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U.S. Senate Shows Leadership in Bipartisan Response to Opioid Epidemic
Article by: Brad Bachman
This March has been a historical month for the government agencies, medical associations, recovery organizations, providers, patients, families and communities that have long been advocating for the treatment of addiction as a disease. The United States Senate almost unanimously passed the first legislation to address addiction and drug use in over a decade. The Comprehensive Addiction and Recovery Act (CARA) will provide a broad response to the opioid and addiction epidemic through prevention, treatment, recovery and law enforcement programs.
Less than a week later, the Senate continued its bipartisan work on confronting the opioid epidemic. The Senate Health, Education, Labor and Pensions (HELP) Committee approved by voice vote five bills on mental health and addiction, one of which is The Recovery Enhancement for Addiction Treatment Act (TREAT Act). The amended version of the bill that the HELP Committee approved would raise the patient limits on physicians who are certified to prescribe buprenorphine for opioid treatment and allow nurse practitioners and physicians assistants to prescribe buprenorphine where permitted by state law.
While these victories are significant accomplishments for those in the addiction medicine field, it is important to clarify their status in the legislative process and put them in context of the current political environment on Capitol Hill.
After beginning debate on CARA on Monday, February 29, the Senate voted to pass the bill 94 to 1 on Thursday, March 10. This was after a quick, but contentious discussion regarding the nearly 60 amendments that were introduced to the bill from both sides of the aisle on topics ranging from mandatory prescriber education to cooperative purchasing agreements for naloxone. Senate leadership was adamant about keeping debate to a package of amendments that were non-controversial, but a key vote was held for an amendment filed by Sen. Jeanne Shaheen (D-NH) that would appropriate $600 million to the bill. Senate Democrats were concerned that the $80 million under CARA would not be enough to fight the epidemic, while Senate Republicans assured them that there is approximately $400 million included in last year’s omnibus spending bill that could be directed toward CARA. Ultimately, Sen. Shaheen’s amendment failed to be included by twelve votes.
CARA now moves on to the House of Representatives where it will be considered by the Judiciary, Energy and Commerce and Education and Workforce Committees. The bill will need to be approved by the committees it is assigned to before it can be up for debate on the House floor. A similar process that happened in the Senate will need to take place on the House side. Cloture votes must be held on whether to begin and end debate on the bill and any amendments introduced, followed by a final vote for passage that will send CARA to President Obama’s desk to be signed into law.
The Senate HELP Committee had announced since the beginning of March that they would be marking up bills on mental health and addiction. However, it wasn’t known until a few days before the hearing that TREAT Act would be among the bills being marked up. Thanks to the support of Carol McDaid and Holly Strain from Capitol Decisions, ASAM’s Board Member Dr. Yngvild Olsen along with ASAM’s CEO and Executive Vice President, Penny Mills, met with many members of the Senate HELP Committee in the week leading up to the markup. These meetings focused on key provisions and legislative language around raising the patient limits for buprenorphine prescribers. The TREAT Act that passed the HELP Committee was amended by a manager's amendment introduced by Senators Edward J. Markey (D-Mass.) and Rand Paul (R-Ky.). The amended legislation would increase the limits on buprenorphine prescribers from 30 to 100 in the first year and from 100 to 500 thereafter. In addition, the bill also allows nurse practitioners and physicians assistants to prescribe buprenorphine for up to 100 patients where state law allows them to prescribe controlled substances and state law requirements would also determine physician collaboration or supervision for prescribing.
TREAT Act now heads to the Senate floor where cloture votes will be held on whether to begin and end debate on the bill and any amendments introduced, followed by a final vote of passage that will send the legislation to the House side. During the HELP Committee markup, Sen. Orrin Hatch (R-UT), one of the authors of the original buprenorphine law, DATA 2000, asked to be added as a cosponsor to the bill. He then went on to express his support for an expeditious floor consideration of this bill in the face of the opioid epidemic and the destruction it has brought on families and communities. Senate passage of TREAT Act would send the legislation to the House side to be approved by committee, debated on the floor and voted for passage.
ASAM would like to thank all of its members who reached out to their Senators regarding the passing of CARA. It is safe to say that the work and advocacy done by our members has contributed to the passage of this landmark legislation. With that said, our work is not done yet! ASAM will be developing online engagement tools for members to call or email their members of Congress. Please contact your Senators to encourage them to vote in favor of TREAT Act and your Representatives to vote in favor of CARA!
