There are several bills floating around the hallowed halls of Congress that address methadone and Suboxone treatment. A search through news websites shows that many journalists are confused about which bill addresses what. You can keep your scorecard accurate by reading these descriptions of the bills that affect medication-assisted therapy whether it’s utilizing methadone or Suboxone treatment. All of them now sit in committee but should be addressed in 2016.
H.R. 2536 – The Treat Act: Recovery Enhancement for Addiction Treatment Act.
Right now, the physicians who obtain training necessary to offer Suboxone treatment can care for only 30 clients in the first year after that training. After that, the government limits them to 100. Even if they practice at multiple locations, the clients across all locations cannot exceed 100. The Treat Act will allow them to manage up to 100 clients in the first year and an unlimited number afterward.
Opponents are concerned about the potential for abusing treatment privileges by herding clients or patients into their offices without regard to their progress. Such a practice becomes a literal money machine for the doctors. Supporters, however, worry about the waiting lists in many parts of the country that prevent people from accessing Suboxone treatment when they need it. People who have to wait to get help will almost certainly go back out and use, and who knows if that will be the time when they overdose and die.
Qualifying practitioners currently include the physicians who receive the training; passage of this Act means that physicians can also qualify through the American Board of Addiction Medicine’s certification process. Nurse practitioners and physician’s assistants will also be able to qualify as Suboxone treatment providers.
This Act would mandate evaluation of its success so that a plan to update and improve it will automatically follow its implementation.
H.R. 953 – CARA: The Comprehensive Addiction and Recovery Act of 2015
CARA is a wide-ranging bill that addresses prevention and education; law enforcement and treatment; treatment and recovery; collateral consequences; and services specifically for women and veterans.
Prevention and Education: An interagency task force will address best practices for pain management—a serious issue for many people who end up in methadone or Suboxone treatment. The Attorney General’s office will designate funds to special populations such as teens and the elderly to educate them about opioids and heroin. Grants will be directed toward communities where there are spikes in extended or increased periods of drug use.
Law Enforcement and Treatment: Funding will increase for programs like Treatment Alternatives to incarceration Programs (TAIP), also known as Treatment Alternatives to Street Crimes (TASC). Grants will facilitate expanded training in the use of naloxone used to reverse opioid overdose. Additional monies will fund the expansion of drug take-back systems so that opioid pain pills don’t sit in medicine cabinets, waiting for experimenting hands to grab them.
Treatment and Recovery: Monies will become available to increase treatment in places where opioid drug use spirals upward, so that both treatment and education (above) are available. This will include methadone and Suboxone treatment. A National Youth Recovery Initiative will target high schools and colleges in order to reach young adults. Grants will expand the creation of recovery communities to accommodate more people in treatment.
Addressing Collateral Consequences: Grants will pay to educate the people who end up in jail, prisons, or juvenile detention centers as a result of drug-related crimes. FAFSA forms will no longer require students applying for federal aid for college to answer whether they’ve been convicted for drug charges. A national task force comprising multi-resource agencies will identify the most common consequences of drug use and pinpoint ways to stop them.
Addiction and Recovery Services for Women and Veterans: Grants will expand state services for women who have children or are expecting them. Family-based substance abuse treatment will keep parents with their children while they work on recovery, instead of going to jail. Veterans’ treatment programs will address the specific needs of our wounded warriors who now need our help.
H.R. 2872 – Opioid Addiction Treatment Modernization Act
People who offer buprenorphine or Suboxone treatment in opioid treatment programs (OTPs) have long felt concern about the loose standards that exist in office-based opioid treatment programs (OBOTs). Finally, the doctors who hold office hours to pass out Suboxone prescriptions will find themselves held accountable—at long last—for providing genuine therapy to the people they supposedly serve. The congressman who introduced this bill is, in fact, a physician himself. He has long been concerned about the doctors running OBOTs who provide no actual medical care or counseling—they just pass out prescriptions to the people who line up at their office doors and then rake in the cash. This bill, however, has a poor prognosis for passage as it is now.
H.R. 1988 – BAA: Breaking Addiction Act of 2015
This legislation resulted from old legislation dating back to the 1960s, and it took substance abuse treatment professionals a few months to unearth its origins. It permits waivers to inpatient or residential substance abuse treatment centers so that they can receive Medicaid payments if they have more than 16 clients filling their beds. While most states previously had departments for substance abuse that were separate from their mental health departments, most such departments now have been combined, one way or the other. This happened in a wave across the country starting somewhere around 2005, and by now most of them everywhere do in fact share a budget. The tricky part is that mental health department administrators must decide how much of their budget they will allocate to substance abuse treatment, and you can believe that the administrators over both areas are engaged in hot combat over available monies.
As a result, someone dug up an old bill from the 1960s. It originally related to Social Security funds, and it restricted state Medicaid payments to mental health facilities that housed more than 16 substance abuse clients. If the facility had 16 substance abuse clients or less, it could receive funds. If it had over 16, it would receive nothing for any of the clients. Some bright group of people resurrected that old law in 2015 in an attempt to keep mental health funding reserved primarily for mental health purposes.
With increasing numbers of people left hanging on waiting lists for methadone or Suboxone treatment, H.R. 1988, the Breaking Addiction Act of 2015, will permit state Medicaid agencies to waive that requirement. The bill also specifies the Secretary of Health and Human Services to report on the effects of the waivers after a year. There would then be a determination whether use of the funds for substance use disorders in a residential setting should become routine without a need for a waiver.
An Overall Expansion of Suboxone Treatment
There’s nothing more heartbreaking than a man or woman who comes to a methadone or Suboxone program for an assessment and is accepted into treatment, and then told that they must wait a week or two to be seen. “I can’t wait that long,” they say, amazed that they have finally gained the awareness or the guts to reach out for help but they are told that help won’t come quite yet. What all of these bills address, in one way or another, is the overwhelming need to expand and improve treatment for the people who suffer from opioid addiction. We can all do our part by keeping track of these bills in the news and urging our congressmen to support them.