Funding fight threatens bipartisan opioid bill in Congress

WASHINGTON — A partisan feud over money to treat drug addicts split a House and Senate conference committee on Wednesday as it considered legislation to address the nation's deadly opioid epidemic, imperiling a bill many had hoped would be one of this Congress' most significant accomplishments.

Democrats on the conference committee lost in their effort to insist that the bill include at least $920 million to help pay for additional treatment of addicts, most of whom cannot find or afford the treatment they need.

The bill would authorize the federal government to provide states with grants to fund training for first responders to treat overdoses, create alternatives to incarceration and investigate ways to combat illegal opioid distribution. The Senate version of the law originally required states receiving grants to set up prescription drug monitoring programs that doctors would have to consult when prescribing the drugs. Such mandatory programs have been found to significantly reduce opioid prescribing.

But after doctors' and pharmacist groups complained that the programs can be burdensome, the final language of the conference report made the adoption of such programs voluntary.

The law is expected to pass the House as early as Friday on a party-line vote, but Senate Democrats said they were still considering their options. Should they decide to filibuster over lack of money for treatment programs, the legislation could founder.

"We all know that without more funding to expand access to medication-assisted treatment, states simply won't have the resources they need to put people on the path to recovery and save lives," Sen. Patty Murray, D-Wash., said during the committee meeting.

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But Rep. Fred Upton, R-Mich., who serves as chairman of the conference committee, responded that funding for additional treatment would be provided by House and Senate Appropriations Committees in separate legislation.

"I would note that just this morning, the House Appropriations Committee announced that they'll be providing some $581 million to address the opioid and heroin abuse," Upton said.

After Upton's comments, the committee defeated a Democratic proposal to add money to the law, known as the Comprehensive Addiction and Recovery Act. Versions of the law passed the Senate and House in March with overwhelming bipartisan majorities — 94-1 in the Senate and 400-5 in the House.

The law is considered crucial to the electoral prospects of embattled Senate Republicans such as Rob Portman of Ohio and Kelly Ayotte of New Hampshire as they campaign for re-election in states that have been devastated by the opioid epidemic. Fatal overdoses from opioids — prescription painkillers and heroin — have continued to rise, taking more than 28,000 lives in 2014, according to the most recent federal health data.

On Wednesday, Portman hailed the conference report as "a significant step forward in our collective efforts to combat this heroin and prescription drug epidemic that is tearing apart families and devastating communities."

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But other members, including Sen. Ron Wyden, D-Ore., criticized the version that emerged from the conference. "Opioid addiction is ripping through many American communities like wildfire, and in my view you cannot fight an inferno with a treatment and prevention package that is no more than a thimbleful of water," he said during the committee meeting.

Gary Mendell, the founder and chief executive of Shatterproof, a New York-based anti-addiction advocacy group, had been lobbying for months to make prescription drug monitoring programs mandatory. He said he was distraught that the requirement had been eliminated and said he also was concerned by the lack of funding. He said he did not know whether he would support the final legislation.

Patrick J. Kennedy, a Democrat who is a former congressman from Rhode Island and former addict, said that even a weak bill was worth passing.

"How can we just let a number of people die from overdoses just so we can make a political point that Republicans are wrong on funding?" Kennedy asked in an interview.

In a conference call with reporters Tuesday, administration officials emphasized that funding to expand addiction treatment was crucial to any effort to address the opioid epidemic, and they said they supported Democratic efforts to insist on money for treatment now

Michael P. Botticelli, the director of the White House Office of National Drug Control Policy, said that Republicans and Democrats had long recognized that "without additional funding and without treatment funding, we're not going to make a dent in this issue."

Botticelli said it was "premature" to declare whether Obama would veto the bill if it did not include additional funding. The administration has asked for $1.1 billion to fight heroin and opioid addictions.

Also on Tuesday, administration officials announced that they would increase the number of patients that qualified physicians who prescribe a specific drug for opioid abuse could treat to 275 patients, up from 100.

There are about 2.2 million opioid addicts in the United States, of whom about 1 million received some form of treatment in 2014. Somewhere between 600,000 and 650,000 people were given the drug buprenorphine. Administration officials estimated that the rule change could increase the number of patients getting such treatment by up to 70,000 in the first year, still leaving most untreated but expanding care nonetheless.

Buprenorphine is one of the few drugs known to help addicts kick the habit, but it has its own set of problems, since it can be used as both a medication and a way to get high.

Like methadone, another treatment for opioid addiction, buprenorphine is an opioid itself and can produce euphoria and cause dependency. Its effects are milder, however, and they plateau, making overdoses less likely — and less deadly. Buprenorphine is available by prescription to treat addiction only from federally authorized doctors with restricted patient loads.

Partly because of these restrictions, a volatile subculture has arisen, with cash-only buprenorphine clinics feeding a thriving underground market. The administration's new rule is intended in part to resolve some of these problems. The American Medical Association applauded the new rule.