Pubdate: Mon, 16 May 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company


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 

Congress may be late to wake up to the epidemic, but it does at last 
seem prepared to open more paths to treatment.
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MAP posted-by: Jay Bergstrom