Thursday, 27 September 2018

In Rare Bipartisan Accord, House and

Bipartisan Accord

In Rare Bipartisan Accord, House and Senate Reach Compromise on Opioid Bill

WASHINGTON — The House and Senate have reached agreement on an enormous package of measures to address the opioid epidemic.

The legislation, backed by leaders of both parties may be a rare bipartisan achievement that lawmakers are wanting to have in hand when they go home to campaign for the midterm elections.

The 653-page bill contains a mixture of enforcement and public health measures, including one that aims to dam deadly fentanyl from being imported through the mail and one that will allow more nurses to prescribe medication for opioid addiction.

Another provision could make it easier for Medicaid recipients to get inpatient care for substance abuse over the next five years.

“While there is more work to be done, this bipartisan legislation takes an important step forward and can save lives,” a gaggle of Republican and Democratic committee leaders said in a statement.

But addiction experts say that while many of the measures will help incrementally, the investment remains meager and scattershot compared with what's needed, and with what the govt spent to stem the tide of AIDS-related deaths within the 1990s.

With 72,000 overdose deaths in 2017, including nearly 50,000 involving opioids, members of Congress are wanting to wield the bill as a substantive policy achievement amid the drama surrounding Fates of Judge Brett Kavanaugh, President Trump’s Supreme Court nominee, and Rod Rosenstein, his deputy attorney general.

Both chambers still need to vote on the compromise bill.

The House could vote as soon like Wednesday night, before its members adjourn to hit the campaign trail and the Senate could take it up next week.

The Congressional Budget Office has yet to attain the new bill and estimate its cost, but an earlier Senate version would have cost an estimated $8 billion over five years.

Improved access to treatment One of the foremost expensive provisions — which had been a detail between the two chambers — will repeal an obscure rule that blocks states from spending federal Medicaid dollars on residential addiction treatment at centers with quite 16 beds.

The rule was originally intended to discourage warehousing of individuals with mental illnesses in psychiatric hospitals, which was much more common when it had been written in 1965.

More recently, the rule has limited the number of beds available for low income patients affected by addiction, although there have been several ways for states to circumvent it.

Some addiction specialists worry that the bill’s expansion of inpatient care will eclipse the importance of longer-term outpatient programs that focus on medication-assisted treatment, which researchers consider the gold standard for treating opioid addiction.

Many residential programs for opioid addiction still don’t offer such treatment as a part of their protocol, and therefore the bill does nothing to deal with that.

“The evidence for residential stays is extremely thin in terms of science,” said Dr. Ken Duckworth, medical director for behavioral health at Blue Cross Blue Shield of Massachusetts.

“I’m not against the residential model, but the linchpin is that with it, you have to have exposure to medication-assisted treatment.”

The opioids bill that the House passed in June limited the expansion of inpatient treatment only to patients with cocaine and opioid addiction; the Senate version left the the old rule in place.

The compromise bill lifts the rule for all substance use disorders for residential treatment lasting up to 30 days.

The bill also permanently allows nurse practitioners and physician assistants to prescribe buprenorphine, an anti-addiction medication that needs a special license and additional training.

Only about 5 percent of the nation’s doctors are licensed to prescribe it, and shortages are especially acute in rural regions.

The bill further aims to increase access to the medication by allowing nurse anesthetists, nurse midwives and clinical nurse specialists to prescribe buprenorphine for the subsequent five years.

Blocking mail orders of illegal drugs The bill includes a provision to assist stop the flow of illicit opioids into the country by mail, especially synthetic fentanyl and its analogs, which are fueling the increase in overdose deaths.

The supply was pushed by Senator Rob Portman, Republican of Ohio, whose the state has been especially hammered by the opioid epidemic.

It will require us a mail to start out collecting information on international mail shipments, even as private carriers like Fed Ex and DHL has already got to do.

By the end of this year, the Postal Service will need to provide the name and address of the sender and therefore the contents of the package, as described by the sender, for a minimum of 70 percent of all international packages, including all of these from China. It will have to provide the knowledge on all such shipments by the top of 2020.

The mail could block or destroy shipments that the knowledge isn't provided.

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