Congress Passed 18 Bills to Address the Opioid Epidemic, But Where's the Money?

Two months after the Senate passed a comprehensive bill to address opioid addiction – and three weeks after Prince died, possibly of an opioid overdose – the House of Representatives went on a binge last week, passing 18 bills to try to stem the epidemic that claimed 28,000 lives in 2014.

Opioid overdose has overtaken car crashes as the number one cause of injury deaths in the United States among 25- to 64-year-olds. The number has quadrupled since 1999.

Most of the House bills were introduced by one Republican and one Democrat – a show of bipartisan support that’s getting less and less common on Capitol Hill.

The bills attempt to limit access to opioids and expand access to drugs that can reverse an overdose. Some of the bills target newborns; others target veterans. A complete list is below.

The House has authorized $103 million for the programs. It's a low number for some working to combat opioid abuse. And it is a mysterious number for others, since Congress failed to say where the money will come from.

Not just a law enforcement bill -- anymore

Advocates are cautiously pleased. Many had sounded the alarm in the weeks prior because the primary House bill -- the Comprehensive Opioid Abuse Reduction Act (CARA), a companion to a similar Senate bill creating grant programs to address various elements of the opioid problem – was too focused on law enforcement. Advocates say that treatment and recovery need to be pillars of any plan to address addiction.

“Addiction is a health issue and not a crime,” said Patty McCarthy Metcalf, executive director of the nonprofit Faces and Voices of Recovery and herself a recovering alcoholic and drug addict. “If CARA is really going to make an impact, we need to look at the longer-term chronic care model, the supports in the community, connections with treatment, and the resources for communities to work together to solve this problem.”

Many drug rehab facilities have long waiting lists, meaning even addicts who are ready to confront their illness are waiting months for a chance to work toward recovery.

An amendment on Thursday added treatment and recovery into the House bill, but the bill still doesn’t require certain amounts to be spent on certain areas. It’s still possible for a state to decide to spend all its money on law enforcement, even though technically they're allowed to spend it on treatment as an alternative to incarceration.

Show them the money

Others are disappointed in the House opioid package, too. President Obama wants to spend 10 times more than the $103 million the House has authorized to fight the opioid epidemic. Making matters worse, the House didn’t say where the money would come from.

That’s fine, says Jessica Nickel of the Addiction Policy Forum. She says the number in the bill is just a placeholder, and it’s now up to the appropriations committees to fully fund it.

“Our hope is that there will be new actual money in the FY17 bill for CARA,” Nickel said. She said the 178 national organizations that have all been working together on the content of this bill will now turn their attention to the funding strategy. Plus, some of the most powerful appropriators in both chambers are major champions of the legislation.

But other advocates say if Congress were really serious about this, they would have found the money by now -- and it would have been a lot.

“If this is their version of their big moment to address the overdose epidemic, then they’ve only done half their job,” said Daniel Raymond of the Harm Reduction Coalition. “They passed some solid bills that will make a difference for things like medication-assisted treatment and naloxone-reversed overdoses, but if states and communities don’t get a substantial investment… we will continue to see the number of deaths going up.”

Raymond says the House could have authorized higher levels of funding, or freed up emergency funding, or required unspent funds to be used for these programs.

“The [Republicans] have not heeded calls to say, ‘We’ve got a crisis, we need to urgently ramp up our response and that requires new funding,’” said Raymond.

What else was left out?

The New York Times -- which has insinuated that the House action on opioids had as much to do with giving vulnerable Republicans something to brag about on the campaign trail as it does with actually addressing the crisis – has editorialized in favor of broadening access to buprenorphine, an opioid that’s found to be effective at weaning addicts off stronger drugs. The House does expand access to medication-assisted treatment, but not as much as the Times suggests.

Meanwhile, chronic pain patients are growing concerned that the panic over opioid addiction is restricting access for people who need those medications.

Many senators, both Democrats and Republicans, are also disappointed in the House’s approach. The differences between the Senate bill and the 18 House bills will need to be ironed out in what the Washington Post calls “potentially tense negotiations.” Advocates are hopeful, however, that there is enough desire to get the bills passed -- and enough similarity between the House and Senate versions -- that the negotiations will be quick and relatively painless.

Here’s what the bills do

· studies best practices for prescribing opiate painkillers, building on guidelines the Centers for Disease Control released a few months ago (H.R. 4641)

· authorizes a report on the effect on babies when their mothers took opiates while pregnant (H.R. 4978)

· helps veterans who got medical training in the military become licensed as emergency responders (while not explicitly a bill that deals with the opioid crisis, it is viewed as a public health measure and was included in the package) (H.R. 1818)

· expands access to medications that can help wean people off addictive opioids or reverse overdoses (H.R. 4981)

· makes sure youth athletes and their families are getting all the information they need about the dangers of opioid abuse if they’re prescribed potentially addictive painkillers for injuries (H.R. 4969)

· allows for partial filling prescriptions to reduce the amount of opioid drugs hanging around in people’s medicine cabinets (H.R. 4599)

· pushes the FDA to exercise caution when approving new opioid drugs (H.R. 4976)

· studies the availability of drug treatment and what’s needed to improve it (H.R. 4982)

· restricts the use of dextromethorphan, which is found in cough syrup, among minors (H.R. 3250)

· authorizes a grant program to address the opioid epidemic, including the use of treatment as an alternative to incarceration, the use of overdose reversal drugs, and much more (H.R. 5046) – more on this one below

· evaluates the effectiveness of that grant program (H.R. 5052)

· studies the effectiveness of “Good Samaritan” laws that provide immunity for people who call emergency responders when someone has overdosed (H.R. 5048)

· provides funding for overdose reversal drugs to be “co-prescribed” along with opioid painkillers for people at risk of overdose (H.R. 3680)

· increases the availability of overdose reversal drugs and trains people in their use (H.R. 4586)

· ensures that all telephones can make a 911 call without dialing 9 to get an outside line or any other kind of additional code (H.R. 4167)

· improves safety oversight of the use of opioids in veterans’ hospitals (H.R. 4063)

· keeps information classified that’s used in deciding when to designate a drug trafficker a “kingpin,” which allows the U.S. government to freeze their financial accounts (H.R. 4985)

· targets transnational drug trafficking activity (S. 32)

You can see CDC stats on your own state’s opioid epidemic here.