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Policy Update: Combatting Opioid Addiction

For the past seven months, the 114th Congress has been hard at work on the issues facing America. But there still is much to be done. 

In this week’s newsletter (which you can sign up to receive here), I thought I would bring to your attention one of the bills I hope will join the 49 that have been signed into law so far this Congress – and that’s the Opioid Addiction Treatment Modernization Act (H.R. 2872), which Congressman Larry Bucshon, M.D. (R-IN-8) and I introduced on June 24, 2015. 

The United States is in the midst of an opioid overdose epidemic.  Fueled by the dramatic increase in the use of illicit prescription opioids and heroin, the number of prescription drug overdoses have tripled, while heroin overdose deaths have increased five-fold in the past decade.  Unfortunately, Arkansas is not spared.  Our overdose mortality rates have more than doubled and remain higher than the national average. 

The impact on our communities is devastating.  According to the Office of National Drug Control Policy, the economic cost of drug abuse in the United States was estimated at $193 billion in 2007 (last available estimate).  Of this amount, 62 percent was attributable to workplace costs (e.g., lost productivity), 31 percent to criminal justice costs, and 7 percent to health care costs (e.g., abuse treatment).

In spite of investment in opioid addiction treatments at the federal level, the problem has worsened substantially… and now, nearly 70 Americans lose their lives each day due to opioid overdose.  If I’ve said it once, I’ve said it a million times – bureaucratic red tape is part of the problem. 

The National Institute of Drug Abuse (NIDA) defines addiction as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.  Yet, among all diseases, opioid addiction is unique 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.  While today we know this not to be the case, during FDA-approval trials buprenorphine was believed to be non-addictive and have a lower risk of abuse, addiction, and side effects compared to methadone.  Therefore, the regulations written for OBOTs are less strict than those that govern OTPs.  Consequently, the treatment a patient receives is almost entirely based upon where they seek treatment rather than on their specific clinical needs.

If we are to attempt to reverse incidence of opioid dependence and the increasing numbers of opioid overdoses and opioid-related deaths associated with prescription drug and heroin addiction, medication-assisted therapy is an essential tool and patients must have access to all FDA-approved treatment options.  

The Opioid Addiction Treatment Modernization Act modernizes the segregated addiction treatment system to ensure that opioid-dependent patients are provided with individualized, evidence-based treatment by requiring that both OBOT and OTP providers are trained on and provide – either directly or by referral – all FDA-approved opioid addiction treatment medications based on the clinical needs of the patients, as determined by the physician.  Additionally, the bill requires both addiction treatment settings to provide relapse prevention counseling and medication adherence monitoring, as well as develop individualized treatment plans and diversion control plans. 

In 2013, NIDA estimated that 22.7 million Americans (8.6 percent) needed treatment for a problem related to drugs or alcohol, but only about 2.5 million people (0.9 percent) received treatment at a specialty facility.  Once enacted, H.R. 2872 will allow health care professionals – working with their patients – to prescribe the most appropriate treatments based upon the patient’s individual needs, ultimately helping us bridge the “treatment gap” and providing our country an important tool to combat the opioid epidemic.  

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, and I am hopeful that we will be able to count the Opioid Addiction Treatment Modernization Act as another victory of the 114th Congress.

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