Trump Signs the SUPPORT for Patients and Communities Act

(Winter 2018) In late October President Trump approved a set of about 70 measures called the SUPPORT Act (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act). This Legislation package includes verbiage that will

• permit nurse midwives, nurse anesthetists and clinical nurse specialists to write buprenorphine prescriptions for individuals addicted to opioids
• allocate money to formulate new, non-addictive pain medications
• ease inpatient treatment access for Medicaid and Medicare recipients requiring addiction therapies
• advocate for a greater number of first responders to carry and administer the opioid-overdose reversal drug naloxone
• create harsher punishments for pharmaceutical makers and distributors connected to the over-prescription of opioids
• develop new programs to promote best practices for pain management among physicians and other health care professionals

One of the laws, the STOP Act (Synthetics Trafficking and Overdose Prevention), will work to curtail the flood of hazardous fentanyl entering the United States. It requires the U.S. Postal Service to electronically gather data on goods sent into the country to help weed out fentanyl and other illegal items. The goal of the STOP Act is to allow customs agents to identify suspect pieces of mail for inspection. Critics point out that the new legislation might become harder to impose due to the United States backing out of the Universal Postal Union (UPU), a 150-year-old multi-national shipping agreement.

Some say the UPU is critical to collecting data necessary for filtering out illicit drug shipments. However, the Trump White House asserts that the UPU puts American manufacturers at a disadvantage, resulting in higher shipping rates than for nations such as Singapore and China. Individuals backing the STOP Act are pushing for a negotiation that would promote data sharing as well as lowered international freight charges.

Overall, the SUPPORT for Patients and Communities Act is touted by legislators as a major step toward better access to drug addiction treatment and a boon for other efforts to reverse the opioid crisis. However, the group of measures has its critics. Although the bills look good at face value, detractors say they barely scratch the surface of what truly must be done to confront the opioid epidemic. In simple terms, it’s about funding. Although the laws work to provide an easier path to treatment, throw up roadblocks for dangerous — and illegal — manmade opioids such as fentanyl and carfentanil from entering the country, and expand research efforts on addiction and alternatives to opioids, they do little to monetarily back these efforts.

It’s surmised that the current lack of funding shows a difference of opinion between Republicans and Democrats on whether the federal government should invest the large amount of money needed to adequately address the problem. Setting that aside, Congress tried to find common ground on other matters related to the opioid epidemic.

Appropriations within the new legislation pale in comparison to those allocated by the U.S. for prior crises of this magnitude, such as the AIDS/HIV epidemic. The SUPPORT Act does renew the Cures Act, which gives $500 million annually toward fighting the opioid epidemic and changes laws to allow states additional leeway in how the money is used. But experts say that tens of billions of dollars should be funneled into efforts to rapidly turn the opioid crisis around.

And it truly is a crisis. Over 72,000 Americans perished due to a drug overdose in 2017 alone. Of those, approximately 67% were opioid-related deaths. This is the largest amount of U.S. citizens who ever succumbed to a fatal overdose within a one-year period. It exceeds the total number of Americans who lost their lives to auto accidents, HIV/AIDS, or guns in a 365-day period in the United States. If the course is not changed, over the next 10 years, hundreds of thousands more may perish solely from opioid overdoses.

Unfortunately, the United States is ill-prepared for the demand for substance abuse treatment. Only 10% of individuals with any addiction problem — and just 20% of opioid abusers — attempt to find a specialist to treat their disorder. Of the addiction treatments currently in existence, less than 50% have medication-assisted therapy available (the scientifically favored approach at this time). To sum it up, there are enough barriers to treatment that most individuals requiring it don’t get it, and when treatment is accessible, it doesn’t offer the industry’s best therapies.

To improve both access and quality of addiction treatment, federal lawmakers must allocate a great deal more funding for a sustained period. Additionally, experts say that truly successful legislation will overhaul America’s management of addiction, as was similarly done by hospitals and physicians when they changed protocols to respond to the Zika and Ebola outbreaks.

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