Congress Wakes Up to the Opioid Epidemic

http://www.nytimes.com/2016/05/16/opinion/congress-wakes-up-to-the-opioid-epidemic.html

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The opioid epidemic is now a leading cause of death in the United States, ravaging communities across the country. At last, Congress has snapped to attention. But its recent flurry of legislation will be of little help unless lawmakers are willing to fund treatment and prevention programs.

The House last week passed 18 bills related to opioids, and the Senate approved a comprehensive bill in March. The bills, which will be reconciled in a conference committee, are overdue. Opioids, a category of drugs that includes heroin and prescription painkillers like oxycodone, killed more than 28,000 people in 2014, and the rate of overdoses has tripled since 2000, according to the Centers for Disease Control and Prevention. Almost two million Americans abused or were dependent on these drugs in 2014.

The question now is whether Congress will appropriate enough money to address the scale of the problem. Democrats are seeking $600 million, and President Obama has asked for $1.1 billion. Republican leaders have not said how much they would be willing to spend, but insist that the total be offset by reductions in other programs or increases in revenue. The country is facing a health emergency, and it would be tragic if a self-imposed budget rule got in the way of a robust federal response.

The federal government can make the biggest difference by expanding high-quality treatment programs. States, which have more sway over doctors and hospitals, need to do more on the prevention side by placing limits on opioid prescriptions. States can encourage doctors to order alternative pain treatments, like physical therapy, and require insurers to cover those services.

“Many people become addicted because of being prescribed an inappropriate amount of opioids or for too long,” said Gov. Maggie Hassan of New Hampshire. Ms. Hassan, a Democrat, is part of a worthwhile effort by the National Governors Association to come up with opioid prescription protocols that could be adopted by state governments. Several states, including New Hampshire and Massachusetts, have already adopted policies or passed laws to reduce the prescribing of opioids.

On the treatment side, according to patient groups, state lawmakers and medical experts, some programs are turning away patients. In some cases, that is because insurers won’t cover treatment and patients cannot afford to pay. Federal and state officials need to consider regulations and laws that would require all insurance plans to cover substance-abuse treatment; Medicaid and plans sold on health insurance exchanges are required to do so.

In other cases, treatment centers just do not have enough capacity. Federal grants would help those centers expand. About 75 percent of people with drug-use disorders never receive any treatment, according to a National Institutes of Health survey published in November.

There is a drug on the market that could be helping many more people deal with addiction, if only Congress would remove some roadblocks. Buprenorphine is an opioid that the C.D.C. and other medical experts say is effective at weaning people off stronger drugs like heroin, and its use is unlikely to end in overdoses. Under current law, doctors must have eight hours of training before prescribing the drug and then are limited to treating 100 patients. That curtails access to the drug, especially in rural areas where there are fewer doctors.

The Department of Health and Human Services has proposed doubling the number of patients a doctor can treat with buprenorphine, to 200, but it could take months to change the rule. A better option is a bill introduced by two senators — Edward Markey, Democrat of Massachusetts, and Rand Paul, Republican of Kentucky — that sets a limit of 500 patients. It would also let nurse practitioners and physician assistants prescribe the drug. A committee has already approved the measure, but the full Senate has not acted. Ideally, the conference committee would incorporate this measure into the opioid legislation.

Congress may be late to wake up to the epidemic, but it does at last seem prepared to open more paths to treatment.