Advocacy groups are cheering the passage by the House of Representatives of the SUPPORT for Patients and Communities Act, a massive legislation package that aims to address the opioid crisis crippling the country and killing tens of thousands each year.
The bill passed overwhelmingly in a 396 to 14 vote, and now moves onto the Senate for consideration. It contains dozens of measures that lawmakers hope will advance treatment and recovery initiatives and improve prevention programs.
The bill establishes and expands programs that boosts detection and monitoring of fentanyl and other synthetic opioids, and increases the maximum number of patients that healthcare practitioners may initially treat with medication-assisted treatment. The bill makes changes to the Medicare and Medicaid programs as well to facilitate treatment and prevention.
"We are pleased to see overwhelming support for provisions that would: expand the use of telehealth services for substance use disorder; guide improved care for infants with neonatal abstinence syndrome; increase the types and capacity of providers offering medication-assisted treatment; cover screening for opioid use disorder as part of the Welcome to Medicare physical examination; allow former foster children to keep Medicaid coverage until age 26 when they move across state lines; and require states to automatically restore Medicaid coverage to young people post-incarceration," said Tom Nickels, executive vice president of the American Hospital Association.
"This really shows that Congress is paying attention to this serious issue. We remain hopeful that not only will these be passed into law but that they'll have adequate support to actually be implemented throughout the country," said Laura Wooster, associate executive director of Public Affairs for the American College of Emergency Physicians.
Wooster said emergency physicians are on the front line of the opioid epidemic and see the crisis from two different perspectives. They see what happens when people aren't able to get treatment and they come in with overdoses. And she said, ER physicians and staff actually do play a role in prevention. Many people who come into the emergency department have a pain issue related to an injury or illness and sometimes do need opioids. Wooster said ER physicians are always mindful of what kind of medications they prescribe and are always looking for alternatives.
ACEP actually worked on two of the bills that made it into the final package. One was a measure based on a pilot program started at St. Joseph's Hospital in Paterson, New Jersey. The program had clinicians look for different ways to avoid using opioids in the ED when clinically appropriate, since the best way to avoid an opioid use disorder is to never be exposed to one.
Under the pilot, they saw an 80 percent drop in use of opioid prescriptions and the program was replicated in Colorado at a number of hospitals. The SUPPORT Act provides grants for other EDs in other hospitals to start their own similar pilots, Wooster said.
Another measure seeks to help prevent overdoses and relapses due to withdrawal starting in the ED. It is geared toward medication-assisted treatment for opioid use disorders. Wooster said when someone comes into the ER with an overdose, they are typically treated and stabilized then sent home for follow-up. But access can be a problem and withdrawal can be really hard to deal with.
"Having some sort of bridge for that can be helpful," Wooster said.
Some EDs have started medication-assisted treatment in the ER itself and that can buy the patient more time to find care in the community or get an appointment before they start getting additional withdrawal symptoms. Buprenorphine is the most common medication used.
The SUPPORT legislation provides grants to extend those programs into more EDs, since up until now, many regarded MAT as something done in a doctor's office.
Wooster said the timing is a little worrisome, and ACEP is hoping the Senate will take up the SUPPORT Act and pass it before the August recess. If they don't there is time before the election but time is short. There is no clear timeline on implementation if the bill is signed into law. But Wooster said ACEP is hopeful.
"The fact that two emergency medicine bills were included shows the big role emergency medicine and physicians are playing on both the prevention and treatment sides of the opioid crisis," she said.
"We look forward to continuing to work with the Senate to enact these provisions and further refine other elements of opioid legislation moving through Congress," Nickels said.