APPROXIMATELY 60,000 people died from non-methadone opioid overdoses in the United States last year, according to preliminary data from the Centers for Disease Control and Prevention. If you squint at the CDC statistics very hard, you can barely make out a positive trend: the growth in deaths attributable to heroin and common forms of prescription opioids seems to have slowed between 2015 and 2017. However, that smidgen of progress was more than offset by a wave of death from synthetic opioids, primarily fentanyl, which killed 29,406 people in 2017 — up from roughly 3,000 in 2013.
The United States’ opioid addiction and overdose epidemic, in short, is not withering away but morphing into a new and deadly form. The federal government is still playing catch-up. Each house of Congress has passed a package of measures this year, with the Senate having acted on its version of the legislation Sept. 17. The vote in the upper chamber was 99 to 1, and, as is often the case on Capitol Hill, wide bipartisan support indicated that lawmakers had settled on the lowest common denominator of policy: a series of incremental reforms that will help here and there, but still fall far short of what’s needed: an all-out national effort akin to the one that finally began to slow the AIDS epidemic.
Though a House-Senate conference is still needed to iron out differences, the main provisions of the two bills would reauthorize grants to states and Indian tribes for opioid addiction prevention, response and treatment; support medication-assisted treatment; channel funds into the development of non-addictive painkillers; require special safety packaging for opioids; and encourage state prescription drug monitoring programs (PDMPs), which help pharmacists and doctors spot potentially drug-seeking addicted patients, to share data.
Probably the most significant potential change under consideration is the STOP Act, legislation aimed at the flow of fentanyl from abroad, especially from China. Given that the drug is so highly concentrated, large numbers of doses may be shipped through international mail. The STOP Act authorizes U.S. Customs and Border Protection to process shipments and requires postal shippers to put advanced electronic data on packages, including the names and addresses of senders and recipients, plus details about the parcels’ contents. Under the bill, it would have to be on at least 70 percent of international mail arriving to the United States by Dec. 31, 2018, and 100 percent by Dec. 31, 2020.
Still unresolved between the two houses is whether to allow larger facilities to provide short-term treatment of up to 15 days paid for by Medicaid, rather than only facilities of 16 beds or smaller as at present. The law, devised in an era when Congress was trying to help phase out large, state-run mental hospitals, probably needs an update, but won’t be of much help in fighting the current crisis unless there’s generous funding for the follow-up treatment that most patients require. That’s expensive; in fact, any truly effective approach to the opioid crisis is going to take billions of dollars over many years. The Trump administration and lawmakers of both parties may claim credit for the start this Congress is making, but they’ve left a lot more work for the next one.