The under-the-radar battle over opioid addiction treatment legislation

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In today’s edition …  Gun control groups are divided over whether the Senate should hold a vote during the lame duck on an assault weapons ban … What we’re watching: The Senate’s rail strike vote and a crypto hearing … Here’s how federal judges think about diversity in hiring law clerks … Where the House GOP Impeachment 10’s aides are landing … but first …

The under-the-radar battle over opioid addiction treatment legislation

In the final legislative sprint of the year, a quiet battle is being waged in Congress over how best to treat certain drug addictions, as the opioid epidemic continues to ravage parts of the country and deaths from overdoses remain historically high.

In many ways, it is a classic Washington showdown: Lawmakers and certain advocates are pushing one policy, while an industry fights to keep it from being enacted.

But the life-or-death nature of the opioid crisis and the destructive path it has cut through all manner of communities have lent an intensity to the debate that you don’t find in the push-and-pull over which corporate tax breaks should be extended.

At issue is access to methadone as a treatment for opioid addiction and whether patients should have to show up at a treatment facility each day to receive their dose or if they can simply call their doctor. 

Rep. Donald W. Norcross (D-N.J.) and Sen. Edward J. Markey (D-Mass.) are pushing legislation they introduced one year ago that would enable certified addiction-treatment physicians to prescribe methadone at a local pharmacy for stable patients who could then take the treatments at home. Certain patients would also be allowed to take home as much as a one-month supply of the medication.

Most methadone treatment is required, by federal rulemaking, to take place at a certified opioid treatment facility, known as an OTP. But those rules were eased during the coronavirus pandemic. Norcross, Markey and their supporters argue this flexibility helped patients by making it easier to take the medication. Having to go to a clinic each day is difficult with work, child care, lack of transportation — and there is a stigma associated with going to one, they contend.

Some people also don’t have easy access to an OTP: 24 percent of the population, or 77 million people, don’t have one in their county, according to a 2019 report by the Congressional Research Service. 

“The idea of having to go to this one location to pick up your meds is just nuts,” Norcross said. 

Ronnie Hartman, 33, can attest. He has been recovering from opioid addiction and using methadone for five years. He’s slowly weaning off the medication but said accessing his treatment makes the road to recovery more difficult. 

“I know how hard it can be having to go to the clinic every day in order to get medication,” Hartman said. “It takes a lot of energy and time to get medication that can be used to do positive things during the recovery period to rebuild their lives.”

The trade group that represents the clinics, which must be certified and accredited to qualify as OTPs, says that permanently loosening the rules is misguided and that lax oversight of patients by doctors helped created the opioid epidemic in the first place.

The American Association for the Treatment of Opioid Dependence, or AATOD, is the trade group that represents more than 1,800 OTP facilities across the country. 

Mark W. Parrino, the association’s president,  said he is adamantly opposed to allowing non-OTP doctors to prescribe methadone. He doesn’t trust doctors, he said.

“We have reason. It’s not because we’re paranoid,” Parrino said. 

Parrino blames doctors’ over-prescription of opioids, including methadone, in the ’90s and early 2000s to treat pain for the current crisis.

“We think there’s a place for doctors, especially those working with OTPs, but, yes, frankly, to go back to the era of methadone mortality” is not acceptable, he said, referring to the period earlier this century when methadone overdoses spiked.

Markey charges the clinics are just trying to protect their business interests, which he calls a “methadone monopoly.”

“Their lobbyists want to bottleneck access clinics to increase profits,” Markey said in an interview. “Recovery is hard. We don’t need to make it any harder.”

The House version of the legislation was folded into a larger mental health bill that overwhelmingly passed in June with 402 votes, but it has yet to be brought up for a consideration in the Senate. The bill has at least some bipartisan support in the Senate. Sens. Rand Paul (R-Ky.) and Mike Braun (R-Ind.) are co-sponsors.

The legislation’s supporters are looking to attach to it a must-pass bill such as a year-end spending bill or the annual defense policy bill.

Markey said the biggest impediment to doing so is the lobbying campaign being carried out by Parrino’s group.

Drug overdoses have increased for the past two decades, with deaths in 2021 surpassing the previous record in 2020 with most of the deaths coming from fentanyl. (Our colleagues Julie Vitkovskaya and Courtney Kan have an excellent explainer on fentanyl.)

Advocates for expanding access to methadone say studies that AATOD is using to undermine the legislation dealt only with methadone treatment for pain, not for addiction recovery, and that the doctors prescribing treatment would have to obtain the highest addiction treatment certification.

Zac Talbott, president of the National Alliance for Medication Assisted Recovery, runs an opioid treatment facility in eastern Tennessee. He said he finds it a burden on some patients deep into their recovery to rely on OTP services.  

“Patients who have benefited from OTP that no longer need the services, they should have choice,” Talbott said. “Stabilized patients deserve choices, and this would allow them that.”

Dems under pressure on assault weapons ban

As lawmakers hustle to avert a rail strike and keep the government funded, Democrats are still under pressure to take up long-shot legislation before they lose their House majority in January.

March for Our Lives, Brady, Guns Down America and several other anti-gun-violence groups are sending a letter to Senate Majority Leader Charles E. Schumer (D-N.Y.) today urging him to bring the assault weapons ban legislation that passed the House in July up for a vote in the Senate. They’re making the push even though the bill lacks the 60 votes needed to overcome a Republican filibuster.

“Look, if we don’t hold the vote, then the votes certainly aren’t there,” said Igor Volsky, Guns Down America’s executive director.

“Part of our push here is to signal that the days of making rhetorical promises and not acting are over,” he added.

Other gun-control groups are holding off their efforts until it’s clear that such legislation has the votes to pass.

“We’re focused on bolstering our gun-sense majority in the Senate and reelecting Senator Warnock next week,” Stacey Radnor, a spokeswoman for Everytown for Gun Safety, the gun-control group backed by former New York mayor Mike Bloomberg, wrote in an email to The Early. “We also support legislation to regulate assault weapons and look forward to bringing it to the floor as soon as it secures enough votes for passage.”

Looming rail strike: Will the Senate reach an agreement to vote on the legislation to prevent a rail strike? The House passed it Wednesday, sending it to the Senate, where Republicans are haggling over how to proceed so that it can be passed quickly, without all the procedural machinations. 

Republicans are a bit all over the place on the issue. A couple say the workers should have sick leave, many say President Biden shouldn’t intervene, and others support moving quickly. 

One proposed Republican amendment would extend the deadline into the new year. Sen. Bernie Sanders (I-Vt.) still wants his amendment that would provide the workers with seven paid sick days, too. 

To try and help push the legislation over the finish line, Labor Secretary Marty Walsh and Transportation Secretary Pete Buttigieg will attend Senate Democrats’ policy lunch today.

House Democrats’ leadership elections: House Democrats will continue their leadership elections today. They’ll vote for the new No. 4 position — assistant minority leader — which is now a contested race after Rep. David N. Cicilline (D-R.I.) announced that he would challenge Rep. James E. Clyburn (D-S.C.). Cicilline, who is gay, says there should be LGBTQ representation in the top rungs of leadership, but it’s highly unlikely he’ll beat Clyburn.

Probing the collapse of FTX: The congressional response to the fall of cryptocurrency giant FTX kicks off today with a hearing on the matter. Commodity Futures Trading Commission (CFTC) Chairman Rostin Behnam will appear before the Senate Agriculture Committee.

• 👀Reminder: Former FTX chief executive Sam Bankman-Fried and former FTX Digital Markets CEO Ryan Salame gave tens of thousands of dollars in campaign contributions to lawmakers on the committee — the same committee tasked with investigating its collapse.

Here’s how federal judges think about diversity in hiring law clerks

New: According to an article published online Wednesday, the nation’s top appeals court judges consider race and gender when evaluating applicants for prestigious one-year clerkships — a crucial steppingstone to obtaining a Supreme Court clerkship and advancing a career in appellate law, our colleague Ann Marimow reports.

Of the 50 federal judges interviewed about their hiring practices for the article, “many reported difficulty hiring Black and Latino clerks,” Ann writes. “Those with the most success hiring people of color took steps to broaden their applicant pool and to consider indicators of talent beyond law school rank and grades. Black judges, the study shows, are particularly successful in recruiting and hiring Black clerks; they comprised less than one-eighth of all active appeals court judges at the time of the study, but accounted for more than half of the Black law clerks working in those courts.”

• Here’s what one Black judge told the authors of the study: “I’ve seen a broad range of talent. … I don’t care where students went to school. You have to do your homework and dig underneath the transcript, figure out the curve, look beneath the law review editor titles. I drill deeper. … There’s no monopoly over brains or qualifications; it’s a question of opportunity.”

Long story short: “Diversity among judges affects diversity among clerks,” the authors wrote.

As Theo and Tobi reported last month, diversity is scarce throughout the entire appellate bar. The elite group of lawyers who argue before the Supreme Court justices remains mostly White and male, as well as the lawyers who clerk for them. When asked about the lack of diversity among clerks during a 2009 congressional budget hearing, Justice Clarence Thomas told lawmakers: “We receive what the law schools prepare.”

Where the House GOP Impeachment 10’s aides are landing

First in The Early: Jordan Evich, the deputy chief of staff to Rep. Jaime Herrera Beutler (R-Wash.), is heading to K Street.

Evich will lead the appropriations practice at the lobbying firm Monument Advocacy.

Herrera Beutler is one of the 10 House Republicans who last year voted to impeach President Donald Trump. Eight of them are leaving Congress — four of them didn’t run for reelection, while Reps. Liz Cheney (R-Wyo.), Peter Meijer (R-Mich.), Tom Rice (R-S.C.) and Herrera Beutler lost their primaries — meaning their staffers will need new jobs.

Evich isn’t the only one to land on K Street. Maggie Woodin, Meijer’s legislative director, recently left for the U.S. Chamber of Commerce.

Thanks for reading. You can also follow us on Twitter: @LACaldwellDC and @theodoricmeyer.