“Subdued and on-script, President Donald Trump struck a bipartisan tone as he signed sweeping legislation Wednesday to combat the opioid epidemic, an issue that has animated his effort to support Republican midterm candidates.
Discussing a crisis affecting urban centers as well as rural communities that supported his election, Trump touted the measure as a bipartisan response to a problem rarely cited as a top issue for voters that nevertheless touches millions of them personally.
“We are going to end it or we are going to at least make an extremely big dent in this terrible, terrible problem.” Trump said during an East Room event that drew members of both parties. “We have mobilized the entire federal government to address this crisis.”..
Speaking at a rally in Nevada this past weekend, Trump touted the “bold action” and “historic effort” he said his administration embarked on to address the problem. His administration’s response has fallen into two categories, he has said: Stepped up enforcement and more funding for states to expand treatment.
“We obtained $6 billion to fight the opioid epidemic,” Trump said during his most recent stop in Houston this week, referencing a funding bill approved by Congress in March.
The new legislation that Congress approved Oct. 3, makes it easier to intercept drugs being shipped into the country, authorizes new funding for more comprehensive treatment, speeds up research on non-addictive painkillers and clears Medicare and Medicaid regulations that advocates have said can stand in the way of treatment. “ (A)
“Addiction treatment advocates say two provisions — one that would allow Medicaid, the federal-state health insurance plan for the poor, to pay for residential treatment in large facilities and another that would allow Medicare, the federal health plan for people 65 and older, to pay for methadone treatment — will substantially improve access to treatment.
The legislation, approved last month by the House and Wednesday by the Senate, also would pay for research into opioid alternatives, support greater use of non-opioid pain management and invest in new law enforcement efforts to curb illicit drugs.
Some critics say the legislation, which calls for roughly $8 billion in federal investment over five years, doesn’t go far enough given the magnitude of the drug overdose crisis.
In an epidemic that killed more than 72,000 people in 2017, the federal government should commit to spending far more money on treatment, prevention and access to the life-saving drug naloxone, advocacy groups have argued. The groups, including the Harm Reduction Coalition, recommended $100 billion more in federal spending, similar to the Ryan White HIV/AIDS Program.
Still, treatment advocates say that Medicaid coverage of residential treatment and Medicare coverage of methadone would go a long way to boosting treatment quality and capacity, as well as people’s ability to pay.
The residential treatment provision would lift a 53-year-old ban in the federal Medicaid statute that prohibits coverage of mental health and addiction treatment services in facilities with more than 16 beds. Called the “institutions for mental disease” or IMD exclusion, the rule was intended to prevent states from using federal dollars to warehouse people with addiction and mental disorders.” (B)
“While very broad in scope, the final legislation contains a number of provisions related to Medicaid’s role in helping states provide coverage and services to people who need substance use disorder (SUD) treatment, particularly those needing opioid use disorder (OUD) treatment.
Services. The most controversial measure in the bill amends the long-standing prohibition against the use of federal Medicaid funds for services in “institutions for mental disease” (IMDs) for nonelderly adults by creating a state option from 10/1/19 to 9/30/23 to cover those services up to 30 days in a year for individuals with a substance use disorder. To be eligible to receive federal matching funds, states must meet maintenance of effort and other requirements..
The SUPPORT Act also requires state Medicaid programs to cover medication-assisted treatment (MAT), including all FDA-approved drugs, counseling services, and behavioral therapy, from October 2020 through September 2025, unless a state certifies to the Secretary’s satisfaction that statewide implementation is infeasible due to provider shortages…
Demonstrations. Prescription Drug Oversight. The SUPPORT Act requires states to have drug utilization review safety edits in place for opioid refills, monitor concurrent prescribing of opioids and other drugs, and monitor antipsychotic prescribing for children” (C)
“Together,” the president told grieving mothers and fathers, cabinet members, lawmakers, and representatives of local law enforcement, “we will end the scourge of drug addiction in America. We’re going to end it or at least make an extremely big dent in this terrible, terrible problem.”
Almost no one who’s studied the legislation and understands the magnitude of an epidemic in which an estimated 72,000 people died from drug overdoses in 2017 thinks it will do any such thing. The bill’s provisions to expand addiction treatment, speed up research on alternative drugs, and provide Medicaid funding to treatment centers with more than 16 inpatient beds will certainly help, as will $6 billion in funding to fight opioids, “the most money ever received in history,” Trump said. But many public-health experts, and some of Trump’s Democratic opponents in Congress, say something closer to $100 billion is needed over 10 years to end or “make an extremely big dent” in opioid addiction. Senator Elizabeth Warren cites “broken promises” by an administration that still does not have a confirmed director of its Office of National Drug Control Policy (ONDCP) after nearly two years in office.
Formed in 1988 through the Anti-Drug Abuse Act, the ONDCP is supposed to coordinate drug-control policy and funding between 16 federal departments and agencies. The director of the office is intended to be the U.S. president’s “principal advisor” on drug-control issues. The Senate has to confirm whomever the president appoints…
The office has yet to release the annual National Drug Control Strategy, which spells out how the administration will tackle drugs and how it will develop a drug-control budget. Three months after taking office, Trump chose an unorthodox approach to drug policy, establishing the President’s Commission on Combating Drug Addiction and the Opioid Crisis, appointing Governor Chris Christie, a Trump political ally, as chair. The commission, staffed and funded by ONDCP, released a report that recommended nearly 60 ways to address the crisis. The recommendations cover prevention, treatment, recovery, and more. “ (D)
“The legislation takes wide aim at the problem, including increasing scrutiny of arriving international mail that may include illegal drugs. It makes it easier for the National Institutes of Health to approve research on non-addictive painkillers and for pharmaceutical companies to conduct that research.
The Food and Drug Administration would be allowed to require drugmakers to package smaller quantities of drugs such as opioids. And there would be new federal grants for treatment centers, training emergency workers and research on prevention methods.
Karen Yost, CEO of Prestera Center, said in a statement the 70 pieces of this bill is a good start, though there is no “magic bullet” to solving the opioid crisis.
“How this legislation is implemented will be key as even good legislation implemented poorly will not be helpful,” Yost said.
“This bill is a start in the right direction, even though it does not address significant underlying issues in this epidemic, including adverse childhood experiences, extreme poverty, gainful employment, safe affordable housing, related chronic health problems and co-occurring mental health problems.”
That’s a long list, and it helps explain how this problem became so big and is so difficult to overcome.” (E)
“Yet many public health advocates and experts say it doesn’t offer the one thing truly needed: The massive amount of funding needed to fully combat a crisis that deeply affects rural and urban communities across America.
Sarah Wakeman,the medical director for Mass General Hospital’s Substance Use Disorders Initiative, said really targeting the depth of the opioid epidemic would require an infusion of federal dollars on par with the more than $20 billion a year spent on HIV/AIDs.
“We have historically not thought of addiction as a medical issue and so our health care and public health system are woefully unprepared to respond in a robust way,” she said.”..
“I hope Congress doesn’t think they can put this behind them because they passed these bills,” said Patrick Kennedy, a former Democratic congressman of Rhode Island and a mental health advocate . “It takes an urgency like we had during HIV-AIDS. That will call to mind what it takes to address a crisis, it takes political will.” (F)
“”Without real money, it’s just lip service,” said John Rosenthal, co-founder and chairman of the Police Assisted Addiction and Recovery Initiative, to CNHI’s Christian M. Wade. “This disease has been raging for more than a decade without any serious federal response. Now they’re playing catch-up.”
Sarah Wakeman, the medical director for Mass General Hospital’s Substance Use Disorders Initiative, told the Washington Post that really targeting the depth of the opioid epidemic would require an infusion of federal dollars on par with the more than $20 billion a year spent on HIV/AIDs.
Rosenthal agreed and said there are “good things” in the bill, but it needs “billions” of dollars in money — similar to the federal response to cancer and HIV/AIDS prevention and treatment.” (G)
“Governments around the globe and their citizens routinely respond to ecological disasters. Think Exxon Valdez or Love Canal in the U.S.; Chernobyl in the Soviet Union; Bhopal in India; and far too many others. The responses, though not always immediate or thorough, at least tend to be multifaceted. We are currently in the midst of a human-made ecological disaster, the opioid crisis, that isn’t recognized as such, but that can benefit from the same sorts of responses made to ecological disasters…
Treating the opioid epidemic as an ecological disaster could set important precedents for cleanup and prevention that can be particularly useful in areas where effective responses have been lagging. Such efforts are relatively easy to visualize when the disaster is a pollutant like mercury. But what does a cleanup look like when the offending substance is, for some people, a medically essential resource?..
The opioid disaster is occurring simultaneously on so many levels and affecting so many lives in ways that other disasters may not. It can be viewed through many different lenses. I see the opioid disaster as an individual living with chronic pain who depends on opioid medications to manage each day. But I also acknowledge and suffer with members of my community who are experiencing substance abuse themselves, or are in recovery from it, or who have lost family members or friends to opioid overdoses.
Even now, nearly 30 years after the Exxon Valdez struck a reef and spilled nearly 11 million gallons of crude oil into Prince William Sound, some of that oil persists in Alaskan soil and water, breaking down minutely year by year. The opioid disaster will continue to saturate our environment for the near future, but it should not need to take three decades for us to break it down.” (H)
(A) President Trump tries to project image of bipartisan action with opioid bill signing, by David Jackson and John Fritze, https://www.usatoday.com/story/news/politics/2018/10/24/donald-trump-opioids-bill-signed-into-law-weeks-midterm-election/1750400002/
(B) Opioid Bill Expands Treatment Options, by Christine Vestal, https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/10/04/opioid-bill-expands-treatment-options
(C) Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act, by MaryBeth Musumeci, https://www.kff.org/medicaid/issue-brief/federal-legislation-to-address-the-opioid-crisis-medicaid-provisions-in-the-support-act/
(D) Trump’s ‘Big Dent’ in the Opioid Crisis, by Lola Fadulu, https://www.theatlantic.com/politics/archive/2018/10/trumps-signs-landmark-law-fight-opioid-addiction/573850/
(E) Federal opioid law moves in right direction, http://www.reflector.com/Editorials/2018/10/02/Federal-opioid-law-moves-in-right-direction.html
(F) Senate easily passes sweeping opioids legislation, sending to President Trump, by Colby Itkowitz, https://www.washingtonpost.com/politics/2018/10/03/senate-is-poised-send-sweeping-opioids-legislation-president-trump/?utm_term=.25aa48506c2b
(G) Where’s the money? Federal opioid bill gets flack for lack of funds, by Jonathan Greene, https://www.richmondregister.com/news/politics/where-s-the-money-federal-opioid-bill-gets-flack-for/article_c7f460c6-8d37-5542-ab4a-a6b219e03cb4.html
(H) Viewing the opioid crisis as an ecological disaster could help with ‘cleanup’, by MAIA DOLPHIN-KRUTE, https://www.statnews.com/2018/11/15/opioid-crisis-ecological-disaster/
“The U.S. is about 5% of the world’s population yet consumes about 80% of the world’s oxycodone supply.” http://doctordidyouwashyourhands.com/2018/08/the-u-s-is-about-5-of-the-worlds-population-yet-consumes-about-80-of-the-worlds-oxycodone-supply-i/
US health official reveals fentanyl almost killed his son, http://doctordidyouwashyourhands.com/2018/07/us-health-official-reveals-fentanyl-almost-killed-his-son/
“For at least six months, staffers in the Office of National Drug Control Policy — often political appointees in their 20s — (have) sat through weekly meetings of an “opioids cabinet” chaired by Kellyanne Conway., http://doctordidyouwashyourhands.com/2018/06/for-at-least-six-months-staffers-in-the-office-of-national-drug-control-policy-often-political-appointees-in-their-20s-have-sat-through-weekly-meetings-of-an-o/
“The House on Friday passed bipartisan legislation aimed at fighting the nationwide epidemic of opioid abuse, culminating months of work on the crisis…, http://doctordidyouwashyourhands.com/2018/06/the-house-on-friday-passed-bipartisan-legislation-aimed-at-fighting-the-nationwide-epidemic-of-opioid-abuse-culminating-months-of-work-on-the-crisis/
Why is there a nationwide hospital shortage of injectable opioids? – follow the money. , http://doctordidyouwashyourhands.com/2018/04/why-is-there-a-nationwide-hospital-shortage-of-injectable-opioids-follow-the-money-part-3-of-a-continuing-case-study-on-the-opioid-crisis/
“In 2016, more than 40 percent of opioid overdose deaths in the U.S. involved a prescription opioid.”, http://doctordidyouwashyourhands.com/2018/04/in-2016-more-than-40-percent-of-opioid-overdose-deaths-in-the-u-s-involved-a-prescription-opioid/
CASE STUDY ON THE OPIOID CRISIS. “We still have lacked the insight that this is a crisis, a cataclysmic crisis”, http://doctordidyouwashyourhands.com/2018/03/case-study-on-the-opioid-crisis-we-still-have-lacked-the-insight-that-this-is-a-crisis-a-cataclysmic-crisis/
Opioid commission member: Our work is a ‘sham’, http://doctordidyouwashyourhands.com/2018/01/opioid-commission-member-our-work-is-a-sham/
“White House counselor Kellyanne Conway will be the point person for the Trump administration’s opioid crisis efforts…, http://doctordidyouwashyourhands.com/2017/12/white-house-counselor-kellyanne-conway-will-be-the-point-person-for-the-trump-administrations-opioid-crisis-efforts/
Facebook users can easily find these drugs – Oxycodone, Hydrocodone, and Percocets, http://doctordidyouwashyourhands.com/2017/11/facebook-users-can-easily-find-these-drugs-oxycodone-hydrocodone-and-percocets/
“…the president.. reversed course to instead declare opioids a public health emergency, a move that releases no new funding to contend with a drug crisis….”, http://doctordidyouwashyourhands.com/2017/10/the-president-reversed-course-to-instead-declare-opioids-a-public-health-emergency-a-move-that-releases-no-new-funding-to-contend-with-a-drug-crisis/
“At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence…..”, http://doctordidyouwashyourhands.com/2017/10/at-a-time-when-the-united-states-is-in-the-grip-of-an-opioid-epidemic-many-insurers-are-limiting-access-to-pain-medications-that-carry-a-lower-risk-of-addiction-or-dependence/
Congress blocked DEA action against drug companies suspected of flooding the country with prescription narcotics, http://doctordidyouwashyourhands.com/2017/10/congress-blocked-dea-action-against-drug-companies-suspected-of-flooding-the-country-with-prescription-narcotics/
The rise of ‘grandfamilies’: Opioid crisis requires more Hoosier grandparents to raise children.., http://doctordidyouwashyourhands.com/2017/09/the-rise-of-grandfamilies-opioid-crisis-requires-more-hoosier-grandparents-to-raise-children/
Opioid Crisis. ““We got here in part because there was a paper done in the 1980s by a well-meaning physician that said opioids are not addictive…., http://doctordidyouwashyourhands.com/2017/09/opioid-crisis-we-got-here-in-part-because-there-was-a-paper-done-in-the-1980s-by-a-well-meaning-physician-that-said-opioids-are-not-addictive/
“To manage and (eventually) reverse the opioid epidemic, state Medicaid programs should now take a deeper look at the role prescribing plays…”, http://doctordidyouwashyourhands.com/2017/08/to-manage-and-eventually-reverse-the-opioid-epidemic-state-medicaid-programs-should-now-take-a-deeper-look-at-the-role-prescribing-plays/
As Washington dawdles, the States step in on the opioid crisis, with initiatives and lawyers, http://doctordidyouwashyourhands.com/2017/08/as-washington-dawdles-the-states-step-in-on-the-opioid-crisis-with-initiatives-and-lawyers/
“We would never tolerate a situation where only one in 10 people with cancer or diabetes gets treatment, and yet we do that with substance-abuse disorders,” (A), http://doctordidyouwashyourhands.com/2017/08/we-would-never-tolerate-a-situation-where-only-one-in-10-people-with-cancer-or-diabetes-gets-treatment-and-yet-we-do-that-with-substance-abuse-disorders-a/
“For most of my surgical career, I gave out opioids like candy….” “With approximately 142 Americans dying every day”….” We need to take away the matches, not put out the fires.”, http://doctordidyouwashyourhands.com/2017/08/8224/