Washington is Finally Tackling the Opioid Crisis

10.15.18
U.S. News /15 Oct 2018
10.15.18

Washington is Finally Tackling the Opioid Crisis

In 2016, opioid overdoses claimed the lives of 42,000 Americans. That’s up dramatically from 26,000 opioid deaths in 2014. To put things in perspective, terrorists have claimed the lives of 2,961 Americans in the last 17 years, most of which occurred on a single September afternoon in 2001.

When it comes to protecting lives, America clearly has multiple very reasonable priorities to attend to. The trouble is, we rarely get the balance quite right.

Of the clear and present dangers to life in America, the opioid epidemic is one of the most urgent. This problem doesn’t abide by any socioeconomic, racial or gender divides. It has the potential to affect any one of us, regardless of our status or how otherwise healthy we appear to be.

The Senate and House of Representatives have had this crisis on their backburner for some time. And with midterms right around the corner, many members of Congress are keen to look busy for their constituents. To that end, the House has successfully passed a bill to help fight the ongoing opioid crisis. It’s filled with several encouraging developments — but it also leaves some of our biggest healthcare challenges unaddressed.

What’s in the Opioid Bill?

Cooperation isn’t totally dead in Washington quite yet. At the very end of September, the House of Representatives carried out a 393-8 vote to pass a bill directly targeting the opioid epidemic in the United States. It’s called the “SUPPORT for Patients and Communities Act,” but previous names have included “H.R. 6” and the “Opioid Crisis Response Act.”

Here are some of the most important steps this bill has committed the U.S. government to undertaking.

Until now, the Medicaid Institution for Mental Diseases had placed a limit on Medicaid payouts for addicts seeking opioid dependence treatment. Under this bill, some of these limits — known as “IMD exclusions” — have been lifted in the hopes of expediting addiction treatment for Medicaid participants and freeing up more public funding for this cause.

This is one of the most encouraging signs yet that the U.S. government is taking steps to recognize that mental illnesses are diagnosable, serious, and reimbursable public health concerns just like any affliction of the body.

The bill also provides stricter punishments and greater oversight when it comes to illegal opioids being imported to the United States. Previously, it was common for drugs of this type to enter the country from elsewhere in the world by covert means — including paid postage in the mail.

Additionally, the bill lifts restrictions on certain types of medical providers, including nurse practitioners, when it comes to prescribing medications for addiction treatment, including buprenorphine.

Here are some additional measures included in the legislation, each one targeting a different part of the opioid overdose epidemic and its collateral damage:

  • Section 7073 creates new educational and support programs for medical practitioners in the field of pain management, including new resources covering the dangers of opioid prescription misuse, detecting warning signs of abuse disorders and a stronger emphasis on alternatives to opioid-based pain care.
  • Section 8081 requires the Department of Health and Human Services (HHS) to issue guidance at the state level concerning family-oriented, residential treatment programs for substance abuse.
  • Section 8082 was drawn up with the reunification of families in mind. It allocates $15 million for a new HHS-based “recovery coach” program for families that have been separated as a result of substance abuse. There are thousands of children in foster care in every state in the Union, and this part of the bill has recovery in mind for every member of these broken homes and families.

Indeed, the foster care crisis as a result of these displaced children of opioid addicts has officially been labeled a “crisis” in some of the hardest-hit areas of the country. It’s obvious that medicinal approaches to abuse and dependence are some of the smallest pieces of the larger puzzle. Ameliorating the social damage is one of the biggest challenges.

Unfortunately, some of the proximate causes of social damage in America, at least when it comes to healthcare, remain largely untouched by this legislation.

What Critics Are Saying and Where the Bill Falls Short

The failures of this bill mirror the failures of the larger American healthcare system. According to some prominent Democrats like Elizabeth Warren (Massachusetts) and Frank Pallone (New Jersey), the bill is a welcome step in the right direction — but one that falls short of the more realistic funding target of $100 billion over the next decade, which is what addiction experts recommend.

Some thirty years ago, Congress faced a similar watershed moment as it contemplated the HIV/AIDS epidemic. Warren and other Democrats are suggesting that remedies for the opioid epidemic should follow the general model set forth by those largely successful efforts. That means a lot more money. It also means specifically earmarking such funds for federal, state and tribal/native use. As with the HIV/AIDS efforts, it’s imperative that approved funding be used for prevention, treatment and medical research alike.

The House has approved an encouraging bill that would help improve the fortunes of thousands of Americans in the throes of opioid addiction. But beyond Republican echo chambers, it’s seen as something of a symbolic measure that tinkers in the margins instead of tackling the epidemic directly. And it leaves most the U.S. healthcare apparatus — itself one of the major reasons we’re in this situation to begin with — untouched.

For a look at why, just familiarize yourself with some of the most common reasons why people turn to opioids for relief in the first place:

  • To treat pain from unaddressed or poorly healed injuries.
  • To self-medicate for chronic illnesses or undiagnosed mental disorders such as PTSD and depression.
  • Usage patterns may be exacerbated by daily and financial stresses.
  • To find relief from social isolation or ostracization.
  • Some patients self-medicate with heroin because it’s cheaper and more accessible than opioid treatments.
  • Doctors provide unnecessary opioid prescriptions for personal gain, causing patients to become dependent or addicted during the course of their treatment when other pain management tools were readily available.

In some of these cases, problems begin when American citizens forego or postpone professional medical treatment for their problems due to “sticker shock” or a lack of a primary care physician or specialist in their area. At the root, opioid abuse became a crisis in this country because self-medicating is less expensive and less of a hassle than navigating health insurance marketplaces or wondering about mental illnesses, pre-existing conditions and other arbitrary barriers in a profit-motivated healthcare system.

There’s a lot of encouraging progress packed into this bill, but much of it turns a blind eye to the larger problems in U.S. healthcare, including runaway drug prices, a lack of community health centers in underserved areas and a general lack of oversight for doctors with strong ties to the pharmaceutical industry. Big Pharma, unsurprisingly, made every effort to weaken the parts of this legislation concerned with keeping drug prices low, including alternatives to opioid-based treatments.

What’s Next for This Legislation?

The Senate passed this piece of legislation earlier in September. With the House of Representatives having successfully passed it as well, it will now make its way to the current president’s desk. Shifting political winds may end up seeing these efforts improved or even combined with other progressive campaigns to overhaul our healthcare system for the common good. But for right now, it’s a step in the right direction for some of our most vulnerable citizens.

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