WASHINGTON ― In a rare instance of bipartisanship and compromise in Congress, the Senate on Wednesday passed legislation by a 92-2 vote that addresses the opioid epidemic. President Barack Obama, who in his State of the Union speech had ad-libbed a plea to lawmakers to do something about the crisis, will now have a bill to sign.
The bill, known as the Comprehensive Addiction and Recovery Act, or CARA, was sponsored by Sens. Rob Portman (R-Ohio) and Sheldon Whitehouse (D-R.I.). Both saw the epidemic ravage their states. In 2014, Ohio had the second highest number of overdose deaths nationwide, while Rhode Island’s fatal overdoses continue to rise.
Every few months, the U.S. Centers for Disease Control and Prevention seems to put out yet another report on surging opioid-related deaths; more than 28,000 Americans died from opioid overdoses in 2014, an all-time high. Weekend surges in overdoses have become routine news across the country.
In the last few years, there has been no shortage of hearings and legislative proposals to deal with the epidemic. Addiction specialists, old drug warriors, and law enforcement officials have all marched up to the Hill to give testimony and express frustration as the death toll continued to climb and those suffering with addiction got added to waiting lists for treatment.
The CARA legislation, influenced by such testimony and other bills, tilts the federal response away from the old drug war tactics of mass incarceration to one that seeks to enhance and build up the country’s treatment capacity. It embraces the use of naloxone, the medication that can instantly reverse the effects of an overdose, and seeks to incorporate a more medical approach to the U.S. treatment system.
Democrats had criticized the bill as one that had good ideas but no real funding to implement them. Sen. Chuck Schumer (D-N.Y.) argued recently about the bill, saying that “we believe you’ve got to walk the walk, not just talk the talk. And doing all these changes without funding? Law enforcement needs more funding, treatment needs more funding.”
CARA doesn’t come close to the more than $1 billion the president had proposed to spend on evidenced-based treatment services. In a recent press call, the White House’s Drug Czar Michael Botticelli reiterated that he felt the bill was inadequate.
The White House press office issued a statement following CARA’s passage saying the president would sign the bill. But it did express regret that his funding request was not included.
“The Administration has consistently said that turning the tide of the prescription opioid and heroin epidemic requires real resources to help those Americans seeking treatment get the care that they need,” the White House said. “We continue to believe this bill falls far short.”
The bill does contain at least one provision that will have an impact on preventing future deaths: the expansion of those eligible to prescribe buprenorphine to treat opioid addiction. Now, nurse practitioners and physician assistants will be allowed to be certified so they can provide the medication that established medical experts view as essential in treating those with opioid-use disorder. This was a rule change that had been pushed hard by Sen. Ed Markey (D-Mass). He had introduced the idea in his own bill.
The medication, commonly sold in the U.S. under the brand name Suboxone, has been shown to blunt cravings and ease withdrawal symptoms. Before CARA, only doctors could get certified to prescribe it ― and only to treat 30 patients at any one time in their first year. They could then treat up to 100 patients in their second year of prescribing the medication. The Department of Health and Human Services announced recently that it would be making a rule change to allow doctors to prescribe to as many as 275 patients. The change goes into effect in early August.
In January 2015, The Huffington Post reported that access to such medication-assisted treatment was nearly impossible to find within the treatment industry. In a follow-up story, it reported that doctors struggled to maintain waiting lists and that patients in rural areas had to drive hundreds of miles to find a doctor willing to treat them with Suboxone.
The American Society of Addiction Medicine praised CARA’s passing but cautioned that there was much more to be done to address the epidemic.
“This is a major bipartisan acknowledgement of the opioid crisis, and shows the ability of advocates to educate and lawmakers to act,” Dr. Kelly Clark, ASAM’s president-elect, explained in an email to The Huffington Post. “We next need to engage Congress to fund the programs approved today by the Senate.
“Allowing advanced practice providers to prescribe buprenorphine will increase access, but we need this to be an ongoing ability rather than a 5 year trial program. The HHS increase in the physician cap to 275 will increase access as well, but these measures will not close the treatment gap. Major strides have been taken but the journey is not yet over.”