Last week, the U.S. House of Representatives advanced several bills aimed to address the opioid abuse crisis. A number of key ASA-supported bills were among the over 60 bills considered and passed by the House. Included in those bills was H.R. 5718, the Perioperative Reduction of Opioids (PRO) Act, a bill that directs the U.S. Department of Health and Human Services (HHS) to support the development of initiatives that reduce opioid use in the surgical setting and the development of best practices for pain management, specifically during the perioperative period. H.R. 5718 passed as part of H.R. 5774, the Combating Opioid Abuse for Care in Hospitals Act of 2018 (COACH Act). Other bills and provisions of bills supported by ASA passed as part of H.R. 6, the SUPPORT for Patients and Communities Act or as free-standing bills.
H.R. 5718 was a key ASA initiative throughout the House opioid crisis debate. ASA physician members worked closely with Congressman Jason Smith (R-MO-08), his staff and members and staff of the House Ways and Means Committee to ensure that H.R. 5718 was among the proposals formally considered and passed out of committee. ASA built support for the bill at LEGISLATIVE CONFERENCE 2018, where more than 600 members advocated in support of the bill on Capitol Hill. The bill builds upon the ASA’s joint pilot with Premier, Inc.’s network of hospitals and the pilot’s goal to reduce utilization of opioids during and following surgery. ASA also believes the bill, once enacted, could expand the use of the Perioperative Surgical Home (PSH) as a model of care to reduce patient exposure to and use of opioids as part of the surgical experience.
Other ASA-supported proposals cleared by the House included:
• H.R. 5002, the Ace Research Act: gives additional flexibility to the National Institutes of Health (NIH) Director to help speed research in the basic science of pain as well as development of non-addictive pain medications and other non-opioid pain management therapies.
• H.R. 5801, the Medicaid PARTNERSHIP Act: will encourage prescription drug monitoring programs (PDMP) integration into clinical workflow and establish standard criteria for PDMPs.
• H.R. 6082, the Overdose Prevention and Patient Safety Act: will align the use of substance use disorder (SUD) treatment records with the Health Insurance Portability and Accountability Act (HIPAA). This will enhance health care providers access to SUD treatment records, while also strengthening privacy protections for those records.
• H.R. 5809, the Postoperative Opioid Prevention Act of 2018: creates a pass-through payment extension under Medicare to encourage the development of nonopioid pain management drugs.
• Congressman Joe Barton’s (R-TX-6) Amendment: supports the development of evidenced-based opioid prescribing for acute pain. The amendment directs the FDA to develop high-quality, evidence-based opioid analgesic prescribing guidelines for the indication-specific treatment of acute pain by working with stakeholders. This aligns with work ASA is already undertaking, in partnership with the American Academy of Orthopedic Surgeons (AAOS), to develop recommendations around prescribing for acute pain following surgery.
ASA also worked with members of the Congressional “Doc Caucus” to raise concerns about American Association of Nurse Anesthetists’ (AANA) efforts to expand prescribing authority for buprenorphine. This proposal had not passed out of committee but was added to a package of bills in final negotiations. The provision seeking to expand patient access to medication assisted treatment (MAT) for opioid use disorders (OUD) included language to expand the authority of advanced practice registered nurses, including nurse anesthetists, to provide MAT, such as prescribing buprenorphine. ASA joined “Doc Caucus” members in pointing out that the creation of this untested addiction treatment authority represents a new practice for nurse anesthetists and does not appear to be supported by any data or literature. Moreover, the inclusion of providers who have never had prescribing authority for MAT is contrary to the best interests of patients.
The final AANA-supported language as passed by the House will grant the MAT authority, subject to restrictions in state law, to nurse anesthetists, nurse midwives and nurse specialists for a limited time of five years. It is expected that this language and the new authority will be scrutinized as the Senate’s consideration of opioid legislation continues.
The House passage of the above referenced bills is one step of many. It’s projected the Senate will consider its own legislation in July or later, setting up a potential House-Senate conference committee scenario where the legislation passed by both chambers are merged through negotiation and compromise agreements. ASA looks forward to working with both chambers as they finalize legislation to address the opioid epidemic.
ASA Letter of Support on the PRO Act
ASA Letter of Support to Rep Barton
Pain Care Coalition Communication to House Leadership
View all the measures included in H.R. 6
Letter from the Partnership to Amend 42 CFR Part 2