(Story updated at 1:22 p.m. ET Wednesday, July 13.)
The fate of first bill in at least 30 years aimed at curbing drug abuse hangs in the Senate. Patient advocates view the Comprehensive Addiction and Recovery Act (PDF) as decriminalizing drug addiction.
Lawmakers voted 90-2 in favor of ending debate on the bill. Senate Democrats are concerned about the bill's lack of funding. Republican lawmakers say the funding will come through the fiscal 2017 spending bill. Last week, the House overwhelmingly passed the legislation that supports resources to prevent and treat opioid and heroin addiction.
The bill's provisions include expanding access to medication-assisted treatments, strengthening state prescription drug monitoring programs, developing best practices for providers to improve prescribing of opioids, and making the overdose counteracting drug naloxone available to law enforcement agencies and first responders.
The bill is a departure from anti-drug bills passed in the 1980s, when laws such as the Comprehensive Crime Control Act of 1984 and the Anti-Drug Abuse Act of 1986 focused on criminalizing and incarcerating drug users rather than getting them treatment or supporting prevention efforts.
One of those changes eliminated a provision requiring doctors to consult databases maintained by drug monitoring programs before prescribing opioids to patients. Another provision included in the final version of the bill exempts makers of opioid pain relievers from requirements to charge lower prices to the Medicaid program if they can show their products have new abuse-deterrent formulations. The Congressional Budget Office has estimated the measure would cost Medicaid $75 million over the next 10 years.
Addiction medicine experts say the new approach reflects a changing attitude toward substance abuse, one that views the condition as a public health issue.
“The legislation is a culmination of the reality that we have more science and knowledge about how to treat this disease than the vast majority of diseases out there,” said Dr. R. Corey Waller, chair of the legislative advocacy committee for the American Society of Addiction Medicine. “Now that we have this, it enables us to feel very comfortable that our approach to treatment is as scientific as any other disease treatment that we have.”
While many view CARA's passing as a huge step forward, Waller said there are still concern that inadequate funding could hamper the bill's potential impact. He said the area most impacted would be access to addiction treatment resources, where only about 11% of the 23 million people in need of such services receive them, according to the National Institute on Drug Abuse.
Democrats had advocated including $920 million to provide states with treatment and prevention resources. Republican lawmakers rejected the proposal, opting to fund the bill as a part of the appropriations process for the fiscal year 2017 budget. A recently-released Republican draft of the funding bill would provide more than $580 million to combat opioid and heroin abuse.
Anti-addiction experts hope CARA represents a stronger commitment by the federal government to treat addiction.
“It begins the framework for discussion during the appropriations process,” Waller said. “Without having a specific fund dedicated to the implementation of this bill it definitely makes it harder, but not impossible.”
The issue over funding will remain a key issue. On Wednesday, a number of health officials called on Congress to find money to support the efforts.
“We have made significant strides around the disease of addiction, but we cannot continue to make progress without also providing funding for quality, on-demand treatment,” said Baltimore City Health Commissioner Dr. Leana Wen in a written statement. “While I support the package of opioid policies passed, it will take actual dedicated funding to attack this crisis—funding that this legislation unfortunately does not provide.”
At a White House press briefing last week, Press Secretary Josh Earnest said there was a chance President Barack Obama might not sign the bill without appropriated funding.
“If there is a bill that reaches the president's desk that is geared toward fighting the opioid epidemic but doesn't include any funding, I certainly cannot promise that the president would sign it," Earnest said. “So we'll see what they do, but hopefully Republicans in Congress will listen to the calls from Democrats and Republicans alike who are asking for more resources to deal with this significant emergency.”