Axios Pro Exclusive Content

House, Senate divide complicates opioid talks

Illustration of the US Capitol dome with circles and crosses.

Illustration: Shoshana Gordon/Axios

Key efforts to fight the opioid overdose crisis are among the many issues that Congress has punted to the looming March 1 government funding deadline.

Why it matters: The House and Senate need to work out their differences on the SUPPORT Act reauthorization and related policies if the anti-addiction measures are going to hitch a ride on the larger government funding package.

  • Lobbyists and aides say the chambers are not close to a deal and that there are at least three prominent sticking points.

Xylazine: The House version would make xylazine, a drug increasingly linked to overdose deaths, a Schedule III controlled substance, a provision not included in the Senate measure.

  • It remains to be seen if any Democrats put up a fight on the argument that criminalizing drugs is not the most effective approach.

Methadone: On the flip side, the Senate HELP Committee approved a measure to make methadone, a treatment for opioid addiction, more available.

  • The effort has support from the American Society of Addiction Medicine, which says it would be a major step in fighting the opioid crisis.
  • HELP Ranking Member Bill Cassidy supported that bill, but it faces an uphill climb among House Republicans, given law enforcement concerns about improper use of methadone.
  • Existing methadone clinics, where patients often have to travel in person, are also lobbying against the measure, which would expand access outside of the clinic system.

Medicaid: Republicans have put a priority on making permanent an option for states to provide Medicaid coverage for inpatient addiction treatment — a policy referred to as lifting the IMD exclusion.

  • Democrats in exchange could seek to include policies around Medicaid coverage for people getting out of prison, given that people are much more likely to overdose upon being released.
  • Republicans have said that providing coverage for up to 30 days before release, as stipulated in the Medicaid Reentry Act, is too costly.
  • So narrower, less expensive options are being considered. The House package would require states to suspend, rather than fully terminate, Medicaid coverage while someone is in prison, to make it easier for them to restart coverage once released.
  • Senate Republicans have yet to agree to requiring states to do that.

What they're saying: Senate Finance Committee Chairman Ron Wyden on Monday pointed to the mental health and addiction policies included along with PBM changes in what his panel advanced in November.

  • Asked about Medicaid coverage for people leaving prison, Wyden said: "We need some new policies that help us get people who are in our care off of drugs, because they're going to be back on the street. The policies of yesteryear don't fit."
  • Rep. Paul Tonko, a lead sponsor of the Medicaid Reentry Act in the House, said he is "pushing hard" for its inclusion to ensure "targeted, compassionate treatment to our most vulnerable."
Go deeper