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Congressional Actions to Address the Opioid Crisis

By Timothy Swope

Thursday, August 16, 2018

The United States is in the middle of a public health crisis. Based on provisional data from the Centers for Disease Control and Prevention (CDC), nearly 50,000 Americans died from opioid overdoses in 2017. Overdose deaths involving synthetic opioids such as fentanyl have tripled from 2015 to 2017. Overdose deaths involving fentanyl and fentanyl analogues are particularly stark in states east of the Mississippi River such as Ohio, Massachusetts, North Carolina, and New Jersey. 

Source: Centers for Disease Control and Prevention. “Provisional Drug Overdose Death Counts.” National Center for Health Statistics. August 5, 2018. Available at: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.

Since enactment of the Comprehensive Addiction and Recovery Act (CARA) in 2016, Congress has taken steps to address these staggering trends.

First, Congress has significantly increased the amount of federal support for programs to combat the opioid crisis, with commitments of $6 billion in new funding over FY2018 and FY2019. In March 2018, Congress enacted over $3 billion in new opioids funding provided in FY2018 appropriations legislation. For FY2019, Congress is in the process of advancing Labor, Health and Human Services appropriations of $3.7 billion in funding to address the opioid epidemic.

Second, Congress has undertaken a flurry of activity on legislative solutions to combat the opioid crisis. On June 22, 2018, the House passed H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act with overwhelming support (396-14). It’s intended to serve as a legislative vehicle for Senate legislation and many of the other 55 House-passed bills aimed at curbing opioid addiction. This legislation includes 63 individual bills, the majority of which approved with strong bipartisan support at the committee level. It also includes several provisions that align with BPC recommendations to address the opioid epidemic in four key areas:

  • Curb Illicit Supply
  • Curb Unnecessary Prescription Opioid Supply
  • Improve treatment for substance use disorders and promote recovery
  • Educate America

Additional details on the SUPPORT for Patients and Communities Act are provided in the House Energy and Commerce Committee one-page summary and section-by-section summary.

The Senate has advanced two major bills through committees of jurisdiction – the Opioid Crisis Response Act (OCRA) and the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act. Both OCRA (April 24) and the HEAL Substance Use Disorders Act (June 12) were approved with unanimous support by their respective Senate committees. Combined, 37 bill sections in OCRA and HEAL line up with House H.R. 6 SUPPORT sections. The table below lists provisions included in both the House and Senate legislative packages which are also in line with BPC recommendations.

BPC applauds Congress’s bipartisan work to respond to the opioid crisis. We encourage congressional leaders to look for additional opportunities to make policy changes – informed by robust evidence – to curb the overprescribing of opioids, increase access to medication-assisted treatment, and advance other policies that address the evolving nature of the issue.

Summary of H.R. 6 Provisions in Line with BPC Recommendations

House SUPPORT for Patients and Communities Act (H.R. 6)Senate OCRA or HEAL Substance Use Disorders Act (S. 2680 / S. 3120)BPC Recommendations
TREATMENTSec. 7041—Advancing Cutting-Edge Research allows National Institutes of Health (NIH) to use its “other transactional authority” to approve projects that respond to public health threats, including the opioid crisis.OCRA Sec. 201BPC has proposed allowing the NIH to use “other transactional authority” for research to respond to public health threats.
TREATMENTSec. 7131—Comprehensive Opioid Recovery Centers (CORCs). CORCs would aim to utilize the full range of FDA-approved medications and evidence-based treatments, have strong linkages with the community, generate meaningful outcomes data, and improve the opportunities for individuals to establish and maintain long-term recovery as productive members of society.OCRA Sec. 401BPC has stressed the importance of acknowledging that opioid use disorders, like all substance use disorders, are chronic conditions requiring long-term support to sustain recovery.
TREATMENTSec. 3003—Allowing for more flexibility with respect to medication-assisted treatment (MAT) for opioid use disorders. Allows more practitioners to qualify to provide MAT: clinical nurse specialist, certified registered nurse anesthetist, and certified nurse midwife. Increases the cap from 30 to 100 patients per practitioner.OCRA Sec. 408—increases the cap from 30 to 100 patients per practitioner, extends provision to allow up to 275 patients.BPC has made several recommendations to increase access to MAT, which is considered the gold standard for treatment of opioid use disorders, including increasing patient caps.
TREATMENTSec. 2007—Medicare coverage of certain services furnished by opioid treatment programs. Expands Medicare coverage to include Opioid Treatment Programs (OTPs) for the purposes of delivering MAT to expand access to treatment options for Medicare beneficiaries.HEAL Sec. 109BPC has made several recommendations to increase access to MAT, which is considered the gold standard for treatment of opioid use disorders, including expanding Medicare coverage.
TREATMENTSec. 7031—Ensuring Access to Quality Sober Living. Authorizes SAMHSA to develop, publish, and disseminate best practices for operating recovery housing that promotes a safe environment for sustained recovery from substance use disorder.OCRA Sec. 409BPC has recommended establishing best practices for recovery housing, which is essential to ensure quality support programs for people in recovery and to decrease fraudulent practices.
TREATMENTSec. 7171—Special Registration for Telemedicine Clarification. Provision to clarify telemedicine waivers. Directs the Attorney General, with the Secretary of HHS, to promulgate interim final regulations within one year of passage of the law.OCRA Sec. 413BPC has recommended clarifying DEA’s ability to allow qualified providers to prescribe controlled substances via telemedicine, which is particularly important in rural areas facing a workforce shortage.
TREATMENTSec. 2001—Authority not to apply certain Medicare telehealth requirements in the case of certain treatment of a substance use disorder or co-occurring mental health disorder. Expands the use of telehealth services by instructing CMS to evaluate the utilization of such services in treating substance use disorder.HEAL Sec. 102BPC has recommended expanding the utilization of telehealth services for the treatment of substance use disorder.
TREATMENTSec. 8021—Assisting States’ Implementation of Plans of Safe Care. Requires the Secretary of HHS to issue guidance and, if appropriate, technical assistance – including sharing best practices – to support states in promoting protections for young children and family-centered responses.OCRA Sec. 412BPC has recommended that the Secretary of HHS be required to identify and share model strategies to support state and local implementation of “plans of safe care” and data collection and reporting.
PREVENTIONSec. 7071—Substance Use Disorder Workforce Loan Repayment. Creates a loan repayment program for SUD treatment providers. Specifically, the bill will offer student loan repayment of up to $250,000 for participants who agree to work as a SUD treatment professional in areas most in need of their services. The program will be available to a wide range of direct care providers, including physicians, registered nurses, social workers, and other behavioral health professionals.OCRA Sec. 415BPC has recommended expanding loan repayment to National Health Service Corps (NHSC) behavioral health providers practicing in areas with shortages of substance use treatment professionals to help to fill in critical workforce gaps.
PREVENTIONSec. 7201—Creating Opportunities that Necessitate New and Enhanced Connections that Improve Opioid Navigating Strategies (CONNECTIONS). Provides additional authority to CDC to improve current federal support for state-run prescription drug monitoring programs (PDMPs).OCRA Sec. 505BPC has recommended expanding the use of PDMPs and enhancing their utility, making them more interconnected and usable for public health surveillance and clinical decision-making.
PREVENTIONSec. 7151—Eliminating Opioid-Related Infectious Diseases. Authorizes $40 million to CDC to undertake an injection drug use-associated infection elimination initiative and work with states to improve education, surveillance and treatment of injection drug-use associated infections, like human immunodeficiency virus (HIV) and hepatitis.OCRA Sec. 512BPC has recommended the inclusion of provisions to improve surveillance regarding blood-borne diseases associated with injection drug use.
CURB ELICIT SUPPLYSec. 9001—Stop the Importation and Trafficking of Synthetic Analogues (SITSA). Provides quicker action to stop the illegal importation and distribution of deadly synthetic drugs. Gives the Attorney General greater authority to quickly and temporarily schedule a new drug when it is virtually identical to a currently scheduled drug.OCRA Sec. 303BPC has recommended increased funding and human resource capacity for the FDA and CBP to detect and seize illegal drugs.
CURB ELICIT SUPPLYSec. 8001—Synthetics Trafficking and Overdose Prevention (STOP). To provide for the processing by U.S. Customs and Border Protection (CBP) of certain international mail shipments and to require the provision of advance electronic information on international mail shipments of mail.OCRA Sec. 303BPC’s Governor’s Council recommended legislative solutions to better track and interdict fentanyl and other illegal synthetic
opioids.
CURB ELICIT SUPPLYSec. 7191—Stop Illicit Drug Importation. Streamlines and enhances tools the Food and Drug Administration (FDA) has available to effectively intercept illegal products. In doing so, this bill will create efficiencies for government resources and better protect American citizens from dangerous imported substances.OCRA Sec. 305BPC has recommended increased funding and human resource capacity for the FDA and CBP to detect and seize illegal drugs.

KEYWORDS: 115TH CONGRESS, CENTERS FOR DISEASE CONTROL AND PREVENTION, FY2018, FY2019, HOUSE ENERGY AND COMMERCE COMMITTEE, OPIOIDS