“I never considered a difference of opinion in politics, in religion, in philosophy, as cause for withdrawing from a friend.” – Thomas Jefferson
“The story of the War on Drugs is a story of the law of unintended consequences.” – Neil Woods
I am really excited about writing a post about “warm handoffs” as a way of battling the addiction crisis but my son pointed me to a sweeping drug bill in congress, so I will address that today. This will also give me more time to talk with the RASE Project, the group responsible for warm handoffs here in Lancaster County, Pennsylvania.
Let me just say upfront that I am disgusted with the state of partisan politics in this country and I blame both sides equally. I have my political leanings, but I find that each side is attacking the other with such venom that we are achieving nothing but a wider gap between people with differing views. So, after that disclosure, please join me in a discussion of a significant bill in that the House and Senate are working on together that looks to offer help in battling the addiction crisis. You can find it at (https://docs.house.gov/billsthisweek/20180924/hr6.pdf). The short title is H.R. 6 – SUPPORT for Patients and Communities Act, which I will just refer to as the SUPPORT Bill.
A Common Enemy Yields Bipartisan Action
As I said, I am deeply bothered by the political divide in this country and it’s associated venomous rhetoric. The consequences of the addiction crisis, however, are so severe that they have brought the two sides together to create a bill to address them. I do not have the time to read the entire 660-page bill and no one would read this blog if I tried to cover it all. So, I will make many generalizations about what has been proposed. I am always very concerned about unintended consequences of our actions, but from what I have seen of the SUPPORT Bill there do not seem to be major problems. There no doubt will be issues overlooked and money wasted but that is a function of dealing with such a massive problem. Getting it right will take several attempts.
Hopefully, we can get both sides to continue to work together and get this bill signed into law. You may not agree with every aspect of the SUPPORT Bill and you may wish that it did more, but it is addressing some of the prominent issues in this crisis.
All of this was accomplished without “throwing a bone” to big drug companies, whom many people consider a large part of the problem. The drug companies lobbied hard to get a provision in the bill that would reduce how much profit they must give up supplying medicines to senior citizens that fall in the Medicare donut hole. This is was rejected, making the drug companies continue to provide medicine to senior citizens at a greatly reduced cost under certain circumstances.
Another “bone” that the pharmaceutical companies were hoping to get was a rollback of the CREATE Bill that is designed to streamline or encourage the development of cheaper generic drugs. This will cut into drug companies profits by providing more competition. The CREATE Bill was specifically left out of the discussion for the SUPPORT bill, thereby leaving it intact.
Medicaid
Several of the aspects of the SUPPORT Bill deal with Medicaid requiring greater coverage for; addiction treatment, addiction recovery, greater support for “at risk” groups, and supporting greater access to alternatives to opiate painkillers.
• This bill aims to provide greater Medicare coverage for mothers and addicted babies.
• The bill will permit Medicaid to provide money for housing for some of those struggling with addiction.
• The bill also permits Medicaid funds to be used with more flexibility in order to support alternative treatment strategies like long distance health services through the telephone or internet.
• This bill appears to be making an attempt to help senior citizens who are dealing with opiates and addiction due to over-prescribing of opiate painkillers. Few of us consider that grandparents may have addiction issues, but I have heard that overuse and high costs of opiate painkillers have driven some seniors to seek street-drugs like heroin.
• This bill requires the suspension of Medicaid payments in response to credible allegations of fraud by pharmacies.
Much of the Medicaid provisions use words like “study”, “encourage”, and “evaluation” which no doubt will result in a great deal of money wasted on bureaucratic red tape. However, there appears to be a significant attempt to provide greater Medicaid coverage to those in need as a result of addiction.
Food and Drug Administration (FDA)
The SUPPORT Bill has several provisions to reduce the flow of legal and illegal opioids. The SUPPORT bill will:
• Have the FDA work to support the use of non-opioid treatments and will provide specific guidelines for the prescribing of opioids.
• The bill attempts to reduce the flow of illegal drugs across our borders and the manufacturing of counterfeit drugs. It is my understanding that you can obtain the necessary materials to manufacture synthetic opioids by mail, typically from China.
• The bill proposes greater coordination between the FDA and the Customs and Border Patrol, who are responsible for preventing the flow of drugs across our borders.
• The bill also requires that there be greater safety-enhancing packaging and disposal features for unused drugs.
Disposal of drugs brings up an interesting point. We often leave unused drugs sitting around the house, which in some cases is an open invitation to abuse. However, when we decide to get rid of the drugs we usually flush them down the toilet. You should know that our sewer plants are not equipped to breakdown many drugs and so these drugs end up in our streams. We have seen adverse effects from hormones on fish populations as a result of these compounds passing through sewer plants untreated. So, consider where your drugs end up. Many police departments have drop boxes where you can dispose of unwanted prescription drugs.
The Bottomline
What do I take from this rather boring discussion of new legislation? One of the few (maybe only) positive things about the opioid crisis is that it is something that is forcing this deeply divided country of ours to work together. Secondly, if you talk with addicts or those providing care for addicts, you will hear of numerous shortfalls in our funding of treatment that will make your head explode. The SUPPORT Bill is attempting to address many of these issues involving Medicaid.
Did I miss something important? Do you have thoughts to share about addiction that may have nothing to do with this post? Please comment, let’s work together and help each other to solve this problem.
I hope that you will join me next week for a discussion of “Warm Handoffs, A Brilliant Idea”.