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U.S. - House, Senate pass bipartisan bill to confront the opioid epidemic

S.J.B.

S.J.B.

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The Senate just passed a bipartisan bill to confront the opioid epidemic
German Lopez
Vox
October 3rd, 2018

What the SUPPORT for Patients and Communities Act does

For a full breakdown of Congress's bill, you can read the full text or a section-by-section summary. But here are some of the major policy changes in the bill:

- Reauthorizes funding from the Cures Act, which put $500 million a year toward the opioid crisis, and makes tweaks to hopefully give states more flexibility in using the funding.

- Creates a grant program for "Comprehensive Opioid Recovery Centers," which will attempt to serve the addiction treatment and recovery needs of their communities (in part by using what's known as an ECHO model).

- Lifts restrictions on medications for opioid addiction, allowing more types of health care practitioners to prescribe the drugs.

- Expands an existing program that attempts to get more first responders, such as police and firefighters, to carry and use naloxone, a medication that reverses opioid overdoses.

- Allows federal agencies to pursue more research projects related to addiction and pain.

- Makes several changes to Medicare and Medicaid to attempt to limit the overprescription of opioid painkillers within the programs and expand access to addiction treatment, including lifting some of the current restrictions that make it harder for Medicare and Medicaid to pay for addiction treatment.

- Advances new initiatives to educate and raise awareness about proper pain treatment among health care providers.

- Attempts to improve coordination between different federal agencies to stop illicit drugs like fentanyl at the border, and gives agencies more tools to improve detection and testing at border checks.

- Increases penalties for drug manufacturers and distributors related to the overprescribing of opioids.
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Read the full story here.

Read the full bill here.

Read the section-by-section summary here.
 
This bill is mostly bad. It is largely aimed at pushing the number of opioid prescriptions downward by using a broad campaign of red tape and intimidation across the health care system. It is also increasing the complexity and cost of the international postal system drastically in a futile attempt to stop fentanyl and its analogues from getting into the U.S. There are some positive changes, though, like the fact that maintenance drugs such as methadone and buprenorphine will be prescribed more easily by more practitioners.

One ominous provision, which hasn't garnered much attention, seems to be an attempt to add leeway to the "human consumption" requirement of the Analog Act:

CHAPTER 5--SYNTHETIC ABUSE AND LABELING OF TOXIC SUBSTANCES

SEC. 3241. CONTROLLED SUBSTANCE ANALOGUES.

Section 203 of the Controlled Substances Act (21 U.S.C. 813) is amended--

(1) by striking "A controlled" and inserting

"(a) IN GENERAL.--A controlled"; and

(2) by adding at the end the following:

"(b) DETERMINATION.--In determining whether a controlled substance analogue was intended for human consumption under subsection (a), the following factors may be considered, along with any other relevant factors:

"(1) The marketing, advertising, and labeling of the substance.
"(2) The known efficacy or usefulness of the substance for the marketed, advertised, or labeled purpose.
"(3) The difference between the price at which the substance is sold and the price at which the substance it is purported to be or advertised as is normally sold.
"(4) The diversion of the substance from legitimate channels and the clandestine importation, manufacture, or distribution of the substance.
"(5) Whether the defendant knew or should have known the substance was intended to be consumed by injection, inhalation, ingestion, or any other immediate means.
"(6) Any controlled substance analogue that is manufactured, formulated, sold, distributed, or marketed with the intent to avoid the provisions of existing drug laws.

"(c) LIMITATION.--For purposes of this section, evidence that a substance was not marketed, advertised, or labeled for human consumption, by itself, shall not be sufficient to establish that the substance was not intended for human consumption.".
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Wow could they go after kratom with that provision?
 
cj said:
Wow could they go after kratom with that provision?
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Fortunately not - an analogue still has to have a "substantially similar" structure to a Schedule I substance.
 
This makes me happy that I have found substantial (lol) analgesia from buprenorphine.
 
Captain.Heroin said:
Ugh. It's not an epidemic.
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There is an epidemic of overdoses for sure. Due to fentanyl. But yeah lowering the availablity of painkiller prescriptions is not a way to combat that whatsoever.

These provisions are the only ones that will have any positive effect:

- Lifts restrictions on medications for opioid addiction, allowing more types of health care practitioners to prescribe the drugs.

- Expands an existing program that attempts to get more first responders, such as police and firefighters, to carry and use naloxone, a medication that reverses opioid overdoses.

But making it harder to prescribe painkillers will outweigh these if I were to guess.
 
So which doctors will be able to write methadone for maintenance ? I was basically forced to quit methadone because of our state laws against family practitioners not being able to write it anymore. Now I'm 100 days clean and sure as heck ain't going back , but curious.
 
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hikfromstik said:
So which doctors will be able to write methadone for maintenance ? I was basically forced to quit methadone because of our state laws against family practitioners not being able to write it anymore. Now I'm 100 days clean and sure as heck ain't going back , but curious.
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Doctors should be able to write it for pain still.
 
hikfromstik said:
So which doctors will be able to write methadone for maintenance ? I was basically forced to quit methadone because of our state laws against family practitioners not being able to write it anymore. Now I'm 100 days clean and sure as heck ain't going back , but curious.
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From the summary:

Chapter 1 – More Flexibility with Respect To Medication-Assisted Treatment for Opioid Use Disorders

Section 3201. Allowing for more flexibility with respect to medication-assisted treatment
for opioid use disorders.

This provision will increase the number of waivered health care providers that can prescribe or dispense
medication-assisted treatment (MAT)by authorizing clinical nurse specialists, certified nurse midwives,
and certified registered nurse anesthetists to prescribe MAT for five years. It also makes permanent the
prescribing authority for physician assistants and nurse practitioners and allows waivered practitioners
to immediately treat 100 patients at a time if the practitioner is board certified in addiction medicine or
addiction psychiatry; or if the practitioner provides MAT in a qualified practice setting. This provision
codifies the ability for qualified physicians to prescribe MAT for up to 275 patients. The Secretary of
HHS, in consultation with the Drug Enforcement Administration, will be required to submit a report that
assesses the care provided by physicians treating over 100 patients and non-physician practitioners
treating over 30 patients.

Section 3202. Medication-assisted treatment for recovery from substance use disorder.

This provision ensures physicians who have recently graduated in good standing from an accredited
school of allopathic or osteopathic medicine, and who meet the other training requirements to prescribe
MAT, to obtain a waiver to prescribe MAT.

Section 3203. Grants to enhance access to substance use disorder treatment.

This provision authorizes grants to support the development of curriculum that will help health care
practitioners obtain a waiver to prescribe MAT.
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I don't think this will supercede state restrictions, though.
 
Take away opioids from pain patients and give opioids more freely to heroin users...that about right from the government.
 
Actually in regard to captain.heroins point, it's not an opiate epidemic but a fentanyl and rc opiate epidemic.
 
Trump opioid bill just passed. Gives Sessions sole power to set caps for manufacture

Jeff sessions now has the sole power to determine how many opioids can be manufactured for the US. It allows him to make this determination off of "estimates." This is terrifying.

Here is the law:


?(2) The Attorney General may, if the Attorney General determines it will assist in avoiding the overproduction, shortages, or diversion of a controlled substance, establish an aggregate or individual production quota under this subsection, or a procurement quota established by the Attorney General by regulation, in terms of pharmaceutical dosage forms prepared from or containing the controlled substance.?;

?(i) (1) (A) In establishing any quota under this section, or any procurement quota established by the Attorney General by regulation, for fentanyl, oxycodone, hydrocodone, oxymorphone, or hydromorphone (in this subsection referred to as a ?covered controlled substance?), the Attorney General shall estimate the amount of diversion of the covered controlled substance that occurs in the United States.
 
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holy shit that's scary. This is the guy who said, "People need to take some aspirin sometimes and tough it out.”

Hospitals need to start cancelling the surgeries of some key people to get the message across...
 
wow, this is seriously fucked up.

i suspect any further restrictions on pain patients' medications will have the exact opposite outcome of what they are apparently aiming for; more people will turn to dangerous black market opiates to manage their pain, and legitimate pain patients that will be forced to suffer for no good reason.

i just wish politicians would leave medical treatments to prescribing doctors and health professionals.

i hope everyone who may be affected by this will be voting in the midterms. :|
 
I'm working hard to ensure I can afford land by the time I'm old enough to have chronic pain, so I can grow poppies for my wife and I. I also hope the fentanyl crisis will blow over before then because we could just get heroin then. I fear growing old in this day and age, not because of the pains of age, but because opioids may not exist when I'm old...
 
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