Policy News Roundup: February 16, 2023

Key reads

Removal of buprenorphine waiver requirement eliminates key barrier

In his State of the Union address, President Biden highlighted a recent policy change wrapped into the omnibus bill signed into law in December that made it easier for doctors to prescribe buprenorphine for opioid use disorder by eliminating the waiver requirement. The waiver requirement discouraged doctors from prescribing and contributed to stigma. The article quotes Lindsey Vuolo, Partnership to End Addiction’s Vice President of Health Law and Policy, who said that the waiver requirement limited access to treatment during an unprecedented opioid crisis. She also highlighted that cost and affordability continue to be major barriers to treatment.

Source: The Biden administration quietly eliminated a barrier to medication for opioid addiction (NBC)

Substance use measures improve but mental health worsens among adolescents

The Centers for Disease Control and Prevention’s 2021 Youth Risk Behavior Survey found that while substance use measures improved among adolescents, mental health worsened significantly. Across almost all measures of substance use, experiences of violence, mental health and suicidal thoughts/behaviors, female students are faring worse than male students. In 2021, nearly 30% of female students drank alcohol in the past 30 days, almost 60% experienced persistent feelings of sadness/hopelessness during the past year and nearly 25% made a suicide plan. LGBTQ+ students were more likely than peers to have used/misused all substances in the report, close to 70% experienced persistent feelings of sadness/hopelessness during the past year, 50% had poor mental health during the past 30 days and almost 25% attempted suicide in the past year. White students were more likely than Asian and Black students to have ever used select illicit substances. Black and Hispanic students were more likely than Asian and White students to misuse prescription opioids. Black students were less likely to use alcohol but more likely to use marijuana than Asian, Hispanic or White students.

Source: Youth Risk Behavior Survey: Data Summary & Trends Report (Centers for Disease Control and Prevention)

NIDA director stresses need for treatment, not criminalization, for pregnant people with addiction

National Institute on Drug Abuse Director Nora Volkow explains that pregnant people with substance use disorder need support, not criminalization. Overdose is a leading cause of death during and after pregnancy. Pregnant people are less likely to be able to receive treatment appointments, and Black and Hispanic pregnant people experience even greater challenges. Fear of criminal punishment deters many from seeking help. Many states have punitive policies, including regarding substance use during pregnancy as child abuse or grounds for commitment or being charged with a criminal act. Penalties can include fines, loss of custody, involuntary commitment or incarceration. Pregnant Black people are more likely to be referred to child welfare and less likely to be reunited with their infants. Punitive policies also lead people to avoid or delay obstetric care. In states more likely to criminalize pregnant people with addiction, fewer receive treatment, and more infants are born with neonatal abstinence syndrome. Treatment reduces risk of overdose and fetal health problems and helps people stay employed, take care of their children and engage with families and communities.

Source: Pregnant people with substance use disorders need treatment, not criminalization (STAT)

New bill would close loophole for flavored disposable vapes

Rep. Cherfilus-McCormick (D-FL) introduced the Disposable ENDS Product Enforcement Act of 2023 to close the loophole on disposable electronic nicotine delivery systems (ENDS) containing flavors specifically intended to entice children. The bill would direct the Department of Health and Human Services to update the guidance under Section 2 of the Federal Food, Drug, and Cosmetic Act to describe how the agency will prioritize enforcement against disposable ENDS products, including non-tobacco-derived nicotine products. In 2020, the Trump administration prohibited the sale of flavored e-cigarettes, but only for e-cigarettes that required a cartridge refill. This left an opening for companies to sell disposable versions with the same flavors.

Source: Congresswoman Cherfilus-McCormick Introduces Legislation to Protect Children From Flavored Disposable E-Cigarettes (Congresswoman Sheila Cherfilus-McCormick)

FDA advisers recommend approving OTC naloxone

An advisory committee to the Food and Drug Administration (FDA) voted unanimously to recommend that naloxone nasal spray (Narcan), used to reverse opioid overdoses, be sold and distributed without a prescription. While the FDA is not bound by the result, it almost always adheres to advisory committees’ recommendations. The result came following discussion regarding the medication’s safety and whether non-health care professionals could follow instructions in Narcan’s packaging well enough to effectively administer it in an emergency. Despite voting to recommend approval, the advisers noted that manufacturer Emergent’s user-friendliness tests did not include time limits and included leading language that may have yielded misleadingly low rates of user error. Some of the study groups also failed to include significant numbers of limited-literacy participants. Naloxone’s broader safety profile, however, went unquestioned. The advisers agreed that the urgency of the overdose crisis far outweighed potential delays associated with gathering new data.

Source: FDA advisers recommend approval of over-the-counter naloxone to fight opioid overdose (STAT)

New York launches harm reduction campaign

The New York Department of Health is launching a harm reduction campaign, Safer Choices, to help prevent overdose deaths. The multi-media campaign, starting with a focus on social media platforms and web-based resources, is meant to equip individuals with an understanding of how to reduce overdose, as deadly fentanyl continues to be found in a wide variety of substances. It also continues to emphasize the importance of naloxone. It shares information and steps for family members, friends and people who use substances. The campaign includes information on naloxone, testing for fentanyl, not using alone and Good Samaritan laws.

Source: New York State Department of Health Launches New Harm Reduction Campaign to Help Reduce Overdoses (New York State Department of Health)

New Jersey expands mental health crisis response program

New Jersey’s Arrive Together pilot program sends plain clothes police officers with mental health counselors to emergencies involving people in emotional distress to better address the mental health needs of people in crisis and reduce the risk that encounters might end in violence. The three-community pilot is now being expanded into 10 of New Jersey’s 21 counties, with teams in 30 communities. State leaders aim to extend the program throughout the state in coming years to become the first statewide effort of its kind. Governor Murphy said he would include $10 million in next fiscal year’s budget to pay for the expansion. Each participating officer and mental health screener must participate in intensive training, which includes instruction on the special needs of veterans, for example, as well as people with substance use disorder. The officer and social worker are also expected to remain in contact with residents whom they meet on calls.

Source: One State’s Effort to Keep Some Police Encounters From Turning Deadly (The New York Times)

Opioid settlement funds should be used to support treatment for those who are incarcerated

Opioid settlement funds should be used to support treatment in jails and prisons, according to experts writing in Health Affairs. With such investment, cost should no longer impede availability of treatment. Investing in medications for opioid use disorder (MOUD) for justice-involved individuals will help reduce the high overdose rates for incarcerated people, as well as mitigate exacerbation in health inequity and potentially reduce recidivism. Policymakers must also expand community treatment capacity and integrate treatment across jails, prisons, probation, parole and community re-entry programs to ensure treatment during incarceration and release. States should use the opportunity of the settlement dollars to consider funding programs to offer all FDA-approved MOUD in all correctional settings; minimizing administrative, regulatory and policy barriers to access MOUD; diverting individuals with substance use disorder to medical facilities rather than the criminal legal system; and supporting education efforts to reduce stigma that often marginalizes people who use substances and incarcerated populations.

Source: Opioid Settlement Funds Should Support Incarcerated People (Health Affairs)

Framework for localities to optimize opioid settlement funds

To target their opioid settlement funds toward addressing overdoses in their hardest-hit communities, local jurisdictions should make immediate investments to expand the reach of overdose prevention centers, make naloxone ubiquitous across jurisdictions and support other harm reduction and social programs that serve people who use substances, according to experts writing in Health Affairs. Medium-term investments should be made to expand access to low-barrier treatment for populations at greatest risk and expand touchpoints in acute care settings to reach high-risk individuals and link them to community-based services. Long-term investments should be made to invest in social programs that reduce poverty and homelessness, divert individuals away from the criminal legal system toward social and health services and support early childhood interventions and education programs that promote mental health and healthy coping.

Source: Optimizing Opioid Settlement Funds To Save Lives: Investing In Equitable Solutions (Health Affairs)

Harm reduction remains under-resourced

Harm reduction remains underfunded and partially outlawed in many states. The work is often conducted by organizations that run syringe exchange programs (SEPs). Workers can face legal risk in connecting people who use substances to the resources they need. There are only around 1,100 full-time harm reduction workers, along with around 600 part-time workers and 2,000 volunteers. The median annual budget of an SEP is roughly $100,000, far less than what is needed to cover salaries, supplies and travel. Finding money to pay for harm reduction work is difficult, and scaling the response to the magnitude of the crisis is often prohibitively expensive. Groups survive on a patchwork of private donations, grants and local and state funds that come and go. This causes cycles of uncertainty. State and federal laws limit access to some harm reduction services and stifle funding.

Source: Workers Fighting America’s Overdose Crisis Are ‘Hanging by a Thread’ (The New York Times)

Elimination of buprenorphine waiver must be better communicated

The omnibus eliminated the buprenorphine waiver requirement, but the change has not been communicated to the people who need to know about it, according to an opinion piece in STAT. Agencies made announcements, and addiction-focused groups tried to amplify the message, but there is no major effort to reach beyond the small pool of existing providers. The law also does nothing to dismantle state regulations that create barriers. Vigorously communicating the changes and investing in supports prescribers need to effectively manage patients on buprenorphine would increase the number of providers. The change will help underserved communities access treatment, as rural populations and communities of color often lack waivered providers. The change may help normalize buprenorphine’s essential role in treating opioid use disorder (OUD). The law directs the federal government to conduct national awareness campaigns that encourage providers to incorporate addiction services into their practices, but there has been little action beyond that high-level commitment. People with OUD need to know they can ask their current providers for buprenorphine.

Source: The X-waiver for buprenorphine prescribing is gone. It’s time to spread the word (STAT)