The year 2016 marked a watershed moment for advocates of treatment for substance use disorders (SUD). Driven by the urgency of an opioid epidemic claiming the lives of tens of thousands of Americans from all walks of life, and building on a multiyear bipartisan lobbying effort at the grass roots and on Capitol Hill, Congress passed the historic Comprehensive Addiction and Recovery Act (CARA).
Enactment of CARA in July 2016 represented a historic and long-sought shift toward enhancing access to addiction treatment and life-saving naloxone, as well as improved supports for people in recovery and a pivot from emphasis on criminal penalties.
In December 2016, Congress doubled down, authorizing $1 billion over two years through the 21st Century Cures Act and then appropriating the first installment of $500 million for states as part of an emergency response to the epidemic. Amid the divisions of a polarized country in an election year, acting on the opioid epidemic was notable for being bipartisan and unifying.
As we move toward the end of 2017, and as the opioid epidemic continues to kill Americans at an unacceptable rate, policymakers in the Trump Administration and in Congress continue to face formidable challenges.
Just last week, 54 Members of Congress testified before the Energy and Commerce Health Subcommittee about the ongoing toll of the epidemic, including full Committee Chairman Greg Walden (R-OR), Ranking Member Frank Pallone (D-NJ), and House Minority Leader Nancy Pelosi (D-CA).
Members urged the panel, in passionate and often personal terms, to take more actions to stem the tide. Themes among the many proposals discussed included:
- Staunching the flood of lethal synthetic opioids such as fentanyl and carfentanil, which have caused a surge in deaths related to these substances in the past year
- Ending or reforming the Medicaid IMD Exclusion that bars Medicaid from providing residential treatment for SUD in a facility of more than 16 beds
- Expanding access to Medication Assisted Treatment (MAT) and expanding the range of health providers who can prescribe MAT
- Curtailing the overprescribing of opioids and enhancing utilization and effectiveness of Prescription Drug Monitoring Programs by states
The Energy and Commerce Committee will also be holding a full Committee hearing on CARA implementation the week of October 23, and the Oversight and Investigations Subcommittee is slated to examine pill dumping and patient brokering in the coming months. With the resignation of O&I Chairman Tim Murphy (R-PA) effective next week, Subcommittee Vice-Chairman Rep. Morgan Griffith (R-VA), whose district bordering Kentucky and West Virginia has been deeply affected, is expected to take up the gavel and lead these investigations in the near-term.
Looking ahead, the Trump Administration is facing a series of decisions that will shape the policy agenda for the next several years. In his Rose Garden press conference on October 16, President Trump announced he expects to formally declare a federal emergency for the opioid epidemic next week – a move that the President’s Commission on Combating Drug Addiction and the Opioid Crisis, led by Governor Chris Christie (R-NJ) recommended at the end of July.
The Commission is supposed to wrap up its work by early November, issuing a final report and recommendations that a wide range of Trump Administration Departments and agencies will be left to implement.
Big question marks remain about implementation of the Commission’s recommendations, however, due to the lack of permanent leadership at critical posts, HHS and DEA are being led by Acting Secretaries or Administrators. Following the explosive Washington Post / 60 Minutes report this past weekend about Rep. Tom Marino’s role in championing legislation that weakened DEA oversight of opioid distributors, Rep. Marino has withdrawn himself from consideration for Director of the Office of National Drug Control Policy. As such, the fate of so much of the Trump Administration’s work on the opioid crisis remains yet to be determined.
One thing is certain: this issue is not going away and Congress and the Administration will continue to grapple with these issues over the coming weeks and months. While many questions remain, both Republicans and Democrats are invested in addressing these challenges. Will this result in more bipartisan legislation? We will soon find out.
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