Pubdate: Fri, 18 Mar 2016
Source: Washington Post (DC)
Copyright: 2016 The Washington Post Company


The House Should Take Up a Bill That Would Mark a Sea Change on Opioids.

SLOWLY BUT surely, like the proverbial aircraft carrier, the U.S. 
government is changing to a new and better course on the 
long-neglected issue of opioid abuse and addiction.

On Tuesday, the Centers for Disease Control and Prevention took an 
emphatic stand against the loose prescribing norms that have fueled 
the growth of opioid consumption for non-cancer pain, with the 
terrible result that 16,000 people a year die from over doses.

Labeling the drugs "dangerous," and noting that evidence did not 
support their long-term efficacy for most cases of chronic pain, CDC 
Director Thomas Frieden urged physicians to follow more-cautious new 
CDC guidelines that emphasize alternative pain management techniques. 
Dr. Frieden and his colleagues deserve credit for incorporating a 
range of views in the guidelines while resisting pressure to weaken 
them from interest groups that support the status quo.

The CDC announcement followed the Senate's passage of the 
Comprehensive Addiction and Recovery Act of 2016 by a vote of 94 to 
1. Whereas the White House this year called for more than $1 billion, 
over two years, in new mandatory funding for drug treatment, this 
bill includes no new funding beyond a previously allocated $400 
million. Still, the legislation, co-sponsored by Sens. Rob Portman 
(R-Ohio) and Sheldon White house (D-R.I.), is a step in the right 
direction-for three reasons.

First, it was bipartisan, and overwhelmingly so, suggesting that 
lawmakers can still work across the aisle on issues, such as public 
health, that should never be part is an in the first place.

Second, the bill addresses addiction to heroin and prescription 
opioids as a public-health issue rather than a law enforcement 
matter, a sea change in federal policy.

Even without new money to back it up, this was a statement worth making.

Importantly, the bill authorizes grants to "medication-assisted" 
treatment programs based on substances such as methadone, 
buprenorphine and naltrexone, which reduce cravings for heroin and 
help stabilize patients as a prelude to weaning them completely. 
Controversial because of what critics call "substituting one 
addiction for another ," medication assisted treatment has been shown 
in studies to work better than abstinence-only programs, and the bill 
wisely recognizes this.

Third, like the CDC guidelines, the bill attacks the supply side of 
the problem.

It provides for $25 million in grants over five years to states that 
mandate provider participation in their computerized Prescription 
Drug Monitoring Programs. These programs help states track the flow 
of prescription opioids to prevent "doctor-shopping" by addicted patients.

Despite federal aid through existing Justice Department grants, these 
programs remain underfunded and underenforced; the bill's provisions 
should help, a bit, on both scores.

We repeat: The bill could be better.

It omitted a proposal by Sens. Ed Markey (D-Mass.) and Rand Paul 
(R-Ky.) that would have deregulated the administration of treatment 
medications so that more doctors could treat more than 100 addicted 
patients a year, which is the current maximum.

Nevertheless, the legislation usefully reorients federal policy, thus 
setting the stage for more effective use of federal dollars when they 
come available, as they should and must. The House should take it up 
and pass it, soon.
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MAP posted-by: Jay Bergstrom