Thoughts On A New Bill To Expand Addiction Treatment

Sep 17, 2014

Sen. Sheldon Whitehouse, along with Sen. Rob Portman (R-OH), has introduced legislation that's designed to provide some incentives and resources for states to develop more addiction treatment and prevention programs. It's called the Comprehensive Addiction and Recovery Act of 2014, and here are a few of its provisions, according to a news release from the Senator's office:

  • Expand prevention and educational efforts—particularly aimed at teens, parents and other caretakers, and aging populations—to prevent the abuse of opioids and heroin and to promote treatment and recovery.
  • Expand the availability of naloxone to law enforcement agencies and other first responders to help in the reversal of overdoses to save lives.
  • Expand resources to identify and treat incarcerated individuals suffering from addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence-based treatment.
  • Launch an evidence-based opioid and heroin treatment and interventions program.  While we have medications that can help treat addiction, there is a critical need to get the training and resources necessary to expand treatment best practices throughout the country.
  • Strengthen prescription drug monitoring programs to help states monitor and track prescription drug diversion and to help at-risk individuals access services.

In August, Sen. Jack Reed also introduced a bill that would, in part, make more naloxone (or Narcan), the opioid overdose rescue drug, available to states. So are the Senators' efforts overlapping? Perhaps not. Here's what Whitehouse's spokesman Seth Larson told me today via email:

"Senator Whitehouse cosponsored Reed’s bill and their offices have been in touch on this issue. The main difference here is that Reed’s bill addresses naloxone specifically, while Whitehouse’s bill tackles a broader range of addiction and recovery issues. We felt that the naloxone provision was important to include in our comprehensive bill, but Senator Whitehouse also supports Senator Reed’s legislation. Both would provide important funding to help make naloxone more widely available."

Larson also answered some of my questions about how Whitehouse's bill would be funded. It's one thing to call on states to provide more addiction treatment and prevention. It's another to expect them to do it with limited funding. So here's what he says:

"Senator Whitehouse’s legislation would make approximately $80 million available to help states and local governments improve drug prevention, treatment, and recovery efforts, and incentivize a more comprehensive approach. ... The bill also provides grants for states and non-profits seeking to expand services for individuals in recovery from substance use disorder.  States and local governments will be able to apply for funding through Senator Whitehouse’s bill to help bolster their efforts....  Additionally, once they have developed plans for addressing certain key goals, they will be eligible to apply for additional funding to implement those plans.  In other words, the bill would give folks a checklist of addiction and recovery goals.  It would make some funding available to help governments complete the checklist, but it would also reward them once they complete it by making them eligible for additional funds."

The legislation has been endorsed by former Rhode Island representative and founder of the Kennedy Forum Patrick Kennedy.

More funding and a comprehensive approach to addiction - prevention and treatment, not just punishment and treatment, for example - could help plenty of addicts get into recovery or even prevent kids from starting on the road to addiction in the first place. But here are a few thoughts on the bill's other components:

- The state's prescription drug monitoring database could definitely use the funding this legislation might be able to provide, because it's currently running on bits and pieces of funding the health department is able to cobble together. That said, a prescription drug monitoring database isn't the only answer to our drug problems. It doesn't capture drugs bought on the street, and most physicians/prescribers in Rhode Island are not currently checking it before prescribing addictive painkillers.

- The bill emphasizes expanding access to "evidence-based" opioid addiction treatment programs. There's some disagreement about what constitutes effective treatment for opioid addicts, but I can tell you that many doctors in the field tell me that medication-assisted treatment (including methadone or Suboxone) should be on the list for people who are addicted to painkillers or heroin.

- There's a lot of emphasis in the bill on opioids. And that's important, because we're facing a prescription painkiller and heroin addiction epidemic, no doubt. But far more people are struggling with alcoholism. And it would be a shame to see resources dedicated to one group of addicts at the expense of another. I don't think anyone's proposing that, necessarily, but I submit that we need to keep the totality of addiction - in all its forms - in mind when allotting resources.