The U.S. House Energy and Commerce Committee cleared 32 bills aimed at addressing the nation's opioid crisis, sending the measures — along with 25 other bills adopted by the panel last week — to the chamber's floor for consideration.
Rep. Greg Walden, R-Ore., chairman of the committee, said he received a commitment from Majority Leader Kevin McCarthy, R-Calif., that the House would take up the 57 bills in June — past the Oregon lawmaker's goal of getting the legislation out of the chamber by the U.S. Memorial Day holiday on May 28.
"Our communities are counting on us to deliver on solutions to help turn the tide of addiction and death that is ravaging towns from coast to coast," Walden said at the May 17 markup hearing.
Sometime this summer, the Senate is expected to consider a package of bills that cleared the Health, Education, Labor and Pensions Committee in April.
Other congressional panels, including the Senate Judiciary and Finance and the House Ways and Means Committees, also have been working on separate bills.
Cowen & Co. analyst Eric Assaraf said he continued to believe that a package of opioid bills would pass Congress before the August recess "that will be broadly positive for treatment facilities and manufacturers of addiction therapies and non-opioid alternatives."
The House Energy and Commerce Committee initially had 34 bills on its plate for the May 17 markup hearing to consider and debate, but two measures were dropped.
Walden's decision to ditch one of those measures — the Addiction Treatment Access Improvement Act, or H.R. 3692, sponsored by Rep. Paul Tonko, D-N.Y. — created a firestorm near the end of the more than seven-hour markup session.
Rep. Frank Pallone, D-N.J., ranking member of the committee, said that decision was "playing politics with a priority of many members of this committee."
The Tonko bill would expand on programs created under the 2016 Comprehensive Addiction and Recovery Act, or CARA, and permit clinical nurse specialists, certified nurse midwives and certified registered nurse anesthetists prescribe buprenorphine, a medication-assisted therapy, or MAT, used to treat opioid addiction and dependence. It would make permanent the authorization that allows non-physician providers to treat patients with the drug.
The legislation also would codify a 2016 regulation that expanded the number of patients qualified physicians could treat to 275, though the bill would give the secretary of Health and Human Services the ability to adjust the patient limit.
Tonko's bill "would have an immediate effect on the availability of treatment in our communities by increasing the number of providers capable of treating patients with medication-assisted treatment," Pallone said at the opening of the hearing. "We all know treatment is critical to preventing fatal overdoses that take the lives of more than 115 people each day and helping individuals with opioid use disorder achieve recovery."
The legislation was backed by the congressional Bipartisan Heroin Task Force in January.
It was also supported by the American Society of Addiction Medicine, the American Nurses Association, American Association of Nurse Practitioners, American Academy of Physician Assistants, the American College of Nurse-Midwives, the American Association of Nurse Anesthetists, the National Association of Clinical Nurse Specialists and the American College of Obstetricians and Gynecologists.
'Not quite baked and ready'
Tonko tried to attach his bill as an amendment to another measure just before the hearing closed, but he was blocked by Republicans.
Walden said the Tonko legislation was "not germane" and violated the rules because it was written to amend the Controlled Substances Act, and the provision the New York lawmaker sought to fasten it to was aimed at amending the Public Health Service Act.
He also said the committee had heard "major concerns" about the Tonko legislation from groups like the American Psychiatric Association, the Opioid Treatment Consortium and the American Society of Anesthesiologists, who told the panel chairman that the buprenorphine prescribing privileges should not be expanded to non-physicians until there was more data.
Walden said the Drug Enforcement Administration, or DEA, had expressed similar concerns, and said not enough time had passed to show the CARA program was "more beneficial than harmful."
He said the DEA was also concerned about the potential for diversion of buprenorphine if MAT programs were further expanded.
Tonko argued the expanded MAT program had worked, "but it hasn't reached the people we need to, and so every day, every week, every month, every year that passes that we don't allow this service delivery, we have to understand that someone is going to lose a loved one, they are going to lose a sibling, a parent, a child, a neighbor, a friend because we are not acting on service delivery."
Walden concluded that there may be a pathway for the Tonko bill later, but for now, it was "not quite baked and ready."