Congress should ignore CBO and increase access to opioid addiction medication
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The Congressional Budget Office’s scoring of healthcare legislation is notoriously unreliable, but within the next two weeks Congress will decide the fate of a bill for which the CBO’s score could be downright dangerous as well.

A conference committee will soon convene to finalize details of the Comprehensive Addiction and Recovery Act, a bill to address the epidemic of opioid addiction that is killing tens of thousands of Americans each year.

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The most important provisions of this legislation could help break down the barriers to recovery medications that research shows are most effective in saving the lives of people with opioid addictions.

These medicines, such as buprenorphine, treat addiction by reducing cravings for opioids. Many studies have shown that they drastically lower the risk of fatal overdoses and increase the chances of recovery. The National Institute on Drug Abuse (NIDA), The World Health Organization, UNAIDS and many physician groups all recommend recovery medicine for people with opioid addiction.

One of the most important changes – raising the cap on the number of patients a doctor could treat with recovery medication from 100 to 500—is in jeopardy of being left out of the final bill because the CBO has scored it at such a high cost. That is the basis of the CBO’s high score: more patients would have access to the medicine they need.

But while the CBO takes into account the cost of prescribing medication to more patients, it doesn’t take into account most of the savings that would result from treating those with addiction and allowing them to return to healthy, productive lives.

It doesn’t consider the earnings of people in recovery who would be able to hold jobs and pay taxes. It doesn’t consider the likelihood that solving the opioid crisis would reduce the crime rate. Nor does it consider the cost of doing nothing—the fiscal and human consequences of an epidemic left untreated because unnecessary barriers block patients from achieving recovery.

And there can be no question about it: the bureaucratic hurdles to medication-assisted treatment are killing Americans and condemning many more to lives of misery. Right now, only 3% of U.S. physicians are certified to prescribe recovery medicine and each can only treat 100 patients. The result is long waiting lists for people with addiction who are ready to get help but can’t get access to the recovery medicine they need.

Many have died while on those lists. In some states with particularly heavy opioid problems, the waiting lists include hundreds of people who have been told they have to wait six months to a year or more to get treatment. This would be unconscionable with any other disease. We must end the bias and get people into long-term recovery.

The science is clear that opioid addiction is a chronic brain disease, and that will-power and talk therapy alone are not sufficient to overcome it. For many people, this a disease which needs to be treated with medication, just like diabetes or asthma.

This week’s announcement by the Department of Health and Human Services to raise the cap to 275 is an encouraging step in the right direction. But the higher cap still doesn’t match the scale of the epidemic. In a perfect world, Congress would eliminate that arbitrary and obsolete barrier to treatment. But since the stigma around treating many behavioral health issues makes eliminating the cap politically unlikely, Congress should at least allow certified physicians to treat 500 patients with recovery medicine, instead of 100. And it should further expand access by allowing nurse practitioners and physicians assistants to prescribe this medication. 

Legislators in the House and Senate should not be fooled by the CBO’s deeply flawed estimate of the measure’s costs, or use it as an excuse to delay this urgently needed reform.

Although not currently in consideration by the conference committee, Congress should consider making other important changes to promote opioid recovery as well. To begin with, any long-term solution to the crisis should ensure publically funded insurance programs, such as Medicare, Medicaid, Veterans and Indian Health and the Federal Employee Health Benefits Program, treat the disease of opioid addiction the same way they treat other chronic diseases—by giving patients access to the treatment they need. 

In addition, some have advocated state block grants as a way to fund addiction treatment programs, and such grants may well be a part of the solution. When Congress block grants money, however, it should also require Medicaid and other state-run insurance programs to cover recovery medicine as well. Right now, too many states do not. Florida, for example, is among the leading prescribers of buprenorphine, but only eight percent of those prescriptions are covered by Medicare or Medicaid.

If the House and the Senate fail to agree on a bill to address the opioid crisis this week, with adequate funding, another year will likely pass before the issue comes up again. With more than 100 Americans dying each day from overdoses, we must address this epidemic now, before Congress breaks for the presidential nominating conventions.

Recovery medicine is essential to combatting the opioid crisis. We wouldn’t tell a person with diabetes not to use insulin. We understand that nicotine replacement therapy is necessary for many smokers to quit their habit. If we are serious about addressing the opioid epidemic, we will treat the brain the same way we treat any other organ in the body – with medication that has been proven to work. 


Gingrich served for 20 years in the House of Representatives and as Speaker from 1995 to 1999. Kennedy is the founder of the Kennedy Forum and served in the House of Representatives from 1995 to 2011. The authors are advisors of Advocates for Opioid Recovery, www.opioidrecovery.org