Congress Is Writing Lots of Opioid Bills. But Which Ones Will Actually Help?
Posted June 20, 2018 8:11 a.m. EDT
If the opioid crisis could be solved by the sheer weight of proposed legislation, Congress would be able to pat itself on the back. Last week, the House began two weeks of voting on what will be more than 50 bills about the epidemic and the Senate has its own stack of opioid bills wending through the chamber.
Some of the bills authorize actions that all involved agree would help ease the epidemic, such as increasing access to treatment or allowing doctors to more easily identify patients who are shopping for multiple prescriptions.
Then there are measures like the Synthetic Drug Awareness Act, the first bill that came to the House floor, which calls for a study of the effects of synthetic drugs like “spice” and “bath salts” on adolescents. Or the Poison Center Network Enhancement Act, meant to improve and build awareness of the national poison control call center.
Taken as a whole, addiction researchers say, the legislative effort has some valuable ideas but falls short of the coordinated response warranted by an epidemic that claimed at least 42,000 lives in 2016, more than guns or car crashes. Some of the measures would probably have little effect, they say, and many evidence-based strategies to expand treatment go unmentioned.
“I didn’t really see that many groundbreaking proposals,” said Joshua Sharfstein, a vice dean of public health at Johns Hopkins University and the former health and mental hygiene secretary in Maryland, who reviewed the dozens of bills.
The volume of legislation reflects the desire of lawmakers on both sides of the aisle to show that they can take action on a growing public health crisis that has touched Americans across the country and in every social class. Opioids legislation is a popular focus for lawmakers facing re-election this fall and House Republican leaders have been eager to draw attention to their members’ work on the subject.
So have outside groups. The American Action Network, a nonprofit aligned with the House Republican leadership, is running digital ads around the country highlighting the anti-opioids work of vulnerable members. Senate Majority PAC, a political action committee that supports Democrats, has created an ad about an opioid bill sponsored by Sen. Joe Manchin of West Virginia, who is running for re-election. In the House, the leadership is bringing many individual bills to the floor, allowing the maximum number of legislators to say they sponsored their own piece of legislation and won passage. At a news conference last week, 10 members each gave a short speech about the constituent story that inspired their bill. (During the Q&A portion of the conference, reporters asked about immigration policy.) The leadership has set up an opioids crisis website to highlight the bills. And there’s a social media hashtag: #opioidcrisis
The list of members sponsoring opioid bills is filled with Republicans facing tough re-election bids. As Politico recently noted, more than half of the Republicans in races considered to be “tossups” by the nonpartisan Cook Political Report are chief sponsors of a House opioids bill. Most of the bills are ultimately expected to be packaged into one piece of legislation this week.
The House’s effort has the patina of bipartisanship — most bills have sailed through their committees on broad bipartisan votes and many of the bills in the first batch passed the full House on voice votes. After all, what legislator would want to be on the record opposing an opioids fix?
But Democrats have been privately grumbling about a rushed process that has ignored their favored ideas for battling the epidemic. “If the first principle of legislation is do no harm, we will have succeeded,” said Rep. Peter Welch, D-Vt., who sits on the House Energy and Commerce Committee. “But if the goal of legislation is to solve a problem, we will have failed.”
Experts who reviewed the package of legislation said there were several bills that could make a difference in helping prevent people from becoming addicted to opioid medications and a few that could help those already struggling with addiction to get treatment. There are also some long-term investments in pain research that could pay off, though not for the currently afflicted: Both the House and Senate legislation would direct the National Institutes of Health to invest more in studying pain treatments that are not addictive.
In February, The New York Times asked a broad panel of experts to recommend priorities for battling the opioid crisis. They overwhelmingly emphasized addiction treatment as most important, citing the expansion of Medicaid to cover more people and the broadening of medication-assisted treatment as particular priorities.
One of the most costly proposals up for a vote this week does not expand who is covered by Medicaid, but would allow Medicaid to pay for addiction treatment inside large residential hospitals, something currently permitted only on a state-by-state basis. Another bill would allow Medicare to cover certain forms of addiction treatment for the first time. Another would expand the types of health care providers who could prescribe medications that help treat people with opioid-use disorders.
But treatment is not the primary focus of this crop of bills. Instead, a large number address various matters related to the prescribing of drugs, the tracking of prescribing, and the packaging and disposal of medications. Many of these measures could be helpful in preventing new cases of addiction: A recent study cited by the Department of Health and Human Services suggests that over half of those in treatment for opioid-use disorders began by using prescription medications. But the push comes as prescriber behavior is already changing amid recent policy changes meant to deter the overuse of opioid medications in medical care. Prescriptions for opioids have been falling since 2012, according to a recent study, even as the overdose death toll has continued to rise.
There are also, of course, many bills calling for studies.
Another missed opportunity, addiction experts said, is the legislative strategy to encourage creation of more treatment options for patients who need them. Earlier legislation, including the recent big spending deal passed by Congress, created short-term state grants for local anti-opioid priorities. But what health care providers and other entrepreneurs really need is a more permanent source of funding so that those setting up clinics or companies will know they can remain in business over the long term, said Caleb Alexander, a professor at the Johns Hopkins Bloomberg School of Public Health. The shorter-term grant programs may not provide the nudge, he said.
“States are getting $500 million here or $200 million there,” he said. “At any given moment, it’s unclear whether the rug is going to be pulled out from under them.”
President Donald Trump has unveiled his own set of preferred opioids policies, many focusing on enhanced law enforcement approaches. The White House has signaled its approval of a number of the House bills under consideration, including the one that would expand coverage of hospital addiction treatment and two that seek to limit trafficking of synthetic opioid drugs like fentanyl.
The Senate is moving ahead with its own legislative push on opioids, though the midterm politics differ in that chamber. Passing opioid bills in the coming months could benefit several Democratic incumbents who are up for re-election in states where the crisis is particularly severe, such as West Virginia, Ohio and Pennsylvania.
Nonetheless, an aide said Sen. Lamar Alexander, R-Tenn., chairman of the Senate health committee, would lead an effort to bring a package of measures to the Senate floor. More legislation may follow. Rep. Greg Walden, R-Ore., chairman of the House Energy and Commerce Committee and a leader in the current House opioid strategy, has said any holes in the current legislation can be patched in the future.
“While these bills are not our first efforts in this fight, you have my word they will not be our last either,” he said in the news conference. “We know there will be more work to do, even after these become law.”