug Administration to require certain opioids be dispensed in packaging that limits their abuse potential.
Critics of the bill say it’s not enough to fully combat the opioid crisis and what is needed is an infusion of money similar to the billions of dollars that has been spent on HIV/AIDS.
Inside Health Policy reports that a House-backed measure that sought to loosen privacy restrictions on medical records containing information about substance abuse was dropped from the final package.
Also missing, Goodnough writes, is a provision that the pharmaceutical industry pushed hard for that “would have softened a requirement for drug manufacturers to start providing larger discounts next year to Medicare beneficiaries whose spending on prescription drugs falls in a coverage gap called the “doughnut hole.”