On opioids, talk is cheap
To be sure, there is a lot to like in the proposals House and Senate negotiators are hammering out. For the most part, they treat opioid addiction as a public health problem rather than a law enforcement issue, and they focus mainly on prevention and treatment. That's a big philosophical step forward for Congress, where until recently a tough-on-crime approach held sway in both parties.
Among the proposals that have passed one or both chambers of Congress are measures to expand the availability of anti-overdose medications like naloxone (including a bill sponsored by Rep. John Sarbanes of Maryland); regulate the approval of new and potentially addictive pain medications by the Food and Drug Administration; study the adequacy of drug treatment facilities; develop better protocols for the prescription of opioids for pain treatment; and authorize the attorney general to provide grants to state and tribal governments for addiction prevention and treatment. Negotiators in a conference committee wrapped up work on Wednesday, and a final vote could come within the week.
But there's a big catch: Though the legislation authorizes grants to the states, they don't actually appropriate any money. President Barack Obama has requested $1.1 billion in new spending to combat addiction, most of it for grants to help states expand treatment. On Wednesday, House and Senate Democrats introduced amendments that would have appropriated $920 million for that purpose, but they were unanimously rejected by the Republicans in the conference committee despite the fact that Democrats provided a list of suggestions for spending cuts that would have more than offset the cost.
Republicans have insisted that the funding be appropriated through the normal budget process, and House Republicans on Wednesday unveiled a health care spending proposal that includes $525 million for opioid abuse. But that's wholly inadequate for a host of reasons. Not only is it too little, it is also far from certain to ever become law. Included in the same legislation is an attempt to gut the Affordable Care Act by stripping money for its implementation, which makes it a non-starter. Even absent that, Congress' recent history of muddling through the appropriations process with continuing resolutions rather than proper budgets raises real questions about whether a promise of funds in the fall is anything more than a hollow gesture.
Gov. Larry Hogan's administration is negotiating with the federal government to expand Medicaid coverage of drug treatment; working to improve continuity of health care and treatment for people leaving the prison system; providing doctors with better tools to assess pain and training on treating pain without resorting to addictive drugs; and expanding the availability of naloxone. But a full commitment from the federal government would provide an invaluable boost to those efforts. The state would gain about $17 million a year for treatment programs under President Obama's funding proposal.
This isn't something Congress can afford to kick down the road for a couple more years. Overdose deaths nationally have more than quadrupled in the last 14 years as more and more people have become hooked on painkillers and, increasingly, have turned to street drugs like heroin. In Maryland, the number of alcohol and drug overdose deaths in the first three months of this year was up 20 percent over the same period last year, with heroin, prescription opioids and fentanyl (or a combination thereof) the chief culprits. President Barack Obama can take some steps on his own, like the administration's overdue decision this week to raise the cap on the number of patients to whom a doctor can prescribe buprenorphine, but a comprehensive response to the addiction crisis is going to require Congress to appropriate more funds for treatment.