EXETER – A slew of bills is being considered by members of the House as the federal government works to address the current opioid epidemic.
U.S. Congressman Frank Guinta said they are working to add funding to the Comprehensive Addiction and Recovery Act (CARA), which the U.S. Senate passed in March by a vote of 94-1. CARA was sent to the House with no funding mechanisms and Guinta said that is one of the items they are working through now. In addition, there are 14 other bills the House hopes to fold into CARA, for a broad effort to address many areas that affect the addiction crisis.
“The task force compiled the list based on 40 pieces of legislation we had to consider,” Guinta said. “Given the fact that we were taking up the CARA bill from the Senate, we wanted to try and include the bills we feel will have the greatest impact on the problem. We want to improve the Senate bill by trying to include part, or all of the components that are important to addressing the issue.”
Guinta said four committees are currently working on the bill package: energy and commerce, judiciary, education and veteran affairs. He said that if all the bills do not make it into CARA, there are other options the House can pursue to get them moved forward to the floor and the appropriations process.
CARA, as currently being considered by the House, would authorize $85 million annually to combat opioid issues through grant programs targeted toward prevention and education efforts while promoting treatment and recovery. The bill aims to create a community-based coalition enhancement grant program allowing states to address local issues.
The bills Guinta said he hopes to see folded into CARA are:
• The Stop Abuse Act would create an interagency task force on heroin addiction and provide $10 million for cross-state drug monitoring. It would offer liability protection for prescribers of opioids who do so in good faith, and would reauthorize three grant programs, including grants to high intensity drug trafficking areas.
Most states have a drug monitoring program, allowing them to track what prescriptions are being prescribed to a patient within the state. States do not have the ability to cross reference nationwide.
“Drug monitoring is incredibly important, and definitely in New Hampshire because we are so small,” said Guinta. “Addicts will drug shop, crossing borders, and there are several they go to from New Hampshire. Putting the mechanism in place to check out of state could make a huge impact in reducing drug shopping.”
Dr. Tom Sherman of Exeter Core Physicians, who is also a state representative in Rye, said he completely agrees that it is vital for states to be able to communicate about drug shopping.
“It is critical,” said Sherman. “Addicts are going state to state, going from a state that is more restrictive to a state that is less restrictive. We need to close that gap and to do that we need a funding mechanism to put in the upgrades we need for cross referencing. A federal grant is probably the best answer for New Hampshire to do this. The money has to come from somewhere.”
• The Prevent Drug Addiction Act establishes a grant program for consumer education about opioid addiction and would strengthen training requirements for practitioners. It would also require the government to collect information on overdose deaths. And authorize Medicare Part D Plan sponsors to establish a drug management program for those at risk of prescription drug addiction.
• Promoting Responsible Opioid Prescribing Practices would change current laws to eliminate an unintended incentive that could cause prescribers to overprescribe prescription medicines. The bill links to Medicare reimbursement from patient satisfaction survey responses on pain management.
“In the Affordable Care Act, we found a provision that can require pain management as a term of reimbursement through Medicare,” said Guinta. “Doctors are feeling obligated to ask about pain and patients are completely pain management satisfaction surveys. Doctors should not be practicing defensively. We want to alleviate that obligation.”
Sherman said that while it’s true that pain management is part of the patient assessment surveys, doctors are already moving away from the feeling that they must provide a complete eradication of pain through opioids.
“We are looking to different medication and are being asked to consider other options,” said Sherman. We are rethinking pain free to looking toward comfort, and comfortable coping mechanisms. Patients with acute or chronic pain are used to opioids and even expect that will be what they receive. That got us to a place where we have addicted patients, so we do need to rethink this. When we do, we get negative responses and are seen as not meeting the expectation.”
• Heroin and Prescription Opioid Abuse Prevention, Education and Enforcement Act requires the Department of Health and Human Services, in cooperation with the Department of Veteran Affairs, the Department of Defense, and the Drug Enforcement Administration to convene a pain management best practices interagency task force to develop best practices for pain management and prescription of pain medications.
• Opioid Overdose Reduction Act provides an exemption from civil liability for trained and certified individuals during the administration of overdose-reversing drugs.
“We want to encourage people to help,” said Guinta. “If someone is lying on the ground, dying of a fentanyl overdose, we want to help them without fear of the liability. Then we want to get the person into a long-term treatment program where they will have a better chance of success.”
• The Stop Tampering of Prescription Pills (STOPP) Act creates a pathway to incentivize and eventually mandate the creation of physical and pharmacological tamper-resistant formulations for commonly abused painkillers by directing the Food and Drug Administration to deny approval to new oral opioids that do not have abuse deterrent properties, if an abuse deterrent drug containing the same opioid is available.
• The Reducing Unused Medications Act allows prescriptions for opioid medications to be partially filled by pharmacists at the request of patients or doctors. The remainder of the prescription could be filled, but not beyond the date that the original prescription would have expired.
“Say I am hurt in an accident,” said Guinta. “The doctor prescribes ten days of medication, but I think I might only need two or three days. If I am wrong, I fill the remainder of the prescription, but unused medication is not left around.”
The only problem Sherman has with this bill is the patient co-pays and pharmacists’ time.
“If patients are expected to pay a co-pay each time, this will not work,” said Sherman. “And, we are adding to the work of the pharmacist. Some adjustments might be needed here. Maybe a better idea is to offer more medication take-back programs.”
• The Jason Simcakoski PROMISE Act directs the Department of Veteran Affairs and the Department of Defense to jointly update the VA/DOD Clinical Practice Guideline for Management of Chronic Pain. It improves the prescription drug monitoring by requiring the Department of Veteran Affairs Medical Clinics to provide specific information about the prescribing of opioids and narcotics to their corresponding state monitoring program.
• The Recovery Enhancement for Addiction Treatment Act increases the number of patients a doctor could treat with buprenorphine for opioid addiction from 30 to 100 patients per year. It would allow qualified nurse practitioners and physician assistants to prescribe the medication and give doctors the ability to remove the patient cap after one year.
“This is a good idea,” said Sherman. “We have places like Families First who are opening programs to deal with addiction. We are already limiting what they can do. They already have more patients than they can treat as it stands right now. We are unnecessarily limiting treatment. Putting numbers into law regarding medicine is problematic.”
• The Reforming and Expanding Access to Treatment Act permits Substance Abuse and Mental Health Services Administration (SAMSHA) grants to provide treatment services to individuals who are incarcerated.
• Cradle Act establishes guidelines for treatment centers caring for newborns with neonatal abstinence syndrome.
• Lali’s Law creates a competitive grant program that will help states increase access to naloxone. The grants would fund state programs that allow pharmacists to distribute naloxone without a prescription.
• Opioid Addiction Treatment Modernization Act modernizes the segregated opioid addiction treatment system to ensure opioid-dependent patients are provided with individualized, evidence-based treatment by requiring that providers are trained on and provide – either directly or by referral – all FDA-approved opioid addiction treatment medications (other than methadone) based on the clinical needs of the patients as determined by the physician. It also requires both addiction treatment settings to provide relapse prevention medication counseling and medication adherence monitoring, and to develop individualized treatment plans and diversion control plans.
• Sentencing Reform Act reforms mandatory minimums for drug offenses by reducing the minimums for two and three strike offenders while strengthening sentencing for individuals convicted of trafficking in fentanyl. The legislation creates a safety valve to allow judges to sentence certain offenders below the required minimum. It allows mandatory minimums to be reduced retroactively.
“We already know that we can’t arrest away this problem,” said Guinta. “We want to help the person who is addicted. We also want the distributors to face the full force of law enforcement. We want to put them away as long as possible.”