Senate passes bipartisan package

In February, a Perry Township man was indicted in federal court for allegedly importing 35 grams of a fentanyl analogue into the U.S. from China.

According to the indictment, 58-year-old Karl L. Brewer imported methoxyacetyl fentanyl from the People’s Republic of China between March 10 and April 25, 2017.

“This defendant illegally imported drugs that are killing thousands of our neighbors and relatives,” U.S. Attorney Justin E. Herdman said at the time of the indictment.

In 2013, there were 84 fentanylrelated overdose deaths in Ohio.

The following year that number rose to 503 and more than doubled again the following year to 1,115. Fentanyl and its analogues now make up more than half of the annual overdose deaths in Ohio and is fueling the spike in overdose deaths across the country.

There were 72,000 total overdose deaths in the United States in 2017. Synthetic opioids like fentanyl contributed to nearly 30,000 of those deaths.

Much of the fentanyl making its way into the U.S. comes the way it did in the alleged Perry Township case: being shipped from China.

In January, the U.S. Senate’s Permanent Subcommittee on Investigations released its findings of an 18-month investigation into how easy it is to buy fentanyl online.

According to the report, the sellers preferred to ship purchases through the international arm of the U.S. Postal Service. They also preferred to get paid through cryptocurrency, Bitcoin in particular,

but Western Union, PayPal, bank transfers, credit cards, and prepaid gift cards were also accepted. The Chinese sellers shipped purchases through other countries to reduce the risk of the drugs being detected and seized by customs officials.

The report was critical of the U.S Postal Service and the U.S. Customs and Border Protection for failing to recognize and prepare for the increase in international shipments.

U.S. Sen. Rob Portman, R-Ohio, who chairs the permanent subcommittee, sponsored the Synthetics Trafficking & Overdose Prevention (STOP) Act. That bill is aimed at quelling the flow of synthetic opioids like fentanyl into the U.S. from foreign countries.

The STOP Act was part of a bipartisan package of opioid initiatives passed by the U.S. Senate in a vote Sept. 17.

The bill would require the U.S. Postal Service to provide information on at least 70 percent of international mail shipments by the end of the year. By 2020, the Postal Service would be required to provide data all international shipments. The agency would be able to block or destroy shipments when the required information

is not required.

Under the bill, authorities would be able to waive the requirements for countries that don’t have the capacity to provide electronic information, as long as they are found to pose little risk to the U.S. and account for a small volume of mail shipments. Lawmakers believe that China does have the capacity to provide the required information.

The Postal Service’s vice president of Network Operations Management, Robert Cintron, expressed concerns about the STOP Act during a Senate subcommittee hearing last year. Cintron said the blocking of inbound mail could lead other countries to block outbound mail originating from the U.S. He added there are costs and fees associated with the measure.

“The STOP Act would also impose enormous new costs upon the Postal Service—costs of approximately $1.2 to $4.8 billion over ten years have been estimated based on our understanding of the current language,” Cintron said at the hearing.

“Notably, the Postal Service would immediately have to pay a new customs fee on most inbound mail

items (except small letters and large-value dutiable items), but, under current international law, the Postal Service would be unable to charge most customers to recoup that cost.”

Portman has said this would keep more fentanyl from entering U.S. communities.

“Will it solve the entire problem? No,” Portman said on the Senate floor in August. We talked earlier about the need for more prevention, education, treatment, the longer-term recovery, but at least, let’s keep some of this poison from coming in. At a minimum, it’s going to raise the price, which is one of our huge problems with fentanyl today. It’s not only 50 times more powerful than heroin and people chase that high, but it is very inexpensive relative to other forms of opioids.”

Other Portman-backed provisions in the package include establishing national recovery housing standards, supporting recovery support programs for high school and college students struggling with addiction, and authorizing $60 million for a plan of safe care for babies born dependent on substances.

The Caring Recovery for

Infants and Babies (CRIB) Act is also part of the package. Sen. Sherrod Brown, D-Ohio, is also a sponsor of that legislation. According to Brown’s Office, it would allow Medicaid to cover certain health care services provided to infants in residential pediatric recovery facilities in addition to hospitals and also clarify that babies receiving services in residential pediatric recovery centers can continue to receive services after one year of age, and provide for activities to encourage caregiver-infant bonding.

“With the right care, newborns suffering from addiction have every shot of growing up and leading a healthy life. But treating these babies in the hospital is expensive and can be overwhelming for families,” Brown said in a statement. “We must ensure that Ohio moms and babies have access to residential treatment facilities that specialize in giving them the specific kind of care they need and at a lower cost to taxpayers.”

Portman said that the Ohio Department of Health estimates that 84 babies are being treated for drug withdrawal every day in the state’s hospitals.

The Senate’s bill will also allow the Drug Enforcement Administration more authority to manufacturing quotas for controlled substances like prescription opioids when the agency suspects diversion.

The Department of Health and Human Services will be allowed to issue regulations to allow doctors to remotely prescribe medication assisted treatments. Currently, medication assisted treatments like Buprenorphine and methadone require in-person referrals and prescriptions because they are controlled substances. The current law creates challenges for those seeking treatment in rural areas.

The bill now needs to be reconciled with the U.S. House of Representatives version of the bill, which passed in June. Among the pieces that’s included in the House version of the bill that’s not in the Senate’s version is the repeal of the Institutions for Mental Diseases exclusion rule, which prohibits federal Medicaid reimbursements for inpatient treatment centers with more than 16 beds. In 2017 Brown and Portman sponsored a bill to lift the 16bed cap.