Judging by lawmakers’ words, addiction might be the most bipartisan topic in Washington.
For years, Democrats and Republicans alike have made speeches, authored bills, and issued statements decrying the national drug overdose crisis. The opioid epidemic even ranks as one of the four elements of President Biden’s “Unity Agenda” — priorities supposedly so uncontroversial that Capitol Hill could tackle them quickly and without fuss.
Judging lawmakers by their actions, however, leaves a distinctly different impression. With just weeks remaining in the current session, Congress appears poised to let Biden’s first two years in office come and go without enacting any significant reforms to the country’s system for preventing and treating addiction — a potential missed opportunity that advocates warn could cost thousands of lives.
“Every other quote-unquote emergency gets money thrown at it in the billions, whether it’s Ebola, monkeypox, Covid,” said Andrew Kessler, a D.C. policy consultant who represents addiction treatment organizations. “Many members of Congress do walk the walk. But others talk the talk, and when it comes time to pony up — no. We’ve gone two years without any real, major policy changes in substance use disorders.”
The stakes could not be higher. More than 107,000 Americans die each year from drug overdoses, roughly three-quarters of which involve opioids. Republicans are set to take control of the House of Representatives in January, suggesting at least two years of potential gridlock.
Lawmakers aren’t ignoring the issue entirely. Several measures meant to expand access to treatment and increase funding for prevention and recovery programs could become part of a year-end spending package. Even as they push to finalize those proposals, however, advocates charge that lawmakers have their sights set too low.
“Unfortunately, I’ve felt that this hasn’t been viewed with the same urgency that it was five years ago,” said Regina LaBelle, who led Biden’s drug policy transition team and, later, was acting director of the Office of National Drug Control Policy. “It hasn’t been top of mind. We don’t have a call for an addiction moonshot.”
Still, LaBelle said, some of the provisions under consideration would represent progress. While it remains unclear whether Congress will pass a major year-end spending package, lobbyists and congressional aides who spoke with STAT said such a bill would likely contain several addiction provisions that passed the House earlier this year.
Those bills include language to allow people to remain in treatment as pre-trial detainees, and for incarcerated people to resume insurance coverage under Medicaid 30 days prior to their release.
Lawmakers are also considering a provision that would require states to spend a certain percentage of federal addiction-treatment grants on evidence-based recovery services. Another proposal would eliminate a requirement that individuals only be admitted into an opioid treatment facility, a specialized clinic offering methadone treatment, if they’ve been addicted for at least a year.
Arguably the most substantial proposals are a pair of bills known as the MAT Act and MATE Act. Those bills, respectively, would allow all prescribers to treat patients using buprenorphine, a common medication for opioid addiction, and require health providers to train staff on managing patients with substance use disorders.
Currently, prescribers must notify regulators if they intend to prescribe patients buprenorphine, and must undergo at least eight hours of specialized training if they want to treat more than 30 patients.
The MAT Act, which has already passed the House and enjoys 248 co-sponsors, is among the most popular addiction proposals on Capitol Hill. Last month, a coalition of over 200 groups ranging from doctors to AIDS advocates to the National Sheriffs’ Association urged lawmakers to pass it, calling it a “common-sense” proposal to eliminate “outdated barriers” to basic addiction care.
A number of other proposals, however, are unlikely to be included, according to lobbyists, aides, and policy experts. In particular, a bill to dramatically expand access to methadone, a key medication used to treat opioid addiction, is seen as a long shot.
The legislation, sponsored by an unlikely seeming coalition of lawmakers including Sens. Ed Markey (D-Mass.) and Rand Paul (R-Ky.), would allow physicians to prescribe methadone directly to patients, who could then receive the drug at a pharmacy.
Currently, methadone can only be dispensed at a specialized facility called an opioid treatment program, or OTP, that often requires patients to show up in person each day to participate in counseling and receive a single dose.
Markey, in a recent statement calling for the bill’s passage, called the proposal “the difference between life and death” for many patients. Its advocates cite methadone’s effectiveness at reducing drug deaths and relatively low rates of overdose.
The American Association for the Treatment of Opioid Dependence, a trade group representing OTPs, has argued that dispensing methadone — itself an opioid sometimes used to treat pain — could do more harm than good.
The idea of expanding access has gained steam in recent years, however — most notably last month, when Nora Volkow, director of the National Institute on Drug Abuse, said at the 2022 STAT Summit that physicians should “absolutely” be able to prescribe the drug outside the context of an OTP.
In some experts’ view, the methadone legislation would represent an adequate response to the ongoing crisis.
“We have to take the wins as they come,” said LaBelle, the former Biden drug policy official. “If they passed everything, that would be meeting the moment. But if just one or two of these pieces passes, we’re not doing what we need to do.”
But LaBelle and others acknowledged it is unlikely the methadone provisions will move forward.
In fact, it’s unclear whether any addiction legislation at all will become law before year’s end. Congress is still debating a sweeping spending bill that lawmakers could use to attach various addiction provisions. If lawmakers can’t reach an agreement, however, they could pass a yearlong continuing resolution that effectively maintains the status quo on government funding and on addiction medicine.
It’s also unclear what actions the Biden administration could take without support from Congress. Though the White House has expressed broad support for new approaches to reducing overdoses, advocates say timing is everything.
“The White House has more than done their part,” Kessler said. “There’s just nothing coming out of Congress, which is kind of a change of pace from the previous administration, when there was nothing coming out from the White House and Congress was really picking up the slack. We can’t seem to hit that sweet spot.”
In the meantime, advocates say, the nation’s overdose statistics speak for themselves. The devastation should be a “a call to action” for lawmakers, said Reyna Taylor, the senior vice president for public policy at the National Council for Mental Wellbeing, a D.C. advocacy group that represents mental health and addiction treatment providers.
“Lives across our nation are being lost every day,” she said. “It does put pressure on Congress to move, and move faster, to abate this. We haven’t seen a decrease in the overdose numbers yet.”
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