Addressing the Opioid Epidemic: Hurry Up and Wait?

July 10, 2018

McDermott+Consulting

Ongoing Crisis

More than 40 percent of all US opioid overdose deaths in 2016 involved a prescription opioid, with more than 46 people dying every day from overdoses involving prescription opioids.[1] Significant increases in drug overdose death rates from 2015 to 2016 were seen in the Northeast, Midwest and South Census Regions, with West Virginia, Ohio, New Hampshire, Pennsylvania and Kentucky having the highest rates of death due to drug overdoses in 2016.[2] This opioid crisis continues to be a challenge for communities, states and the federal government.

Congressional Action

Congress has been working for several years on varying policy approaches. Congress started its focus in 2014, and those efforts culminated in the passage of the Comprehensive Addiction and Recovery Act (CARA) in July 2016. CARA provided a comprehensive approach to addiction through policies that included prevention, treatment, recovery, law enforcement, criminal justice reform and overdose reversal. It also sought $8.3 billion in new funding. In 2018, in the Bipartisan Budget Act, Congress allocated $6 billion to support substance use and mental health programs.

Even following CARA and the subsequent increased federal funding, however, the opioid crisis continues to challenge local communities and states. Recognizing the need for additional policy changes, Congress began another legislative effort earlier this year.

In the US Senate, the Committees on Health, Education, Labor and Pensions (HELP), Finance, Judiciary, and Veterans’ Affairs all held hearings and approved bills intended to address the opioid crisis. Senate committee leaders are presently working to combine these bills into a consolidated package before bringing it to the Senate floor.

In the US House of Representatives, the Committees on Energy and Commerce, Ways and Means, Judiciary, and Veterans’ Affairs also held hearings and passed bills. The House, however, has gone a step further. Over a two-week period in mid-June, the full House approved more than 55 bills (most by unanimous consent or with overwhelming bipartisan majorities). These bills now await consideration by the Senate.

The policies included in these bills focus broadly on prevention, treatment, research and data collection, payment and reimbursement, support for local communities, target patient populations, law enforcement, and prescribing processes and practices. This wide range of policies would affect every corner of the health care industry—from emergency room physicians to pharmacists, diagnostics to drugs, independent provider practices to hospitals, personal health records to large health IT systems, behavioral and mental health services to community support centers. Because this is an ongoing public health crisis, players across the health care landscape have an opportunity to demonstrate progress, show innovation and make positive change.

Administration Action

While Congress has been busy with legislative efforts, the administration also has been taking action through the implementation of CARA and distribution of federal funding. For example:

  • The Centers for Medicare and Medicaid Services is using new and existing authority to improve access to prevention and treatment, and to increase and streamline data collection and analysis in order to appropriately target resources and address emerging issues.
  • The federal Substance Abuse and Mental Health Services Administration is providing educational resources to states and communities, and distributing grant monies to states, communities and health providers.
  • The US Food and Drug Administration is using its authority to incentivize development of non-opioid alternative treatments, among other activities.

What Is Missing

On the surface, there appear to be many policy changes, added resources and genuine attempts to help address the opioid crisis. However, some argue that these most recent efforts are low-hanging fruit. To be fair, while there are many provisions that require further studies, coordination, task forces, data collection, research and the like, there also are some meaningful changes to payment policies in Medicare and Medicaid, as well as expanded physician access to personal, protected health information, that have the potential to change not only the dynamic and landscape of opioid-related issues, but of other aspects of health care in the future. Most will agree, however, that federal funding is lite this time around.

Next Steps

The House has acted. It is the Senate’s turn. If history is any guide, it is likely that House and Senate committee leaders and staff are already working behind the scenes to develop a comprehensive package that melds all of the bills together and could obtain swift bipartisan agreement. The timing of possible Senate floor action remains unclear, as the Senate is focusing its priorities on other legislative issues and judicial nominations. Floor time will be further limited with the anticipated consideration of a Supreme Court of the United States nominee.

Even if legislation passes and is signed into law in 2018, the opioid crisis is not going away any time soon. It can be expected that Congress will need to consider even more legislation in the future, and perhaps even before the dust settles on whatever measures are approved in the current round.

 

For more information contact Rachel Stauffer.


 

 

[1] Seth P, Scholl L, Rudd RA, Bacon S. Increases and Geographic Variations in Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants with Abuse Potential – United States, 2015-2016. MMWR Morb Mortal Wkly Rep. ePub: 29 March 2018; Seth P, Rudd RA, Noonan RK, Haegerich. Quantifying the Epidemic of Prescription Opioid Overdose Deaths. American Journal of Public Health 108, no. 4 (April 1, 2018): pp. 500–502.

 

[2] Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. 2017/ CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov.

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