House Passes Slate of Opioid Bills, Moves to Conference on Bill to Raise Prescribing Limit

The week of May 9, the House of Representatives dedicated several days of Floor time to the consideration of multiple bills related to opioid addiction and the overdose epidemic.  This week’s action comes as House leaders have said they want to go to conference with the Senate quickly to iron out differences between House and Senate versions of the bills so legislation will be ready to go to the President’s desk for his signature by the end of June. 

Two ASAM-endorsed bills were among those approved: The Co-Prescribing to Reduce Overdoses Act of 2016 (HR 3680) and the Opioid Use Disorder Treatment Expansion and Modernization Act (HR 4981). The full list is available below.

HR 4981, as approved by the Energy and Commerce Committee last week, would have raised the DATA 2000 patient limit to 250 and expanded prescribing privileges to nurse practitioners and physician assistants. ASAM worked closely with the sponsors, Reps. Bucshon (R-IN) and Tonko (D-NY), over the past year to help create a bill that would expand access to treatment and create additional safeguards to ensure care quality. Unfortunately, the bill was modified from the version approved by the Energy and Commerce Committee due to cost concerns.  The bill approved this week:

• Includes only a “Sense of Congress” (language which doesn’t have the force of law) that HHS should increase the caps on buprenorphine prescribing by physicians to 250 patients
• Only temporarily permits nurse practitioners and physician assistants to prescribe buprenorphine for 3 years (the bill as reported permanently allowed them to prescribe) 

The bill was scaled back after the Congressional Budget Office (CBO) estimated the cost of the legislation would be approximately $700 million over 10 years.  While bill sponsors said they were disappointed the scaled back bill was brought to the floor, without an offset to pay for the legislation, the alternative would have been to pull the bill from the House schedule entirely.  By bringing it forward in the more limited fashion, the hope is to tee it up for conference negotiations with the Senate.  On the floor, bill sponsor Rep. Tonko called on Congress to replace the Sense of Congress with a statutory increase and permanently permit mid-level prescribing during the House/Senate negotiation process.  

Before the House vote, ASAM sent this letter to House leadership expressing our continued support for the process but the need for the legislation to go further if it’s going to have a meaningful impact on the current epidemic. After approval, ASAM President Jeffrey Goldsmith issued the following statement:

The American Society of Addiction Medicine is excited to hear that the House has passed the Opioid Use Disorder Treatment Expansion and Modernization Act (HR 4981). This bill is a good first step and we are pleased it temporarily permits nurse practitioners and physician assistants to prescribe buprenorphine.  However, we are very concerned the bill does not increase the number of patients to whom a physician may prescribe buprenorphine. We look forward to working with House and Senate conferences to reinstate this critical provision, which will increase access to life-saving addiction treatment.

The other ASAM-endorsed bill, HR 3680, establishes grant programs to encourage and train health care providers to co-prescribe naloxone with opioid prescriptions for patients at high risk of overdose.  The Energy and Commerce Committee included an offset to pay for the bill when it considered the legislation earlier this month.   

Despite the number of bills passed, one missing piece is the lack of new funding, which Democrats have heavily criticized. However, there are reports that Appropriations Committee Chair Rogers (R-KY) has committed to funding an additional $103 million to address the opioid misuse and overdose epidemic. Additionally, to address this lack of funding, a Democratic substitute was introduced yesterday, HR 5188.  This bill is not expected to pass but will be a marker in the negotiations 

Bills Passed

H.R. 4063 – Jason Simcakoski PROMISE Act, as amended (Sponsored by Rep. Gus Bilirakis / Veterans’ Affairs Committee)

H.R. 4985 – Kingpin Designation Improvement Act of 2016 (Sponsored by Rep. John Katko / Foreign Affairs Committee)

S. 32 – Transnational Drug Trafficking Act of 2015 (Sponsored by Sen. Dianne Feinstein / Judiciary Committee)

H.R. 5048 – Good Samaritan Assessment Act of 2016 (Sponsored by Rep. Frank Guinta / Judiciary Committee)

H.R. 5052 – OPEN Act (Sponsored by Rep. Kevin McCarthy / Judiciary Committee)

H.R. 4843 – Infant Plan of Safe Care Improvement Act (Sponsored by Rep. Lou Barletta / Education and the Workforce Committee)

H.R. 4978 – NAS Healthy Babies Act, as amended (Sponsored by Rep. Evan Jenkins / Energy and Commerce Committee)

H.R. 3680 – Co-Prescribing to Reduce Overdoses Act of 2016, as amended (Sponsored by Rep. John Sarbanes / Energy and Commerce Committee)

H.R. 3691 – Improving Treatment for Pregnant and Postpartum Women Act of 2016 (Sponsored by Rep. Ben Ray Lujan / Energy and Commerce Committee)

H.R. 1818 – Veteran Emergency Medical Technician Support Act of 2016 (Sponsored by Rep. Adam Kinzinger / Energy and Commerce Committee)

H.R. 4969 – John Thomas Decker Act of 2016 (Sponsored by Rep. Pat Meehan / Energy and Commerce Committee)

H.R. 4586 – Lali’s Law (Sponsored by Rep. Bob Dold / Energy and Commerce Committee)

H.R. 4599 – Reducing Unused Medications Act of 2016 (Sponsored by Rep. Katherine Clark / Energy and Commerce Committee)

H.R. 4976 – Opioid Review Modernization Act of 2016 (Sponsored by Rep. Sean Patrick Maloney / Energy and Commerce Committee)

H.R. 4982 – Examining Opioid Treatment Infrastructure Act of 2016 (Sponsored by Rep. Bill Foster / Energy and Commerce Committee)

H.R. 4981 – Opioid Use Disorder Treatment Expansion and Modernization Act, as amended (Sponsored by Rep. Larry Bucshon / Energy and Commerce Committee)

H.R. 4641 – To provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes (Sponsored by Rep. Susan Brooks / Energy and Commerce Committee)

H.R. 5046 – Comprehensive Opioid Abuse Reduction Act of 2016, Rules Committee Print (Sponsored by Rep. Jim Sensenbrenner / Judiciary Committee)