Raise your hand if you're a public official and you want to end the heroin and opioid scourge. It's unanimous, then: Washington is officially in agreement -- on all but the methods and the money.
That was made clear again Tuesday when the White House renewed a call, first made in early February, to spend $1.1 billion over the next two years to fight addiction and provide recovery services -- with up to $45 million of it for Ohio. Congressional leaders decry the drug epidemic, but they say that with this country's multiple other challenges, President Barack Obama and congressional Democrats are asking for too much and want it too soon.
So how much will Washington agree on?
That's still unclear. With so many numbers thrown around, and so many lawmakers pushing for solutions and vying for political credit, it's hard not to feel confused.
Maybe this will help.
Obama's wish:
The White House wants $1.1 billion over two years. Of that, $920 million would go to states to expand medication-assisted treatment. There are pockets of resistance to this kind of treatment because critics say it can replace an addiction to one substance with another, but experts say the scientific consensus is that drugs can work to wean an addict off a much more dangerous substance.
The money would be paid out based on the severity of the opioid epidemic in each state and the strength of each state's drug programs. Ohio would get up $45 million over two years to expand treatment for opioid use disorders, according to the White House. (See fact sheet, below.)
"It goes without saying that this opioid epidemic is one of the most pressing issues facing our country," said Michael Botticelli, director of national drug control policy at the White House. "Every day, 78 lives are lost to overdoses involving opioids like heroin, fentanyl and opioid medications."
The deaths are avoidable, he said, and "one of the most important things we can do on this end is to expand treatment." But there is a shortage of treatment facilities, providers and the money to pay for them. "And this needs to change, and needs to change now."
The Senate Republican plan:
This is far from final, but a Senate spending committee last week approved dedicating $261 million in fiscal year 2017 to the opioid crisis, a 93 percent increase over last year.
"The investments made in this bill will help to ensure that those who are grappling with addiction have access to the crucial lifesaving treatment they need," Sen. Susan Collins, a Republican on the committee, said in a statement.
Comparing this with anti-opioid spending in 2015, it represents 542 percent increase, said Sen. Roy Blunt of Missouri, the Republican chairman of the Senate Appropriations Subcommittee on Labor, Health and Human Services and Education. The full Senate now must take up the bill, and the House will have to agree.
Watch those numbers to see how this works: 93 percent is huge, and 542 percent is gigantic. So this seems to be very good -- but it's still not as much money for fighting addiction as Obama and Democrats want to spend.
"We need to treat this epidemic like the national public health emergency that it is," Sen. Jeanne Shaheen, a Democrat from New Hampshire, said on a press conference call sponsored by the White House Tuesday. "And there is no excuse for Congress providing emergency funding for Ebola, for swine flu ten years ago, and ignoring an opioid crisis that's killing tens of thousands of people across this country right now."
The Senate Democrats' wish:
In March, the Senate passed a different bill 94 to 1 -- this one authorizing expansion of a number of drug treatment programs. It was called the Comprehensive Addiction and Recovery Act, and Sen. Rob Portman of Ohio was the lead Republican on it. Portman, facing reelection this year, has made it a centerpiece of his agenda, both as a lawmaker and a politician.
Authorization bills give agencies the power to do their work, so in this case, the addiction and recovery act confers on government agencies the right to fight the heroin and opioid epidemic. But the agencies still need appropriations to receive the money.
So in a spending bill in late December, Congress provided about $80 million for the purpose of Portman's drug-fighting effort. Portman wound up voting against the broader bill that contained this money -- he said the $1.1 trillion in overall government spending was too high -- but only after working to get the drug money included.
Fast-forward to March: Democrats including Shaheen said the authorization bill Portman was pushing needed more money. So they offered an amendment that would have provided another $600 million. Portman joined them.
But they lost. Other Republicans said money was already approved for the drug programs -- in that year-end bill, including the $80 million from Portman and about $300 more for existing programs -- and requests for more money could wait until the next fiscal year.
The House of Representatives' plan:
The House, which like the Senate is led by Republicans, passed its own package of addiction and recovery authorization bills in May. Among other things, the House legislation would make it easier for emergency responders to access overdose reversal drugs like naloxone and establish a task force to modify how pain medication is prescribed.
Now the House must negotiate the differences with the Senate authorization bill. But House Democrats have another concern: money.
Like the Senate, the House did not provide anything extra. House Democrats tried to do what Senate Democrats failed at: provide an extra $600 million. But they, too, failed. Republicans said the requests could wait until later this year, when the 2017 spending bills get approved.
There's more than money:
To help you keep track, the sums mentioned so far include:
But there's more to this debate than money. Different lawmakers prefer different approaches. Sen. Sherrod Brown, an Ohio Democrat, supported Portman's bill and the attempt to get $600 million. But Brown has another bill, which would authorize more than $500 million for such things as first-responder training, needle exchange programs and grants for various treatment programs.
Meantime a different disagreement rages in Washington, over the number of patients a doctor should be able to treat with the opioid derivative buprenorphine, also known as Suboxone. Suboxone helps wean heroin addicts from their drug, but critics say it comes with its own risk of addiction and black-market diversion.
Federal rules limit each doctor to treating 100 patients with Suboxone, despite specialized addiction-treatment training. A bipartisan group of senators including Brown, Massachusetts Democrat Elizabeth Warren, Kentucky Republican Rand Paul and Vermont independent Bernie Sanders want to increase that five-fold.
The U.S. Department of Heath and Human Services has proposed raising the cap to 200 patients per doctor. The senators say it should be 500. Measures can be put in place to avoid abuse, they said in a June 1 letter to HHS, and the current and proposed caps severely limit access to addiction treatment.
Portman was not a signatory to the letter. But he, too, says he supports raising the cap to 500.
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