The Senate on Wednesday overwhelmingly approved a bill intended to change the way police and health care workers treat people struggling with opioid addictions.
The bill, which had previously passed the House, will now be sent to President Obama. He has indicated that he will sign it, despite concerns that it doesn't provide enough funding.
The bill is an amalgam of more than a dozen proposals passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create prescription drug monitoring programs — it doesn't have much money to put them in place.
President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn't include all that money. It provides about half that much.
"It's clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments," Sen. Patty Murray, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.
But Sen. Lamar Alexander, R-Tenn., argued that the money for treatment has been rising for three years.
"Our friends on the other side say, you have to fund it. We are funding it," he said in a statement on the Senate floor Friday. "And they helped fund it. We've increased funding for opioids already by 542 percent."
Still, Democrats supported support the bill even without the additional money.
And that's a good thing, says Linda Rosenberg, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.
For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.
"Treatment capacity is really a crisis. There just isn't enough," Rosenberg tells Shots. "But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that's a very big deal."
She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.
The legislation also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that will allow police departments to send people with addiction problems to treatment rather than to jail.
In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.
Rosenberg says these measures help change the definition of addiction from a crime to a health problem.
"It's a health care issue and not a moral failing issue," she says. That's a big reversal from the "war on drugs" campaigns of a few decades ago.
And the legislation allows more people to have access to naloxone, the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.
The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of Adapt Pharma, which sells Narcan, a nasal spray version of naloxone.
"This bill addresses getting Narcan out into the community, outside of emergency and first responders," Kelly says. "The big thing here is this will fund recovery."