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Tuesday, September 18, 2018

U.S. Senate passes 70 opioid bills, two from McConnell; House-Senate compromise in works for final passage

The U.S. Senate passed a comprehensive, bipartisan opioid package Monday that focuses on prevention and treatment that includes two measures sponsored by U.S. Senate Majority Leader Mitch McConnell. A House-Senate compromise is in the works for final passage.

“The CAREER Act will help individuals in recovery find the housing and the job opportunities they need to rebuild lives of sobriety. And the Protecting Mothers and Infants Act will help the federal government do more to support pregnant women and protect unborn children from these drugs," McConnell said in a news release. "This landmark legislation is like a Swiss army knife that will help the federal government fight opioid addiction in many different ways."

The legislation, comprising 70 bills, passed on a 99-1 vote with Sen. Mike Lee, R-Utah, dissenting. The $8.4 billion package "creates, expands and renews programs across multiple agencies," including provisions to prevent the "deadly synthetic drug fentanyl from being shipped through the U.S. Postal Service as well as allowing doctors to prescribe more medication designed to wean addicts off opioids, such as buprenorphine," Colby Itkowitz reports for The Washington Post.

Opioids were responsible for nearly 50,000 deaths last year, 1,565 of them in Kentucky. President Donald Trump declared the opioid epidemic a public-health emergency in October.

While lawmakers say the bill is a "step in the right direction," many health advocates and experts say it's not enough because it doesn't provide enough money to "fully combat" the crisis, Itkowitz reports.

Sarah Wakeman,the medical director for Massachusetts General Hospital’s Substance Use Disorders Initiative, told the Post that “Really targeting the depth of the opioid epidemic would require an infusion of federal dollars on par with the more than $20 billion a year spent on HIV/AIDS. . . . We have historically not thought of addiction as a medical issue and so our health care and public health system are woefully unprepared to respond in a robust way.”

The House passed its opioids package in June. It included 58 opioid bills, with two of the measures sponsored by Rep. Hal Rogers, Republican from Eastern Kentucky's 5th Congressional District.

According to the Senate bill's author, Sen. Lamar Alexander, R-Tennessee, the Senate and House expect to work out their differences by Friday, Sept. 21, so they can vote on a final bill in the next two weeks, and present it to the president by early October, CBS News reports.

One key difference in the bills is a decades-old federal rule that prevents Medicaid for paying for care at inpatient treatment facilities with more than 16 beds, called the IMD exclusion.

"The House bill partially overturns the IMD exclusion for mental-health patients who also have an opioid use disorder, which the Congressional Budget Office says would cost nearly $1 billion over the next 10 years," the Post reports. "The Senate bill makes some changes to the IMD rule, including making sure pregnant and postpartum women continue receiving Medicaid-covered services administered outside such facilities, such as prenatal care. But it doesn’t allow Medicaid to pay for addiction treatment in bigger facilities."

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