On Oct. 24, 2018, President Donald J. Trump signed a bipartisan bill that was aimed at tackling America’s growing opioid epidemic.
The opioid legislation, titled the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, indicates progress in the national fight against opioid addiction and treatment.
“The legislation is historic in its breadth and commitment to the problem. Whether it’s enough, it’s what we know to do right now. It’s the right legislation at the right time,” according to Brett Giroir, assistant secretary for Health and senior adviser for Opioid Policy at the U.S. Department of Health and Human Services.
The new law targets overprescribing and opioid trafficking. Several of the provisions in the new law are intended to minimize trafficking through “mandatory advance electronic information for postal shipments, civil penalties for postal shipments, international postal agreements, and report on violations of arrival, reporting, entry, and clearance requirements and falsity of lack of manifest.”
Most of the specific costs are still unknown. Vox reported that the opioid legislation reauthorizes funding from the Cures Act, which placed $500 million annually toward the opioid crises and makes tweaks that hopefully give states more flexibility using the funding.
A key provision in the bill is the continuance of state opioid grants through the Substance Abuse and Mental Health Services Administration (SAMHSA). Giroir says, “This adds hundreds of millions of dollars to the states to treat [opioid abuse]. Giroir did not help draft the legislation. He is a former pediatric critical care physician who began working with a variety of federal offices in 1998.
Another piece of the bill increases the types and numbers of health care providers who can provide medication-assisted treatment (MAT).
Giroir says midwives were added.
It makes wonderful sense to have certified midwives. There are mothers who suffer from opioid abuse and providing MAT to the mother helps them and dramatically decreases complications for the babies.
Babies born to mother with opioid addiction are at risk of developing neonatal abstinence syndrome (NAS), a form of drug withdrawal. According to the National Institute on Drug Abuse, from 2000 to 2012, there were 21,732 infants born with NAS.
This is the “equivalent to one baby suffering from opiate withdrawal born every 25 minutes.”
Kellyanne Conway, counselor to the president, recently described the epidemic as “the crisis next door.” This is why the new opioid legislation makes so much sense.
I think part of why it passed in a bipartisan fashion is because everybody sees the need back at home. Whether you represent a state of a congressional district, you just see the need back at home. Law enforcement, access to treatment. Certainly, education and prevention.
Over 200,000 people died in the U.S. from overdoses related to prescription opioids from 1999 to 2016, according to the Center for Disease Control (CDC). Forty-nine thousand people died from opioid-related overdoses. The synthetic opioid, fentanyl, was the biggest driver.
A recent U.S. government report stated the number of drug overdose-related deaths cause life expectancy to drop in 2017. According to the CDC, overdose rates jumped 9.6 percent over the last year and the average life span decreases to 78.6 years.
There are those who believe that the new opioid legislation will not be enough. Dr. Rosalie Pacula is the co-director of RAND’s Drug Policy Research Center and she is one of those people.
The impact is going to be very hard to see immediately and initially. And it’s going to require additional sustained investment, which I worry the taxpayer isn’t going to be as interested in doing, in part because we waited so long to tackle this problem.
Pacula criticized the waiver process for MAT. One of the most effective MAT medications approved by the FDA is buprenorphine. In order for a medical professional to prescribe the drug, they must obtain a special waiver from the DEA and take an eight-hour course on addiction treatment. Pacula says that most physicians do not bother to go through the process of getting waivered.
The new bill does not eliminate the waiver requirement. Rather, it allows nurse practitioners and physician assistants to be eligible for a waiver, same as physicians. The reason why Pacula finds this “really crazy” is because physicians do not need a special waiver to prescribe the addictive drugs.
If the issue is fear of getting addicted, we should have the waiver on every opioid prescribed but we don’t. Why make it harder for them to do treatment than for the drug that causes problem in first place?
Pacula’s biggest criticism is that fact that Trump has these drug initiatives led by people of his choice, “not people who know the problem well and have been studying it for decades.”
[The legislation] attempts to address pieces of the problems without a comprehensive vision for tackling the entire problem. That’s what’s missing here.
Giroir says that DHHS is always looking for new ideas to attack the opioid problem. The next step is to increase the availability of naloxone, and opioid reversal drug. Until then, the organization is taking an extensive look at the new legislation to fully understand it and look for any gaps.
“The current legislation does take some useful steps to fix a few problems, but it doesn’t address them comprehensively, in my opinion. That might be the nature of a bipartisan bill, though. You can’t do everything,” says Pacula.
By Jeanette Smith
Yahoo!: America’s new opioid law ‘is historic in its breadth’
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