The nation鈥檚 opioid has been called today鈥檚 of the 1980s .
In a speech Monday, President Donald Trump pushed for a tougher federal response, emphasizing a tough-on-crime approach for drug dealers and more funding for treatment. And is upping the ante, via a series of hearings 鈥 including 鈥 to study that might tackle the unyielding scourge, which in premature deaths, health care costs and lost wages since 2001.
Dr. Leana Wen, an emergency physician by training and the health commissioner for hard-hit Baltimore, said Capitol Hill has to help communities at risk of becoming overwhelmed.
鈥淲e haven鈥檛 seen the peak of the epidemic. We are seeing the numbers climb year after year,鈥 she said.
from the Centers for Disease Control and Prevention suggest that almost 45,000 Americans died from opioid overdoses in the 12-month period ending July 2017, up from about 38,000 in the previous cycle. (Those data are likely to change, since many death certificates have not yet been reported to the CDC.)
鈥淚t鈥檚 not going to get any better unless we take dramatic action,鈥 Wen said.
And the time for most meaningful change could be dwindling. Advocates say what they need most is money, which would most likely come through the government spending bill that鈥檚 due March 23. But they aren鈥檛 holding their breath.
Show Me The Money
The federal budget deal, which was signed into law in early February, promised $6 billion over two years for initiatives to fight opioid abuse. Congress is still figuring out how to divvy up those funds. The blueprint is expected to be included in the spending bill this week.
Last month, a bipartisan group of senators introduced that would add another $1 billion in funding to support expanded treatment and also limit clinicians to prescribing no more than three days鈥 worth of opioids at a time.
That legislation is likely to have wide support in the Senate, but its path through the House is less certain.
This cash infusion is still not going to be enough, predicted Daniel Raymond, policy director for the Harm Reduction Coalition, a national organization that works on overdose prevention.
鈥淚t鈥檚 not clear whether there鈥檚 a real appetite to go as far as we need to see Congress go,鈥 he said. 鈥淭o have a fighting chance, we need a long-term commitment of at least $10 billion per year.鈥 Academic experts said that assessment sounded on target.
The figure is more than three times what鈥檚 allocated in the budget and 10 times what even the new Senate bill would provide, and far beyond the spending levels put forth by any previous packages to fight the opioid epidemic.
The difficulty in getting funding 鈥 and a key reason why the bipartisan Senate bill might stall in the House 鈥 in part goes to the heart of Republicans鈥 philosophy about budgeting.
The GOP, which controls both chambers of Congress, has 鈥渁lways been very focused on pay-fors,鈥 said a Republican aide to the House Energy and Commerce Committee, explaining that new funding is generally expected to be accompanied by cuts in current expenditures so that overall government spending doesn鈥檛 rise. And that could limit how much money lawmakers are ultimately willing to commit to fight opioid abuse.
Some observers worry this notion is pound-foolish.
鈥淲e have an enormous set of costs ahead of us if we don鈥檛 invest now,鈥 said Dr. Traci Green, an associate professor of emergency medicine and community health science at Boston University, who has extensively researched the epidemic.
Ahead In Congress
Meanwhile, the House could take up聽聽of a separate Senate-passed proposal designed to, in certain cases, make more prominent any opioid history in a patient鈥檚 medical record. The idea is to prevent doctors from prescribing opioids to at-risk patients.
In addition, the House鈥檚 Energy and Commerce Committee in late February held a hearing focused on 鈥渆nforcement鈥 鈥 discussing, , giving the federal Drug Enforcement Administration more power in drug trafficking, and , a particularly potent synthetic opioid, as a controlled substance. This week鈥檚 hearings will tackle a slew of , such as making sure overdose patients in the emergency room get appropriate medication and treatment upon discharge, or expanding access to buprenorphine, which is used to treat addiction.
And the House Ways and Means Committee, which has jurisdiction over Medicare 鈥 the federal insurance plan for seniors and disabled people 鈥 is working to develop strategies that to opioids and make treatment more available.
These are some promising ideas, Raymond said, but it鈥檚 still 鈥減laying catch-up. 鈥 The big gap is the money, and the broader vision.鈥
This flurry of activity comes after Congress in 2016 passed two laws directly dealing with addiction and substance abuse disorders, the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act. CARA promised $181 million 鈥 although it didn鈥檛 appropriate those dollars 鈥 while the Cures Act provided $1 billion over two years.
It鈥檚 playing out against the backdrop of steady policy tensions.
The Trump administration, which in October declared the opioid epidemic a public health crisis, has repeatedly pushed a more punitive approach, such as for , including the death penalty and establishing mandatory minimum sentences. That emphasis, experts said, detracts from other parts of the plan that might highlight, say, addiction treatment.
Instead, those experts emphasized treatment and prevention as well as 鈥渉arm reduction鈥 ideas such as providing more overdose-antidote medication and funding programs like syringe exchanges.
They say focusing on punishment has been ineffective in the past and neglects the heart of the issue.
Certainly, curbing the flow of illegal drugs is important, Wen said. But it鈥檚 insufficient by itself. And the size of the problem means lawmakers need to provide quicker, more direct aid 鈥 not just proposals that tinker 鈥渁round the edges.鈥
鈥淲e would never refuse any funding, because we need it desperately,鈥 she said. 鈥淏ut ask us what we need.鈥
杨贵妃传媒視頻 Health News' coverage of prescription drug development, costs and pricing is supported in part by the .
