Senate passes package of bills to fight opioid crisis

On Sept 17th, in a isolated moment of bipartisanship, the Senate passed a package of bills meant to address America's opioid epidemic. Opioids were responsible for almost 50,000 deaths last year.

This package, which consists of 70 bills, will create, expand, and renew programs across multiple agencies. This package "[aims] to prevent the deadly synthetic drug fentanyl from being shipped through the U.S. Postal Service as well as allowing doctors to prescribe more medication designed to wean addicts off opioids, such as buprenorphine."

On the other hand, public health advocates say that it does not offer the large amount of funding needed to fight the opioid epidemic that affects rural and urban communities. In a Washington Post article, Sarah Wakeman, the medical director for Mass General Hospital’s Substance Use Disorders Initiative, said focusing on the opioid crisis would require funding on the same level as what is spent on H.I.V/AIDS.

“We have historically not thought of addiction as a medical issue and so our health care and public health system are woefully unprepared to respond in a robust way,” she said.

The biggest difference between the House and Senate measures involves the Institutions for Mental Diseases exclusion rule or the "I.M.D exclusion". This rule forbids "...federal Medicaid reimbursements for inpatient substance abuse treatment in centers with more than 16 beds whose patients are mainly suffering from severe mental illness." This means people living with substance abuse disorders who also have a mental illness will not get treated for their addiction in large mental health facilities.

The House bill moderately overturns the I.M.D exclusion, while the Senate bill makes minor changes to the I.M.D like making sure pregnant and postpartum women continue receiving Medicaid-covered services conducted outside such places, like prenatal care. Interestingly, the bill does not allow Medicaid to pay for addiction treatment in bigger facilities.

Heroin overdoses are rising due to the drug being laced with fentanyl (a cheaper, potent, synthetic opioid). According to the Centers for Disease Control, last year 30,000 overdose-related deaths were caused by synthetic opioids. The House and Senate both address in the bill how easy it is to ship synthetic opioids from other countries. The Senate wants to increase access to treatment for people with substance abuse disorders through a grant for recovery centers where people trying to become sober can find temporary housing, job training, and other assistance. While some people think this grant is a good idea, others believe that it is a ploy by the politicians to make people think they are doing something good for citizens.

A couple of months ago Legal Council created a blog series called "Medicaid Matters: Medicaid Awareness Month". In one of the blog posts we stated that "Over two million Americans are dependent on opioids, and medical professionals worry that this public health crisis will only continue to grow." While here are treatment and overdose-reversal medicine that shows positive signs in diminishing opioid addictions, the 200% of opioid users under the poverty line do not have access to this medication.

Here are some facts about Medicaid:

• In 2014, 25 percent of spending for addiction treatment was covered by Medicaid. (Vox)
• Medicaid expansion allows for greater affordability and access to Naloxone and Buprenorphine (overdose-reversal medication). (Commonwealth Fund)
• Further research shows that Medicaid expansion has also improved access to substance use treatment services. We also know typically opioid use doesn’t happen in a vacuum–often those with with substance use disorders also need access to physical and mental health services as well. Medicaid helps those individuals get the comprehensive care they need. (Center on Budget and Policy Priorities)
• In states that expanded Medicaid, the uninsured rate for opioid-related hospitalizations dropped by 79 percent. (Center on Budget and Policy Priorities)
• Illinois was ranked in the top 5 states with the largest drops in the uninsured rate for opioid-related hospitalizations. Illinois’ uninsured rate for opioid hospitalizations decreased by 83 percent. (Center on Budget and Policy Priorities)