Last month, Congress sent a sweeping legislative package aimed at curbing the opioid epidemic to President Trump for approval.
“The Support for Patients and Communities Act,” sped through Congress, winning approval by a margin of 393 to 8 in the House and 98 to 1 in the Senate.
The avalanche of overdose deaths reached more than 72,000 in 2017. More than two thirds of the deaths were due to opioids, including prescription pain pills, heroin, and fentanyl.
Hazelden Betty Ford, a top-flight treatment facility, has taken the lead in promoting its support.
Contents of the Act
The ACT was sponsored by legislators in both houses of Congress, and polls confirm that voters view the opioid crisis as a serious problem and believe the federal government should be doing more to combat it.
The Act is broad. It creates, expands and reauthorizes programs and policies across almost every federal agency.
Among other things, it reauthorizes funding for the 21st Century CURES ACT, which provided $6.3 billion in funding to combat the opioid crisis emphasizing support in the following areas:
Access to Treatment: An estimated 20 million Americans are currently struggling with substance use disorder. Finding enough treatment beds and trained addiction professionals to serve the need is a serious problem.
Addiction has historically been treated with less favor by private insurers and Medicaid/ Medicare. Only one in ten people who need addiction treatment actually receives it.
Increased access to inpatient rehab facilities: The Act repeals the 16-bed Medicaid rule for five years, opening up these facilities to patients needing addiction treatment and permitting stays of up to 30 days. It also expands the availability of Medicare dollars to treat opioid use disorder.
Ensuring adequate treatment services. The Act requires federal review of addiction treatment facilities to assess adequacy of treatment and funding needs. It also requires federal agencies to provide information to Congress regarding insurers who are noncompliant with coverage requirements for addiction treatment.
Expansion of Addiction Treatment Workforce: The Act provides a student loan repayment program for addiction treatment professionals working in areas hardest hit by drug overdoses and where there is a shortage of treatment professionals.
Hospital Emergency Rooms: Often, when an addicted person overdoses and ends up in a hospital emergency room, he is stabilized and released with nothing more than a list of phone numbers for treatment programs. Too often, the person fails to follow up with the listed providers, goes back to using, and overdoses again.
The Act seeks to address this by offering grant money for the development of protocols that will provide a bridge from the emergency room to addiction treatment.
Opioid-substitution medications such as Buprenorphine (Suboxone) and Methadone are considered essential tools for the treatment of opioid use disorder, but these medications are often stigmatized among treatment professionals and the recovery community as “trading one addiction for another.”
Sober Housing and Recovery Support Services
“Recovery homes” provides housing for people in early recovery where they can gain strength in their sobriety. Unfortunately, such homes are subject to few regulations in most states, and this can create situations ripe for abuse. Further, the cost of “recovery housing” is generally not covered by private or public insurance, which can limit access.
The SUPPORT Act requires the Department of Health and Human Services to issue best practices for operating recovery housing, and to assist those recovering from opioid addiction with housing costs. The Act also offers support for a variety of recovery support services, as well as grants for programs to help recovering people transition to independent living.
The Act provides grant funding for the creation of centers that will provide a full range of treatment and recovery services, including medication-assisted treatment, recovery housing, job training, counseling, and peer recovery support services. The Act further supports the expansion of telemedicine to reach rural and other areas where addiction treatment resources are limited.
Enforcement and Prevention
The opioid epidemic has progressed through three waves, each driven by a different type of opioid.
The first wave was driven by prescription pain pills like Vicodin and OxyContin, which caused the majority of opioid overdose deaths from 1999 to 2010. The second wave began in 2011, as physicians began to decrease opioid prescribing, and opioid addicts migrated to heroin, leading to a surge in heroin overdose deaths from 2011 to 2015. In 2013, the third wave began as synthetic opioids like fentanyl flooded the market.
Fentanyl is much stronger than heroin – only a few grains can cause overdose in those without opioid tolerance. In 2013, there were approximately 3,000 deaths due to fentanyl. That number skyrocketed to nearly 30,000 in 2017.
Much of the fentanyl entering the United States is coming from China through the postal service. The SUPPORT Act imposes new requirements on federal agencies, including the Post Office, to help stop the influx of fentanyl at the border, and provides agencies with new tools to improve detection and testing at the border.
Reducing Opioid Prescribing.
The SUPPORT Act provides increased penalties for drug manufacturers and distributors related to the over prescribing of opioids. It also provides grants for education and training of health care professionals on proper pain management, the dangers of opioid misuse, and early warning signs of opioid use disorder. Further, the Act provides support for research and development of new, non-opioid pain relievers.
Prevention is an important part of curbing overdose deaths. The SUPPORT Act requires the Department of Health and Human Services to disseminate best practices for youth prevention, and provides grant money for drug education programs for youth and young adults, including funding for collegiate recovery programs. It also provides support for children at risk of entering foster care, or in foster care, as a result of a parent’s addiction.
Most of the funding included in the new legislation consists of grant authorizations, not guaranteed dollars. Congress will need to appropriate money to fund the grant authorizations through spending bills. So far this year, Congress has appropriated approximately $8.5 million opioid-related programs, but there is no guarantee of funding for future years.
Experts say that turning the tide on the epidemic will require much more money than this, and some have suggested that even – $100 billion over five years which is comparable to the amount the United States spends on HIV/AIDS – may not be sufficient.
In addition to the lack of appropriated funds, much of the new funding authorized by the SUPPORT Act is for pilot programs, which means that it is of limited duration. This can create a disincentive for eligible organizations to invest time, energy, and resources to develop programs when they don’t know if there will be money to continue the programs in the long term.
Lauren A. Rousseau, a professor of law at Western Michigan University Thomas M. Cooley Law School contributed to this article. She is President of the Northwest Wayne County Chapter of Families Against Narcotics, and has spoken and written extensively on the subject of addiction and the opioid epidemic
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