Press Releases

Congressman Larry Bucshon, M.D. (R-IN-8) – joined by Congressman Steve Womack (R-AR-3) – introduced H.R. 2872, the Opioid Addiction Treatment Modernization Act, a bill to help combat the opioid abuse epidemic and ensure patients have access to appropriate treatments.  After introduction, the Congressmen released the below statements:

“As a country, we are facing a growing, deadly opioid addiction epidemic that is tearing apart our communities,” said Congressman Bucshon. “As a physician, I’ve seen the power of addiction first hand and I understand that to effectively combat this complex problem, we need a comprehensive approach that focuses on patient needs. To accomplish that, we must work together to apply science and innovation to modernize the outdated and inadequate treatment system so that every patient – and every community – has a chance at turning the page on this devastating epidemic.”  

“Opioid abuse and opioid-related deaths are unfortunately on the rise, and our antiquated addiction treatment system has prevented us from slowing the epidemic,” said Congressman Womack.  “A patient’s treatment for opioid abuse should not be dependent on the facility he or she happens to walk into, and I am proud to join Congressman Bucshon in the fight to bring much-needed reforms to the segregated opioid addiction treatment system and help ensure that opioid-dependent patients are provided with individualized, evidence-based care.”

The full text of H.R. 2872 can be found here. 

Background

The Problem

The United States is in the midst of an opioid overdose epidemic fueled by a dramatic increase in the use of illicit prescription opioids and heroin.  Every day, 44 Americans lose their lives due to opioid overdose and over 35 babies are born opioid-dependent, requiring detoxification during their first few weeks of life.  Despite investment in opioid addiction treatments at the federal level, the problem has worsened substantially.

Opioid addiction is unique among all illnesses because the federal government has legislated clinical treatment requirements.  Over the past 50 years, the federal government has refined legislation and guidelines governing the treatment of opioid addiction in specialized “opioid treatment programs” (OTPs) that are permitted to offer methadone maintenance therapy.  In 2000, Congress passed the Drug Addiction Treatment Act of 2000 (DATA 2000), which allowed physicians to apply for a waiver to prescribe buprenorphine products for the treatment of opioid addiction at Office-Based Opioid Treatment (OBOT) programs.  At that time, buprenorphine was believed to have an overall lower risk of abuse, addiction, and side effects compared to treatments, such as methadone.  Based on that belief, Congress determined that OBOTs did not need the same regulatory controls required of OTPs, and the regulations put in place for OBOTs were, therefore, far less strict those that govern Opioid Treatment Programs (OTPs), which must meet federally established practice standards and be able to demonstrate compliance as part of their certification requirements.  

Moreover, OTPs almost always treat patients with methadone, and OBOTs almost always treat patients with buprenorphine.  As a consequence, the treatment a patient receives is almost entirely based upon where they seek treatment rather than on their specific clinical needs.  Additionally, buprenorphine has now become the third-most diverted opioid and the eighth-most diverted drug on the market.  

Both the OTP and OBOT settings provide medications (methadone and buprenorphine) that are themselves opioids and DEA Controlled Substances that can be effective opioid maintenance treatments when used responsibly.  However, this opioid addiction treatment system is in need of modernization to ensure that patients are provided with the most appropriate treatments based on their clinical needs and that the standard of care in OBOTs is consistent with modern medical practice.

The Solution

H.R. 2872, the Opioid Addiction Treatment Modernization Act, modernizes the segregated opioid addiction treatment system to ensure opioid-dependent patients are provided with individualized, evidence-based treatment by requiring that OBOT providers are trained on and provide – either directly or by referral – all FDA-approved opioid addiction treatment medications (other than methadone) based on the clinical needs of the patients, as determined by the physician.  In addition, the bill requires both addiction treatment settings to provide relapse prevention medication, counseling, and medication adherence monitoring, as well as develop individualized treatment plans and diversion control plans.  Once enacted, health care professionals, working with their patients, will be able to prescribe the most appropriate treatments based upon the patients’ individual needs rather than the treatment setting they happen to enter.

Specifically, H.R. 2872 will ensure that: 

• All physicians and licensed or certified practitioners employed in OBOTs are trained on opioid detoxification and the use of all FDA-approved medications for the treatment of opioid dependence and overdose. 
• All OBOT practices obtain informed consent from their patients about the available treatment options, including their potential benefits and risks, consistent with practice in OTPs.  
• All patients receiving treatment in an OBOT receive initial and periodic assessments that take into account their unique history and psychosocial characteristics, consistent with current practice in OTPs and current medical practice.
• Physicians and licensed or certified practitioners treating patients in OBOTs develop individualized treatment plans based upon the patient’s assessment that must include selected medication, a plan for preventing relapse, and an overdose reversal plan.
• OBOTs are capable of providing directly, or by referral, all FDA-approved opioid addiction treatment medications. 
• All patients in OBOTs receive medication adherence and substance use monitoring, to detect illicit opioid use, as well as adherence to their prescribed medication regimen. 
• OBOTs, like OTPs, maintain a Diversion Control Plan that contains specific measures to reduce the risk for diversion of controlled substances.
• Physicians and licensed or certified practitioners treating patients in OBOTs certify compliance with these provisions and that HHS has clarified authority to conduct inspections and sanction OBOTs for noncompliance.
• The General Accounting Office performs a thorough review of opioid addiction treatment services in the United States within one year of enactment of this bill, and every five years, thereafter. 

With the introduction of the bill, a working group will be initiated to bring together key players from the addiction community to refine the legislation. 

Statements of Support

“The membership of the National Council for Behavioral Health is committed to being a leader in advancing the most effective community-based treatment of opioid addiction.  We thank Congressman Bucshon for his leadership in focusing upon the need for expanding access to effective treatment.  We look forward to working with him in refining this draft legislation to advance and expand access to opioid addiction treatment.” – Linda Rosenberg, MSW, President and CEO, the National Council for Behavioral Health.

“I look forward to working with Congressman Bucshon, Congressman Womack, and my colleagues in the addiction treatment community to find a path forward that advances access to effective opioid addiction treatments.  Progress will not come easily, but we really have no choice if we are to turn the current trends around.” – H. Westley Clark, MD, JD, MPH, former Director of the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment.

“Across our country, the opioid overdose epidemic is spreading at an alarming rate, devastating many communities.  Community Anti-Drug Coalitions of America (CADCA) is grateful to Congressmen Bucshon and Womack for introducing legislation to address aspects of this major crisis and we look forward to working with them and the other members of the workgroup on advancing more evidence-based solutions to help our communities and the nation.” 

- Gen. Arthur Dean, Chairman and CEO, the Community Anti-Drug Coalition of America.

Congressman Larry Bucshon, M.D., is a physician and Republican member of the House Energy and Commerce Committee serving his third term representing Indiana's 8th Congressional district.   

Congressman Steve Womack has represented Arkansas’s Third Congressional District since 2011 and serves on the House Appropriations Defense, Financial Services and General Government, and Labor-Health and Human Services subcommittees and the House Committee on the Budget.

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