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Will Bipartisan US Opioid Law Go Far Enough to Save Lives?

Allison Inserro
As Election Day 2018 nears, President Trump and Congress pulled off a rare feat, rallying around the signing of bipartisan legislation that will attempt to combat opioid use disorder, which took more than 42,000 lives in 2016.
As Election Day 2018 nears, President Trump and Congress pulled off a rare feat, rallying around the signing of bipartisan legislation that will attempt to combat opioid use disorder, which took more than 42,000 lives in 2016.

According to the White House, the law—actually a package of dozens of bills stitched together in a series of marathon hearings earlier this year—seeks to reduce demand, cut the flow of illegal drugs into the country, and expand evidence-based treatment.

At the bill signing ceremony, representatives from 21 companies or organizations were in attendance, having decided to support the effort in various ways.

Blue Cross Blue Shield Association (BCBS), for instance, reaffirmed its intent to launch Blue Distinction Centers for Substance Use Treatment and Recovery. BCBS will also establish a free national hotline to help people, even those not covered by the company, locate treatment centers. But it will be 2 years before either program is up and running.

For those who work in the field, there are questions about how this will all work and what the impact will be.

“Frankly, the things that are helpful about all of this is related to a broader discussion and decreasing stigma,” said Arwen Podesta, MD, ABPN, FASAM, ABIHM, a psychiatrist in Louisiana who is presenting about medication assisted treatment at the Psych Congress 2018 annual meeting this weekend. “But addiction is addiction, and even though this opioid thing is out of control, it is certainly not the only problem. There are genetic and biological underpinnings of addiction for some people, and traumatic underpinnings for others. And some with both. So removing the drug is never the only thing—we have to treat the biology and the environment, too.”

In an email to The American Journal of Managed Care®, Podesta said implementation will be key. “How exactly will each state use the money? Will they actually improve access to quality treatment or just low level treatment? Are we improving quality of life or just preventing overdoses? There needs to be much more education on the underlying reasons people get addicted in the first place, and on early interventions and quality treatment types.”

The law does seek to increase the quality of treatment centers; it also makes changes to Medicare and Medicaid as they relate to substance use disorder. And Thursday, America’s Health Insurance Plans released a report about low-quality, fraudulent “sober homes,” which the law also targets.

Also this week, the American Society of Addiction Medicine launched an educational program for primary care providers seeking additional training on treating addiction. Increasing the number of primary care clinicians able to offer medication-assisted treatment is another goal of the law.

Still, there is the question of funding—the law includes about $7 billion over 2 years to fight the problem, and the money was already authorized. Some health experts have said that much more is needed, and last spring, Senator Elizabeth Warren, D-Massachusetts, and Representative Elijah Cummings, D-Maryland, called for $100 billion a year for 10 years to be spent on the problem.

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