Congress is advancing bipartisan legislation intended to address the nation's opioid abuse epidemic, but lawmakers appear to be no closer to finding a way to pay for the effort — an omission that even supporters say will severely limit its impact.
As a spiraling nationwide increase in overdoses has captured Washington's attention, both the House and Senate have approved bills to expand access to treatment, make overdose reversal drugs more widely available and strengthen state prescription drug monitoring programs.
But while Congress has started the process of reconciling the bills, little progress has been made in defusing a political confrontation over funding. Because the most substantial proposals involve grant programs, the legislation will require new money to achieve the impact lawmakers envision.
Rep. John Sarbanes, a Baltimore County Democrat, has been named to the committee charged with ironing out the differences in the legislation. Senate leaders are expected to name members to that panel shortly.
Democrats have called for $600 million in emergency spending to address the epidemic, but Capitol Hill already has its hands full with emergency funding for the Zika virus. Republican leaders say money to pay for opioid programs will be negotiated with other government funding this fall.
Susan Awad is director of advocacy and government relations at the American Society of Addiction Medicine in Chevy Chase. "These grant programs require dollars," she said. "In the midst of an epidemic, we would argue that emergency funding is preferable to start getting these grants out the door."
About 28,000 people died of overdoses in the United States in 2014, four times the number in 2000. In Baltimore, more than 340 people died from drug and alcohol overdoses in the first three quarters of 2015, up from the 303 who died in all of 2014.
An estimated 20,000 people in the city are using heroin today.
The spike in overdose deaths has prompted bipartisan interest in Congress, particularly as the epidemic has spread beyond urban centers like Baltimore and into rural areas — many of which are represented by Republicans.
Nationwide, only about 11 percent of patients with addiction received needed treatment, advocates say. It is not clear that the legislation, as is, will increase that number.
Terry Diggs started taking heroin when he was in his late teens growing up in South Baltimore. Now 56 and living at the Gaudenzia treatment clinic, Diggs has been clean for six months and has enrolled in classes at Baltimore City Community College.
Diggs insisted treatment is available to those who want it, but his story underscores the challenges some face in finding it.
Gaudenzia was booked when Diggs first called, a common problem at treatment centers. After making more inquiries, Diggs wound up at a detox facility on the Eastern Shore before he was placed back in Baltimore.
Diggs and others said many seeking help show up at emergency rooms and claim to be suicidal to be admitted, and to gain access to social workers who can help find a treatment slot.
"I didn't want to go to my grave being a disappointment to my family," Diggs said. "I want to be able to go to my grave clean, and being someone my parents wanted me to be."
Paul, a 38-year-old Baltimore native who also has wrestled with addiction since his teens, said he admitted himself into a hospital to get help. He ultimately wound up at Tuerk House, one of the city's best-known substance abuse treatment centers. (He asked The Baltimore Sun not to publish his last name.)
"You find that rehabs are full," said Paul, a Navy veteran who has been in treatment since March. "It's upsetting because you're trying to do the right thing and you can't get help when you want to get help."
The Senate voted 94-1 to create new grant programs to target communities with above-average rates of opioid abuse. The legislation would authorize the Department of Health and Human Services to issue grants for new treatment programs, and expand treatment options — rather than defaulting to jail time — for certain criminal defendants.
The House approved a series of bills last week that, when combined, are broadly similar to the Senate measure.
Advocates view the legislation as a victory because it demonstrates a bipartisan recognition that drug abuse should be treated as a health problem.
The effort "has really helped to shift the politics around addiction," said Grant Smith, with the New York-based Drug Policy Alliance.
Sarbanes managed to move a measure through the House that would encourage and train doctors to prescribe overdose reversal drugs such as Naloxone when they prescribe pain medication and other opiates.
The idea is to ensure that if a patient becomes addicted and overdoses, medication will be on hand that could save his or her life.
Sarbanes, who is in his fifth term, said he believes the attention the legislative process is bringing to the issue might be helpful itself. It could raise awareness, for instance, for patients when they are handed prescriptions for high-powered pain killers that can trigger addiction.
"It takes us beyond a conversation about crisis and alarm to 'What can we do about it?'" Sarbanes said. "I think that can have a positive impact."
Sarbanes said the lack of funding is a challenge. Proposals to expand treatment, he said, "are not going to be up to the task" if there is no money dedicated for them.
But he said the focus on the legislation at hand could gin up the political will to increase funding later. "I'm hopeful that when you get the importance of putting resources behind this, it will become self-evident," he said.
Sen. Rob Portman, an architect of the Senate legislation, has said the new programs should be funded as part of the appropriations process this fall.
Lawmakers have been working toward a comprehensive bill to fund the federal government, but it is not clear whether the politics of a presidential election could lead Congress to pursue another stopgap funding bill instead.
In that circumstance, spending levels would be frozen and no new money would go toward drug treatment.
Portman, an Ohio Republican, has said he is confident lawmakers will approve the current measure, at least, and send it to the White House.
"There's enough common ground that we should be able to pull together quickly," Portman said. "This affects every ZIP code in America."