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Trump signs opioid bill, father who lost son says we need a bigger ‘Band-aid’

On Wednesday, President Donald Trump signed a bill that will expand access to certain kinds of opioid treatment. Keith Humphreys, former drug policy advisor during the Obama and Bush administrations, and Gary Mendell, the CEO of an addiction recovery nonprofit, explain how this bipartisan measure could help in the battle against opioid addiction as well as where it falls short.

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  • Judy Woodruff:

    It's been rare for Congress to get bipartisan legislation on almost any issue for years now.

    But the nation's overwhelming opioid epidemic has provided one of those few opportunities. On average, more than 130 people die in the United States each day from an overdose. And opioids have ravaged families and communities, as millions of people have misused the drugs.

    Today, as William Brangham explains, the president and both parties in Congress were able to come together to tout a plan to provide new money and changes to combat the problem.

  • President Donald Trump:

    In just a few moments, I will sign the single largest bill to combat drug crisis in the history of our country.

  • William Brangham:

    Nearly a year after declaring the opioid epidemic a public health emergency, President Trump today signed a sweeping bipartisan bill to address it. It's a crisis that killed nearly 50,000 Americans last year.

  • President Donald Trump:

    Together, we are going to end the scourge of drug addiction in America. We are going to end it or we're going to at least make an extremely big dent in this terrible, terrible problem.

  • William Brangham:

    The bill, which runs over 600 pages' long, is called The Opioid Crisis Response Act.

    It calls for $8 billion in federal funding over the next five years and tries to do a lot of different things, including reducing the illegal supply of opioids and increasing treatment for those who are addicted. To do that, the law makes various changes to Medicaid and Medicare.

    In Medicaid, it eliminates an old rule that blocked the government from paying for residential addiction treatment at facilities with more than 16 beds. This would expand access to treatment substantially.

    In Medicare, for Americans over 65, the program would now cover methadone treatment, a major opioid-replacement therapy used to treat addiction.

    The new law will also allow nurse practitioners and physician's assistants to prescribe buprenorphine, another one of the three federally approved medications used for addiction treatment.

    Currently, only about 5 percent of the nation's doctors are licensed to do this, and shortages are particularly bad in rural areas of the country.

    The law also tackles the flow of fentanyl into the U.S. Fentanyl is the incredibly potent synthetic opioid that causes the vast majority of overdose deaths.

    Now, just like FedEx, the U.S. Postal Service will have to collect more detailed information on international shipments, which are a main conduit for the drug into the U.S.

    Last year in Boston, DEA Special Agent Michael Ferguson described to me just how deadly fentanyl had become for heroin users in his city.

  •  Michael Ferguson:

    So, the deadly combination is high-purity heroin. And I'm talking about heroin that is 50, 60, 80, up to 94 percent pure. That in itself will kill you.

    Now you add in fentanyl, a synthetic opioid. If anything can be likened to a weapon of mass destruction and what it does to a community, it's fentanyl.

  • William Brangham:

    The law also contains money for research into non-addictive pain treatment, more distribution of anti-overdose medications, and more education about best practices for prescribing drugs.

    Across the country, local officials are pursuing their own various efforts to combat the epidemic. And over 20 states are currently suing Purdue Pharma, the maker of OxyContin, for what they argue is that company's role in fueling this crisis.

    So, given the scope of this epidemic, it's important to understand what this bill can change and what it doesn't do.

    For that, we turn to a pair of experts who know this terrain well.

    Keith Humphreys is a professor of psychiatry at Stanford University who served as a drug policy adviser in the Obama and Bush administrations. He also worked with the Senate and House staff on the bill that was signed today. And Gary Mendell is the CEO of Shatterproof. It's a nonprofit group he founded to help families cope with the addiction of a loved one. Gary lost his own son Brian in 2011. And he attended the White House signing ceremony today.

    Gentlemen, thank you both very much for being here.

  •  Gary Mendell:

    : Sure.

  • William Brangham:

    Gary Mendell, first off, we tried to describe that there are many, many elements in this legislation. What is it you most like about this?

  •  Gary Mendell:

    Right.

    To really reverse the course of this epidemic, there's four big things. It's containing it, so no more will our loved ones become addicted to opioids unnecessarily.

    Number two, for those who are already addicted, let's treat them with protocols based on science.

    Number three, it's a chronic illness. People will relapse. And for those, we need medication to rescue them at the time of relapse, so they don't die, and they live.

    And then underlying it all is to change the way our entire society thinks about this disease. This is a chronic illness. It's not people with bad willpower. It's a change in brain chemistry and we need to treat it with love and empathy and programs based on science.

    With that umbrella, what does this bill have? Really, it focuses on treatment. And there are several clauses in this bill that relate to expanding supply of professionals who can treat it, which is great, and there are several clauses related to expanding the supply, the capacity of our health care system to treat it.

    And those are all good and they're all positive.

  • William Brangham:

    Keith Humphreys, it's the same question to you.

    I know you were involved in crafting some of the draft versions of this legislation. What are you celebrating today in this?

  • Keith Humphreys:

    Well, even though the parties couldn't agree on a big bang, making a huge investment, like we made for HIV/AIDS a generation ago, they were able to agree on taking advantage of the health insurance programs we already have and making them more a part of the addiction treatment infrastructure.

    So that means Medicaid is going to cover more residential care, which is really important. Medicare is going to cover treatment for people who are addicted to opioids. That's more important than a lot of people realize. The stereotype is, everyone is young who have this problem, but, in fact, a number of senior citizens suffer from it as well.

  • William Brangham:

    Gary Mendell, what about this issue of money?

    There is, by my — by some estimates, about $8 billion authorized over five years. I have heard from numerous public health officials who say $8 billion is barely even enough for one year.

    Do you think we're still missing a big chunk of money to address this crisis?

  •  Gary Mendell:

    What we need is two things.

    We need structural change, so this is treated within our health care system through insurance, like any other chronic illness, on an ongoing basis, and then we need a Band-Aid right away, because that's going to take time to do, to help as many people as we can today.

    And $8 billion, $9 billion is not enough to do that. The states need more. And what the states are crying for is not one-year grants. This needs to be five- and 10-year money, so they know what is coming and we can build the system.

    And then we need to create the structural change, where you don't need federal funding anymore; it's built into the system.

  • William Brangham:

    Keith Humphreys, on this issue of treatment, by many accounts, we simply do not have enough treatment beds, we do not have enough facilities that offer the best evidence-based medically-assisted treatment.

    How are we going to surmount that part of this crisis?

  • Keith Humphreys:

    The bill does definitely not do enough in that respect.

    Just to give some comparison points, the President's Council of Economic Advisers estimates the damage of the epidemic at $500 billion. Our health care system spends about $3 trillion a year. So, $6 billion, $7 billion, $8 billion, $9 billion is actually a very small investment, given that we're losing 70,000 Americans a year to this disorder.

    So it's certainly not enough. The thing we need to do, as Gary said, is move away from the idea that this is a one-year problem, a two-year problem that we can fix with a grant. We have to build it into the basic structure of how we finance health care, and I would say too chronic pain as well.

    These are problems that are always going to be with us. We have to permanently build them in. Yes, that cost money, but it will have a huge positive impact on public health and public safety.

  • William Brangham:

    Gary, we know that one of the big genesis factors of this epidemic was the overprescription of these medications.

  •  Gary Mendell:

    Correct.

  • William Brangham:

    And we are years into this epidemic, and yet I still hear stories from good friends whose children have a sports injury, and they come home with weeks and weeks of opioid pills.

    Today, in this day, do you think we're doing enough on educating doctors about how to prescribe these medications?

  •  Gary Mendell:

    Yes, I just want to rephrase that and say, it's not what I think. It's a fact.

    We are absolutely not doing enough. We, in a 15-year period, increased the amount of opioid — opioids being prescribed on an annual basis four times, the amount of deaths, six times. And it's not just correlated. It's causal.

    Everyone — it's — everyone agrees.

  • William Brangham:

    You put more of these drugs out there, more people will die.

  •  Gary Mendell:

    There's no question. It's not opinion. It's not just correlated. The lines go just like that together, in fact, even more on deaths.

    So what's happened with prescribing? It's come down about 25 percent, and now we are over 30 percent. And now we're at three times where we were, still three times the amount of opioids as any other country in the world.

    And we have doctors every day, as you just said with your friends, still prescribing 30 days' worth of OxyContin or Vicodin or Percocet for a sprained ankle or a sprained wrist.

    And this is not the dishonest doctor who is unscrupulous. This is good doc — these are good doctors who haven't changed with the current science. And there's no way you could say we're doing enough if this still happens.

    If this were Zika or Ebola spreading across this country, we would contain it in a weekend.

  • William Brangham:

    Gary (sic) Humphreys, the legislation has been signed. There's maybe a sense of closure to all of this.

    But I would like to put you back in the position of counseling the House and the Senate and the president. From today forward, what would you like to see us do?

  • Keith Humphreys:

    I would like us to stop thinking of this as a crisis, meaning a short-term issue that will be resolved by a couple of years of hard work, and instead just be realistic that addiction is part of the fabric of population health. It has been for the entire history of our country. And it's not going to go away in two or three years.

    We would never have a grant program to take care of cancer for two or three years, because we know we're always going to have people with cancer. So what we need to do is bite the bullet, go into programs like Medicaid and Medicare, adequately reimburse treatment, make a big investment in training, because we need physicians and nurses and psychologists and other professionals who are trained in this, taking care of this disorder, and just accept this will be part of what the health care system does from here on out, because, right now, it's opioids.

    Ten years from now, it's going to be a different drug. And we have to be prepared for that.

  • William Brangham:

    All right, Keith Humphreys, Gary Mendell, thank you both very much.

  •  Gary Mendell:

    My pleasure. Thank you.

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