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Thread: U.S. - House, Senate pass bipartisan bill to confront the opioid epidemic

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    U.S. - House, Senate pass bipartisan bill to confront the opioid epidemic 
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    The Senate just passed a bipartisan bill to confront the opioid epidemic
    German Lopez
    Vox
    October 3rd, 2018

    What the SUPPORT for Patients and Communities Act does

    For a full breakdown of Congress's bill, you can read the full text or a section-by-section summary. But here are some of the major policy changes in the bill:

    - Reauthorizes funding from the Cures Act, which put $500 million a year toward the opioid crisis, and makes tweaks to hopefully give states more flexibility in using the funding.

    - Creates a grant program for "Comprehensive Opioid Recovery Centers," which will attempt to serve the addiction treatment and recovery needs of their communities (in part by using what's known as an ECHO model).

    - Lifts restrictions on medications for opioid addiction, allowing more types of health care practitioners to prescribe the drugs.

    - Expands an existing program that attempts to get more first responders, such as police and firefighters, to carry and use naloxone, a medication that reverses opioid overdoses.

    - Allows federal agencies to pursue more research projects related to addiction and pain.

    - Makes several changes to Medicare and Medicaid to attempt to limit the overprescription of opioid painkillers within the programs and expand access to addiction treatment, including lifting some of the current restrictions that make it harder for Medicare and Medicaid to pay for addiction treatment.

    - Advances new initiatives to educate and raise awareness about proper pain treatment among health care providers.

    - Attempts to improve coordination between different federal agencies to stop illicit drugs like fentanyl at the border, and gives agencies more tools to improve detection and testing at border checks.

    - Increases penalties for drug manufacturers and distributors related to the overprescribing of opioids.
    Read the full story here.

    Read the full bill here.

    Read the section-by-section summary here.
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    This bill is mostly bad. It is largely aimed at pushing the number of opioid prescriptions downward by using a broad campaign of red tape and intimidation across the health care system. It is also increasing the complexity and cost of the international postal system drastically in a futile attempt to stop fentanyl and its analogues from getting into the U.S. There are some positive changes, though, like the fact that maintenance drugs such as methadone and buprenorphine will be prescribed more easily by more practitioners.

    One ominous provision, which hasn't garnered much attention, seems to be an attempt to add leeway to the "human consumption" requirement of the Analog Act:

    CHAPTER 5--SYNTHETIC ABUSE AND LABELING OF TOXIC SUBSTANCES

    SEC. 3241. CONTROLLED SUBSTANCE ANALOGUES.

    Section 203 of the Controlled Substances Act (21 U.S.C. 813) is amended--

    (1) by striking "A controlled" and inserting

    "(a) IN GENERAL.--A controlled"; and

    (2) by adding at the end the following:

    "(b) DETERMINATION.--In determining whether a controlled substance analogue was intended for human consumption under subsection (a), the following factors may be considered, along with any other relevant factors:

    "(1) The marketing, advertising, and labeling of the substance.
    "(2) The known efficacy or usefulness of the substance for the marketed, advertised, or labeled purpose.
    "(3) The difference between the price at which the substance is sold and the price at which the substance it is purported to be or advertised as is normally sold.
    "(4) The diversion of the substance from legitimate channels and the clandestine importation, manufacture, or distribution of the substance.
    "(5) Whether the defendant knew or should have known the substance was intended to be consumed by injection, inhalation, ingestion, or any other immediate means.
    "(6) Any controlled substance analogue that is manufactured, formulated, sold, distributed, or marketed with the intent to avoid the provisions of existing drug laws.

    "(c) LIMITATION.--For purposes of this section, evidence that a substance was not marketed, advertised, or labeled for human consumption, by itself, shall not be sufficient to establish that the substance was not intended for human consumption.".
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    Wow could they go after kratom with that provision?
    Addicted? Want to stop? We can help! Come to the sober living forum!
    http://www.bluelight.org/vb/forums/269-Sober-Living
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    Quote Originally Posted by cj View Post
    Wow could they go after kratom with that provision?
    Fortunately not - an analogue still has to have a "substantially similar" structure to a Schedule I substance.
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    Ugh. It's not an epidemic.
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    This makes me happy that I have found substantial (lol) analgesia from buprenorphine.
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    Quote Originally Posted by Captain.Heroin View Post
    Ugh. It's not an epidemic.
    There is an epidemic of overdoses for sure. Due to fentanyl. But yeah lowering the availablity of painkiller prescriptions is not a way to combat that whatsoever.

    These provisions are the only ones that will have any positive effect:

    - Lifts restrictions on medications for opioid addiction, allowing more types of health care practitioners to prescribe the drugs.

    - Expands an existing program that attempts to get more first responders, such as police and firefighters, to carry and use naloxone, a medication that reverses opioid overdoses.

    But making it harder to prescribe painkillers will outweigh these if I were to guess.
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    Quote Originally Posted by treezy z View Post
    - Lifts restrictions on medications for opioid addiction, allowing more types of health care practitioners to prescribe the drugs.
    even just puts bupe in all US vitamins.
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    It’s not a crisis. Legalize.
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    So which doctors will be able to write methadone for maintenance ? I was basically forced to quit methadone because of our state laws against family practitioners not being able to write it anymore. Now I'm 100 days clean and sure as heck ain't going back , but curious.
    Last edited by hikfromstik; 16-10-2018 at 01:02.
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    Quote Originally Posted by hikfromstik View Post
    So which doctors will be able to write methadone for maintenance ? I was basically forced to quit methadone because of our state laws against family practitioners not being able to write it anymore. Now I'm 100 days clean and sure as heck ain't going back , but curious.
    Doctors should be able to write it for pain still.
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    Quote Originally Posted by hikfromstik View Post
    So which doctors will be able to write methadone for maintenance ? I was basically forced to quit methadone because of our state laws against family practitioners not being able to write it anymore. Now I'm 100 days clean and sure as heck ain't going back , but curious.
    From the summary:

    Chapter 1 – More Flexibility with Respect To Medication-Assisted Treatment for Opioid Use Disorders

    Section 3201. Allowing for more flexibility with respect to medication-assisted treatment
    for opioid use disorders.

    This provision will increase the number of waivered health care providers that can prescribe or dispense
    medication-assisted treatment (MAT)by authorizing clinical nurse specialists, certified nurse midwives,
    and certified registered nurse anesthetists to prescribe MAT for five years. It also makes permanent the
    prescribing authority for physician assistants and nurse practitioners and allows waivered practitioners
    to immediately treat 100 patients at a time if the practitioner is board certified in addiction medicine or
    addiction psychiatry; or if the practitioner provides MAT in a qualified practice setting. This provision
    codifies the ability for qualified physicians to prescribe MAT for up to 275 patients. The Secretary of
    HHS, in consultation with the Drug Enforcement Administration, will be required to submit a report that
    assesses the care provided by physicians treating over 100 patients and non-physician practitioners
    treating over 30 patients.

    Section 3202. Medication-assisted treatment for recovery from substance use disorder.

    This provision ensures physicians who have recently graduated in good standing from an accredited
    school of allopathic or osteopathic medicine, and who meet the other training requirements to prescribe
    MAT, to obtain a waiver to prescribe MAT.

    Section 3203. Grants to enhance access to substance use disorder treatment.

    This provision authorizes grants to support the development of curriculum that will help health care
    practitioners obtain a waiver to prescribe MAT.
    I don't think this will supercede state restrictions, though.
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    Take away opioids from pain patients and give opioids more freely to heroin users...that about right from the government.
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    #14
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    Quote Originally Posted by Captain.Heroin View Post
    It’s not a crisis. Legalize.
    A lot of people are dying but I mostly agree with the second part. Legalizing at least some opiates (maybe codeine and hydrocodone, I don't know) would put a damper on the fentanyl trade.
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    Quote Originally Posted by Captain.Heroin View Post
    It’s not a crisis. Legalize.
    ABSOLUTELY!!

    The only crisis here is people in real pain are not able to get correct medical pain management treatment!
    And
    Adulterated street drugs. Fentanyl!
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    #16
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    Actually in regard to captain.heroins point, it's not an opiate epidemic but a fentanyl and rc opiate epidemic.
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