When you see your members of Congress out campaigning this month you can give them a pat on the back for passing a comprehensive package of bills that makes needed reforms and investments that will aid the federal, state and local response to the opioid crisis.
Then you can give them a kick in the rear to do more.
While the growth in addictions has eased, the deaths caused by drug addiction in the United States numbered 72,000 in 2017, with two-thirds of those caused by heroin and opioids, legal and illegal. It’s estimated that since the 1990s, some 700,000 people in the U.S. have died of drug overdoses; another half-million or more could die in the next decade.
Use of the word “crisis” is not hyperbole.
Regarding the back pat: House and Senate negotiators have reached agreement on scores of bills passed earlier in the year by the House and this month by the Senate, the final step before they are sent to President Trump for his signature.
Among the provisions, the legislation provides $8.4 billion in spending over the next five years, renewing and expanding programs administered by a range of health, law enforcement and other agencies, including:
More screening to prevent the shipping of fentanyl and other synthetic opioids from China and elsewhere through the U.S. Postal Service;
Permanent authorization for doctors to prescribe medically assisted treatment for opioid addiction, such as buprenorphine;
Use of Medicaid reimbursements for addiction treatment for patients with mental health issues that previously were not available to facilities with more than 16 beds;
A significant increase in the civil and criminal fines for opioid manufacturers and distributors that fail to report suspicious orders of prescription opioids or don’t maintain effective controls on distribution;
More law enforcement funding to stop drug trafficking;
Funding for training and resources for first responders to reverse fatal overdoses through the use of naloxone and which also will limit responders’ exposure by contact with fentanyl and other synthetic opioids; and
Funding for drug court programs that have been shown as effective in diverting those with addictions into treatment and reducing recidivism.
The provision ramping up the civil and criminal fines, one of a number authored by Sen. Maria Cantwell, D-Washington, increases the civil penalty to $100,000 per violation from $10,000 and doubles the criminal liability to $500,000 per violation, from $250,000.
Cantwell, at a news conference earlier this month, noted that had those fines been in place earlier, Purdue Pharma — the maker of OxyContin — might have been responsible for $920 million in fines related to the case of an Everett physician who wrote more than 10,000 prescriptions for opioids, activity that wasn’t reported by the drug maker.
Those and other provisions are necessary and provide a welcome example of the good Congress can do when it acts in a bipartisan fashion. But the reaction among public health experts and first responders in media reports before and after passage of the legislation is that much more is required to adequately address the opioid crisis.
As for the kick to the rear: The $8.4 billion to be spent over the next five years represents only a fraction of what is necessary. Some tens of billions of dollars each year should be going to treatment programs; harm reduction programs such as increased availability of naloxone and needle exchange programs to limit exposure to disease; research into pain treatment alternatives to opioids; and programs to address some of the root causes of addiction, including mental illness, homelessness and poverty.
The investment in confronting the opioid crisis falls far short of the $20 billion the federal government spends each year — deservedly — on addressing HIV/AIDS. That concerted response to the HIV/AIDS epidemic has decreased the annual deaths from a high of nearly 42,000 a year in the mid-1990s to less than 6,500 in 2015.
It’s not difficult to imagine how similar funding of the nation’s opioid response would result in a comparable turnaround in the number of deaths and those freed from addictions.
Beyond specific funding for the opioid response, Congress also needs to protect and strengthen the Affordable Care Act, Medicare and Medicaid, so that those remain available to provide prevention and treatment not just for addiction but for the range of public health concerns.
At the state and local level, we’re beginning to see progress from programs and tools focused on the opioid crisis, such as the county’s 44-bed diversion center that opened this year in Everett, the planned remodel of the Denney Juvenile Justice Center that will add 32 treatment beds by 2020; the partnering of social workers with police patrols into homeless encampments; and the collected efforts of the Opioid Response Multi-Agency Coordination Group.
But all depend on adequate and reliable funding from the state and federal governments.