Heroin Bill Moving In Congress, But Leaving A Critical Piece Behind

WASHINGTON -- Last week, the Senate took a major step forward in the effort to combat the opioid epidemic, sending a sweeping piece of legislation to the House for consideration. With more than 90 House co-sponsors, roughly a third of them Republicans , the bill's leaders are optimistic it could become law this year.

But a critical piece is missing from the package. In mid-February, the National Governors Association  came forward with its own list of proposals  on how to address the opioid epidemic that has ravaged so much of the U.S. The organization included in its four-page policy brief a call to scale back federal restrictions on buprenorphine -- a medication that public health officials see as essential to treating those suffering from opioid addiction. That effort is largely missing from the Senate bill, the Comprehensive Addiction and Recovery Act .

Under federal regulations, a doctor must first take a daylong course before being certified to prescribe buprenorphine. In their first year of prescribing, they are only permitted to treat 30 patients with the medication at any one time. For the following years, the patient limit can move up to 100. The restrictions around buprenorphine, along with constraints on methadone treatment, are seen as critical impediments to slowing down the opioid crisis that has already taken so many lives . 

“This issue,” explained Kelly Murphy , program director for the NGA Center's health division, “rose to the top.”

The governors association has called on the federal government to permit nurse practitioners and physician assistants to be able to prescribe the medication. It has also proposed easing prescribing regulations for medical residents.

“Removing this barrier to buprenorphine is particularly critical in rural and underserved areas, where the growing need for [medication-assisted treatment] often outstrips the number of physicians licensed to supply it,” the NGA wrote.

Last year, Huffington Post published a yearlong investigation into the U.S. treatment system that highlighted the lack of access to buprenorphine and the great distances  opioid addicts must travel to find a certified doctor who could treat them.

Sen. Edward Markey (D-Mass.) and Sen. Rand Paul (R-Ky.) introduced a bill that is similar to the proposals endorsed by the governors. Their measure didn't make it into CARA. On Wednesday, the Senate health committee will vote on a Markey-Paul amendment, similar to the pair's underlying bill, they are trying to attach to a separate bill. Democratic presidential candidate Hillary Clinton has advocated for loosening the restrictions as well in her own plan to address the opioid crisis.

The Department of Health and Human Services announced last fall that it would be reforming the regulations on the patient caps. It has yet to announce a draft of those changes. As part of its policy recommendations, the NGA called to lift or do away with the patient caps entirely. The governors association wrote that it hoped that HHS would “expedite” the rule change.

And the association shared its concerns with HHS. “[HHS] has been aware that this is a priority for governors for quite some time,“ Melinda Becker , senior policy analyst at the NGA Center's health division, told Huff Post. “Our understanding is this is a priority for them. We don’t have a sense of the timing, what their proposed changes to buprenorphine are going to look like.”

A HHS spokesperson told HuffPost via email that “this is a priority for the agency and we are working as quickly as possible to move forward with a rule that expands access to MAT.”

Last week, HHS said it had awarded $94 million  to 271 health centers in 45 states. A portion of that money would be going to expanding access to medication-assisted treatment.

But what about the restrictions on the number of patients a doctor can treat? Jean Bennett, a regional administrator at the Substance Abuse and Mental Health Services Administration, said in a conference call with reporters that the feds are going to be issuing “revisions to [the cap] to increase the number.”

“We’ve heard from the field that that would really help," Bennett said. She added that she didn’t have an exact date on when the new proposed regulations would be announced. “I don’t think that I can release anything because it’s not official yet," she said, "but my understanding is that it will be incremental.”