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What it does 

 

HR 992 establishes a grant program for states to fund residential and inpatient addiction treatment services as well as medication-assistance treatment for opioid drug abusers. In particular, the bill tasks the Center for Substance Abuse Treatment (CSAT) to allocate funds for improving access to rehabilitative services for persons suffering from substance use disorder. This legislation, and other similar measures, are part of a larger effort to curb the escalating opioid epidemic in the US.

The bill authorizes individual states to determine which facilities and persons receive funds, so long as the state ensures that:   

  • The head of the state’s primary agency in charge of substance abuse treatment and prevention administers the grant;
  • The grant funds evidence-based services;
  • Services offered through the grant are provided to an individual according to a clinician’s or physician’s recommendation, to ensure an optimal level of treatment;
  • The grant provides for services exclusively to individuals who either: (1) lack health insurance or (2) have health insurance that either does not cover such services or otherwise places barriers to accessing optimal treatment; and
  • Services offered through the grant pay or subsidize for no more than 60 consecutive days of treatment for any one individual.

The bill allows, and in fact encourages, funds to be used for the provision of medication, so long as these medications are:

  • Marketed lawfully under the Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.);
  • Clinically demonstrated to address substance abuse, dependence, or addiction; and
  • Offered “consistent with consumer choice”.

Further, the bill tasks the CSAT with coordinating the grant program with the Substance Abuse Prevention and Treatment Block Grant program (42 U.S.C. 300x-21 et seq.), collecting state-reported outcome measures of services funded by the grants, evaluating and disseminating relevant information to Congress and the public, and offering technical assistance with activities funded through these grants.   

Relevant Science 

Opioids are a class of drugs that bind to opioid receptors in the brain, producing pain-relieving and euphoric effects. Opioids are either derived naturally from the opium poppy plant (e.g., morphine and codeine, commonly referred to as opiates), partially synthesized from opium (e.g., heroin, oxycodone, and hydromorphone), or fully synthesized to mimic the effects of opium (e.g., fentanyl and methadone.) Medically, these drugs are primarily used for their analgesic (i.e., pain-relieving) properties, but are often misused, overprescribed, and abused given their propensity for dependence.

Rates of opioid dependence have significantly increased in the United States over the past two decades, resulting in a drastic increase in overdose deaths nationwide. Prescription medications, such as oxycodone (commonly marketed as OxyContin), are viewed as a primary catalyst in the spike of opioid use. After prescriptions run out, patients may turn to illicit opiates, such as heroin. In 2013, the Substance Abuse and Mental Health Services Administration estimated that over 1.8 million people suffer from opioid use disorder. The Center for Disease Control estimates that over 33 thousand people died from opioid overdoses in 2015 alone; half of those deaths resulted from prescription opioids.

Treatment for opioid use disorder comes in many forms; this bill only deals with treatments that rely on medically- and clinically-provided services. These can include:

  • Residential or inpatient addiction treatment, or what is commonly known as “detox” or “rehab,” where patients remain in residential facilities for a given period of time in order to allow their bodies to detoxify from drug dependence, to spend time away from their previous environments, and to explore various behavioral support systems;
  • Counseling and behavioral therapy, which provides a variety of psychological tools to assist in recovery and reduce the risk of relapse; tools include skill building, adherence to a recovery plan, group therapy for social reinforcement, and professional/educational outcomes assessments. These services are often provided in residential treatment facilities in tandem with medication-assisted treatment; and
  • Medication-assisted treatment (MAT), which involves the provision of various drugs to combat withdrawal symptoms, to mitigate cravings, and to prevent relapse. Specific to opioid use disorder, there are several drugs involved in MAT:
    • Methadone is a slow-acting opioid agonist, which mimics the effects of opioids, thereby reducing withdrawals and cravings. It is only available once daily at methadone clinics;
    • Buprenorphine is a partial opioid agonist, which produces similar effects to opioids but in diminished effect. It is proven to be effective at combating withdrawal symptoms and cravings; and
    • Naltrexone is an opioid antagonist, which does not have the effects of opioid drugs. Naltrexone binds and blocks the opioid receptors, preventing the feeling of getting “high” when users take opioids on the medication. It is available in pill form or a monthly intramuscular injection.

There are many different goals and measures regarding the effectiveness of various treatments used in different fields. Public health officials often cite statistics regarding disease transmission or overdose deaths. Economists look to statistics on employability, or conduct cost-effectiveness comparisons of providing treatment versus either not providing treatment or using punitive approaches. The criminal justice field often measures crime rates or recidivism. Notably, the National Institute of Drug Abuse does not consider relapse a measure of treatment failure, even though it claims that treatment reduces drug use by 40 –60%.

Relevant Experts 

Nicole Schramm-Sapyta, Ph.D., is an Assistant Professor of the Practice in Duke Institute for Brain Sciences.

Relevant publications:

  • Schramm-Sapyta, Nicole, Q. David Walker, Joseph M. Caster, Edward D. Levin, and Cynthia M. Kuhn. 2009. “Are Adolescents More Vulnerable to Drug Addiction Than Adults? Evidence from Animal Models.” Psychopharmacology 206(1): 1 – 21. doi: 10.1007/s00213-009-1585-5
Endorsements & Opposition 

At present, there have not been any publicly reported endorsements of or opposition to this bill.

Status 

HR 992 was introduced in the House on February 9, 2017, and referred to the House Committee on Energy and Commerce on the same day. On February 10, 2017, it was referred to the Subcommittee on Health.

Sponsors 
Primary Author 
Sean Riley, MA
Editor(s) 
John Matthews, JD Candidate; Nicole Schramm-Sapyta, PhD; Andrew Pericak, MEM
Citation 

Duke SciPol, “Expanding Opportunities for Recovery Act (HR 992, 115th Congress)” available at http://scipol.duke.edu/content/expanding-opportunities-recovery-act-2017-hr-992-115th-congress (04/25/2017).