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The Senate Approved a Huge Opioid Bill, but Will It Work?

A close look at the science.
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Photo showing pills spilling out of a prescription bottle

The Senate approved a sweeping bill last week aimed at combating opioid addiction in the United States. The Comprehensive Addiction and Recovery Act of 2016 offers grants to states, smaller jurisdictions, and Indian tribes for services including drug courts, overdose-reversers, and addiction-management medicines. The House of Representatives already approved the bill earlier this month; next, it will go before President Barack Obama to potentially be signed into law.

Will the bill work to curb opioid addiction? Below, Pacific Standard highlights some of the solutions the act would cover, alongside the science supporting—or undermining—the legislation.

Solution 1: Don’t Throw People in Prison; Offer Treatment

The bill supports alternatives to imprisoning folks for crimes related to opioid use disorders. Among their suggested alternatives are drug courts, mental-health courts, and veterans-treatment courts. All of those programs offer defendants a choice between undergoing treatment or punishment for their crime.

The data shows that, while drug courts work for some, they also have a dark side, as journalist Maia Szalavitz reported for Pacific Standard last year. Some courts’ judges don’t allow defendants to undergo maintenance treatment — which doctors consider the standard for caring for those with substance use disorders — while in jail. Such bans put people at risk for overdosing once they’re released, Szalavitz reports. In addition, about half of drug-court attendees fail at their treatment, and those who fail are even more likely to be convicted of another crime than addicts who choose to go through regular courts.

Mental-health courts and veterans-treatment courts have better records.

Solution 2: Purchase Overdose-Reversing Drugs

The bill supports making overdose-reversing medicines — such as naloxone, trade-named Narcan — more easily accessible to police, medics, patients prescribed opioid painkillers, and relatives of opioid users. The suggested fixes include campaigns to teach the public about naloxone, training for doctors and pharmacists in prescribing the drug, and reducing co-pays for it. Naloxone is proven to work with few ill side effects. Naloxone education and distribution programs have also been shown to save lives in various communities.

Solution 3: Build Prescription Drug-Monitoring Programs

Should the Comprehensive Addiction and Recovery Act of 2016 be signed into law, states will be able to apply for federal funds to start or improve a drug-monitoring system. The science on prescription drug monitoring programs has just started to be published over the past few months. So far, researchers are finding that such programs reduce the amount of opioid painkillers doctors prescribe and are associated with fewer opioid overdose deaths.

Solution 4: Save the Children and Veterans

The bill says it will fund programs that aim to “prevent and address” opioid use disorders in youth and veterans, but doesn’t describe what these programs might do, so it’s hard to evaluate whether they’ll work. These lines in the act seem to offer jurisdictions flexibility to try perhaps untested programs, or programs that haven’t been specified elsewhere.

Overall, the Comprehensive Addiction and Recovery Act covers numerous specific, well-studied fixes, as well as a few vague prescriptions that appeal to common sense. In general, it treats opioid use disorders as a mental-health issue, not a criminal justice one. It suggests investigating and monitoring opioid prescribing, but doesn’t talk about punishing opioid users themselves.

Missing from the bill is legislation about reducing the spread of HIV and hepatitis C among those who inject opioids, despite the fact that some towns in America have seen a resurgence of these blood-borne diseases as a result of the opioid epidemic. There was also nothing targeting the manufacturers of opioid painkillers, although newspaperinvestigations have found they’ve played an important role in making opioids widely available in America — and widely abused.