Health Reform WK-EDGE A good step but more is needed to address the opioid crisis
Wednesday, January 16, 2019

A good step but more is needed to address the opioid crisis

By Susan Smith, J.D., M.A.

The opioid crisis continues to have a debilitating impact on the country. According to the Centers for Disease Control and Prevention (CDC), nearly 72,000 Americans are projected to have died of drug overdoses in 2017, outnumbering fatalities from influenza and pneumonia and nearly rivaling the number of deaths from diabetes-related complications each year. In recent years, Congress has taken steps through the passage of at three laws "to address this ongoing and largely preventable crisis," due in a large part to the efforts of health advocates and medical professionals, Corey S. Davis, J.D., M.S.P.H, reported in the New England Journal of Medicine. Davis noted, however, that "more than a decade into the crisisthe country still lacks an integrated federal response to reduce the rates of overdose-related death and disability."

Prior legislation. Although Congress passed and President Obama signed the Comprehensive Addiction and Recovery Act (CARA) (P.L. 114- 669) and the 21st Century Cures Act (P.L. 114-255) in 2016 in an effort to address the opioid crisis, Davis noted that "neither law substantially altered the federal policy landscape . . . and overdose-related deaths have continued to increase." The provisions of the laws intended to expedite access to evidence-based care and treatment for people with substance use disorders (SUDs).

The SUPPORT Act. Most recently, in October of 2018, President Trump signed the SUPPORT for Patients and Communities Act (P.L. 115-271) (see Trump signs wide-reaching opioid bill, October 24, 2018). According to Davis, the SUPPORT Act is a good step in addressing the opioid crisis, but to alter the current increase in opioid use will require "a comprehensive, integrated, and public health–oriented response coordinated throughout all branches and levels of government." The SUPPORT Act, however, does little to further a coordinated federal strategy for addressing the epidemic."

The Act includes provisions that will be beneficial for people with substance use disorders (SUDs) and those at risk for SUDs. Such provisions are designed to improve pain management, support the development of the SUD-treatment workforce, and eliminate kickbacks for referring patients to recovery homes as well as increase access to evidence-based treatment and follow-up care, specifically for pregnant women, children, people in rural areas, and people in recovery from an SUD. The Senate passed the bill in September (see Opioid legislation package passes Senate—but is it enough? September 19, 2018).

Stumbling blocks in providing needed care. In terms of addressing the addictionDavis explained that the surgeon general’s office has strongly supported proven public health interventions such as increased access to sterile syringes and the opioid-antagonist naloxone, while the office of the attorney general has waged a "war on drugs" with a focus on arrest and incarceration. In addition, the Office of National Drug Control Policy has not had director a since President Trump’s inauguration. Furthermore, the Trump administration has threatened to budget cuts and Congress has repeatedly attempted to repeal the Patient Protection and Affordable Care Act (P.L. 111-148), a law, which Davis noted has "significantly reduced the number of people with heroin use disorders who are uninsured."

Conclusion. Davis believes that "the tools and knowledge to reverse the unprecedented and largely preventable, avalanche of overdose-related morbidity and mortality" are available. "The question is not how to end the crisis of opioid-related harm but whether we will choose to mount an effective, evidence-based, and equity-focused response."

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