Treatment is the most vital component in dealing with the opioid addiction epidemic. Treatment saves lives. Due to advocacy efforts, treatment is more available now than it was. In 2016, the NSDUH survey showed that 453,000 (21.6%) Americans with OUD received treatment for OUD. In 2017, that number rose to 603,000 (28.6%).  But this is far short of what is needed.

Obtaining treatment continues to be a real challenge to those with OUD. In general, accessing treatment remains more difficult than getting drugs. We have no simple universal route into treatment, no place where a patient can simply show up and be guaranteed entry. And the power of addiction is such that the OUD patient needs help now, or the opportunity for treatment may be lost.  Difficulty accessing treatment often results in no treatment at all.

Medicaid has provided simpler entry into treatment.  Americans with OUD who are on Medicaid are significantly more likely to receive OUD treatment (43%) than those who are uninsured (21%) or have private insurance (23%).   It is ironic that so few of those with private insurance are receiving OUD treatment, but many of those with insurance who have attempted to obtain treatment can attest to what a frustrating experience it can be. 

              Obamacare (The Affordable Care Act) made Medicaid available to millions of Americans living in the 36 states that accepted the terms of Medicaid Expansion, under which Medicaid eligibility criteria rose from 43% of the poverty line to 138% of the poverty line, making Medicaid newly available to 12.7 million Americans.  This has been of great value to the working poor needing OUD treatment.

              But 14 states did not accept the terms of Medicaid expansion.  Obtaining Medicaid is not possible in those states for many of the 2.2 million people in those states whose income falls between 43% and 138% of the poverty line.  These are the working poor who make too much money to be on Medicaid and are too poor to afford Obamacare insurance, even with subsidies.

Worse, the proposed 2019 Federal Government Budget would eliminate Medicaid for the 12.7 million Americans only recently covered by Medicaid expansion. 

              Over the past few years, the federal government has enacted several pieces legislation designed to improve the prospects of treatment for those with OUD.  These include The Comprehensive Addiction and Recovery Act (CARA), the 21st Century Cures Act, The Omnibus Spending Bill of 2018, and the SUPPORT for Patients and Communities Act of 2018 (see * below for elaboration on these pieces of legislation.) 

None of these have been comprehensive in the way that the successful Ryan White Comprehensive AIDS Resources Emergency Act of 1990 was. The Ryan White Act committed the federal government as the payer of last resort for treatment for all those with HIV or AIDS. None of these allow an OUD patient a guaranteed path of entry into treatment.  And the current legislation does not make a commitment to sustained funding. It is unreasonable to expect people to build a clinic knowing that the funding for treatment could dry up in 2 years.

And parts of the current legislation came with a price which undermined its very goals. The ACA did not allow Medicare to negotiate drug prices with manufacturers 

Last year, Sen. Elizabeth Warren (D-Mass.) and Rep. Elijah Cummings (D-Md.) introduced the Comprehensive Addiction Resources Emergency Act, a bill that would provide $10 billion per year over 10 years to deal with the opioid addiction epidemic.  This bill is modeled after the Ryan White Act.

A major step of this kind is vital if we are to develop easy availability of treatment for all those afflicted with OUD and truly diminish the impact of this epidemic.  Please contact your Congressman and Senators.

The FED UP! Coalition also asks that you contact your Congressional representatives to repeal the Ensuring Patient Access and Effective Drug Enforcement Act since, as we wrote in a letter to the appropriate Congressional Chairmen, “the law constrains the D.E.A.’s ability to enforce the Controlled Substances Act and allows perpetrators of illegal opioid distribution to act with impunity.”

The Ensuring Patient Access and Effective Drug Enforcement Act dramatically increased the standard of proof required for the D.E.A. to suspend a D.E.A. registration. The law was passed because it was falsely promoted as a way to ensure patient access to narcotics and improve cooperation between the D.E.A. and industry. In reality, the law constrains the D.E.A.’s ability to enforce the Controlled Substances Act and allows perpetrators of illegal opioid distribution to act with impunity.

On Sunday, Oct 15, 2017, the Washington Post and 60 Minutes jointly brought national attention to this legislation and its impact to the D.E.A.’s ability to protect public health. The news coverage provided multiple examples of opioid distributors willfully neglecting their responsibility to report suspicious prescription opioid orders.

It is time for Congress to act. Until this law is repealed, the D.E.A.’s ability to enforce the Controlled Substances Act will be hampered. Repealing this law will save lives and help bring the nation’s most urgent public health crisis under control. Please contact your Congressman and Senators and urge them to Repeal this bill.

WRITE YOUR CONGRESSIONAL REPRESENTATIVE TODAY!

IMPLORE HIM OR HER TO SUPPORT THE SOFA ACT (H.R. 2935).  THE SOFA ACT AMENDS THE CONTROLLED SUBSTANCES ACT TO ADD ILLICIT FENTANYL ANALOGS TO SCHEDULE I.

THIS LEGISLATION IS A MUST IN THE FIGHT AGAINST FENTANYL ANALOG OVERDOSE DEATHS.

POINT OUT THAT CHINESE CHEMICAL MANUFACTURERS SWITCHED FROM MAKING FENTANYL TO MAKING MULTIPLE FENTANYL ANALOGS BECAUSE INTRODUCING MULTIPLE FENTANYL ANALOGS MADE IT EASIER TO GET AROUND THE U.S. LAWS.

POINT OUT THAT WHEN THE DEA ENACTED REGULATIONS PLACING FENTANYL ANALOGS IN CONTROLLED SUBSTANCES SCHEDULE I, THE RATE OF INTRODUCTION OF NEW FENTANYL ANALOGS INTO THE UNITED STATES DROPPED DRAMATICALLY.

POINT OUT THAT THE US HAS BEEN ABLE TO PERSUADE CHINA TO MOVE FENTANYL ANALOGS INTO THEIR EQUIVALENT OF SCHEDULE I, AND WE MUST DO THE SAME IN THE U.S.!

POINT OUT THAT ALL 50 STATE ATTORNEYS GENERAL AS WELL AS THE ATTORNEYS GENERAL OF WASHINGTON, D.C. AND PUERTO RICO UNANIMOUSLY SENT A LETTER TO CONGRESS REQUESTING PASSAGE OF THE SOFA ACT.

POINT OUT THAT THE TEMPORARY PLACEMENT OF FENTANYL ANALOGS IN SCHEDULE I WILL EXPIRE FEBRUARY 6^TH UNLESS THE SOFA ACT IS PASSED BEFORE THEN.

Background:

The SOFA Act amends the Controlled Substances Act to add illicit fentanyl analogs to Schedule I.

Schedule I controlled substances have a high potential for abuse and no currently accepted medical value.  They are subject to strict regulatory controls and penalties under the Controlled Substances Act.

              Fentanyl analogs are a group of drugs that share the fentanyl backbone and act at the same receptors as fentanyl. They have minor surface tweaks which make them legally distinct compounds. Federal officials attempting to fight the opioid epidemic were faced with having to go through a lengthy process to get each legally distinct analog moved into Schedule I, and during the lengthy process, new fentanyl analogs were being introduced. 

In February 2018, the Drug Enforcement Administration invoked emergency powers to temporarily move all illicit fentanyl analogs into Schedule I.  The result of this action was that the pipeline of new fentanyl analogs shut down.

But this ban expires February 6^th, and we may expect a rapid resumption of widespread distribution of fentanyl analogs shortly after the expiration. 

The SOFA Act was designed to amend the Controlled Substances Act to permanently add illicit fentanyl analogs to Schedule I.

At this point, the only major resistance to the SOFA Act is coming from civil liberties groups.  They argue that drug use and addiction are primarily public-health matters that need treatment rather than criminal sanctions.  They argue that passage of the SOFA Act would grant the DEA the power to impose harsh mandatory minimum sentences for possession of an analog.

We obviously agree that drug abuse and addiction need treatment, not harsh criminal penalties. But the SOFA Act is aimed at those who are distributing death throughout our country, not at the individual suffering from a substance use disorder.  And it is simply wrong-headed to prevent law enforcement from using the SOFA act to pursue those who are selling deadly fentanyl analogs to men and women suffering from opioid use disorder.

In 2017, 40% of opioid overdose deaths in Florida were due to fentanyl analogs.  We need to do whatever can be done to stop fentanyl analog death.

We need the SOFA Act.

STOPPING OVERDOSES of FENTANYL ANALOGUES (SOFA) ACT

This bill amends the Controlled Substances Act to add certain fentanyl analogues to schedule I. A schedule I controlled substance is a drug, substance, or chemical that: has a high potential for abuse; has no currently accepted medical value; and is subject to regulatory controls and administrative, civil, and criminal penalties under the Controlled Substances Act. Please, contact your senator and congressperson, and implore them to support the SOFA Act, and why they must pass the legislation ASAP!!