Congress is moving to take a second crack at opioid legislation, with lawmakers broadly agreeing that they need to do to deal with a crisis that’s killing over 42,000 people per year.
There’s a sense of urgency to the push, as lawmakers continue to hear story after story of people in their communities dying from overdoses. The crisis doesn’t appear to be stemming, as the rate of opioid overdose deaths increased nearly 28 percent from 2015 to 2016.
Congress already passed the Comprehensive Addiction and Recovery Act (CARA) in 2016, but lawmakers and advocates broadly agree that it’s only one part of the puzzle.
“CARA in a lot of ways provided a starting point for a lot of the work that needs to be done,” said Grant Smith, the interim director for the Drug Policy Alliance’s Office of National Affairs.
On the House side, the Energy and Commerce Committee will begin its push for new opioid legislation Wednesday, holding a hearing on eight enforcement and patient safety-related bills. It’s the first of three hearings, the other two of which will focus on prevention and insurance coverage.
The panel’s chairman, Greg Walden (R-Ore.), says he’s working under an aggressive timetable, in coordination with leadership, to pass opioid legislation out of the House by the Memorial Day weekend.
“This is affecting everybody’s district, and we want to build on our past efforts, which were significant, but this remains a big problem,” Walden told The Hill in a phone interview.
On the other side of the Capitol, Sens. Sheldon Whitehouse (D-R.I.) and Rob Portman (R-Ohio) are working on legislation that Whitehouse referred to as “CARA 2.0.” Part of their goal is to help ensure the $6 billion for combating opioids and mental health that lawmakers included in a spending deal this month goes to the right places.
At an event hosted by The Hill Feb. 14, Whitehouse said he and Portman are working to “make sure that the $6 billion … gets dedicated and appropriated in ways that are consistent with the direction that the Congress displayed in CARA, and so we’re trying to meld the commitment and the CARA principles together,” Whitehouse said, adding, “We’re trying to sort it out fairly quickly.”
The House’s legislation will craft new policies, some of which are likely to need a slice of the newly approved dollars.
“As we begin to look at some of the initiatives, we’ll probably target and authorize spending some of that money on some of these initiatives,” Walden said.
Advocates have been working behind the scenes for months to put together research and policy ideas.
Addiction Policy Forum has been coordinating the effort with a working group of 200 organizations. They’ve met with committee staff in both chambers as well as leadership on both sides of the aisle.
“Our grassroots is heartened that Congress is looking at this issue, dedicating dollars and starting to prioritize the mark up of new legislation,” Jessica Nickel, Addiction Policy Forum’s president and CEO, said. “We hope to work very closely with every member and every committee as we build these bills to make sure that they are informed by families and science.”
The 2016 bill originally included some provisions dealing with opioid recovery services that didn’t make the final product.
To help with the new legislative effort, “we’ve provided some ideas and some feedback particularly from the recovery community,” Nickel said. “CARA had many pieces within the recovery pillar that ended up on the cutting room floor that we need to prioritize to be included in any work that the CARA champions do to build and improve on CARA.”
Patty McCarthy Metcalf, executive director of Faces and Voices of Recovery, mentioned several specific provisions — such as a national youth recovery initiative specifically authorizing grants aimed at helping young people in recovery.
“We’re tired of getting scrapped and being the last to be recognized as a valuable part of the system,” Metcalf said, adding she hopes some of the $6 billion is funneled toward recovery-related efforts.
Advocates stressed the need to bolster the treatment system for people with an opioid addiction.
“We are still lacking infrastructure. We’re lacking in treatment spots, we’re lacking in number of facilities. We’re lacking in number of [treatment] professionals,” said Andrew Kessler, founder of Slingshot Solutions, a consulting firm specializing in behavioral health policy.
Legislation needs to focus on expanding access to evidence-based treatment, Smith said, as well as improving tactics to reduce the harm of opioid usage, such as making an overdose reversal drug accessible to communities and non-medical settings.
“That’s what’s going to fundamentally wind down the overdose crisis,” he said. “A border wall or an emphasis on law enforcement is not going to address the situation.”
Passed in 2016, the CARA bill authorized grants to help states fight the opioid epidemic, and a biomedical innovation bill approved several months later appropriated $1 billion over two years for states to fight the crisis.
Regina LaBelle, who served as chief of staff for the Office of National Drug Control Policy in the Obama administration, said lawmakers and the administration need to focus on what steps the states are taking to combat the epidemic.
“I think what’s really needed is making certain that states have strategies in place, that they are making sure that monies are being spent in local communities, making sure that cities and local governments are getting the money that they need.”