Policy News Roundup: June 15, 2023

Key reads

Federal officials call for expanding access to and research on fentanyl test strips

In a New England Journal of Medicine perspective, National Institute on Drug Abuse, Food and Drug Administration and National Institutes of Health officials argue that the U.S. must ensure fentanyl test strips are legal and widely available and work to develop new products and technologies that facilitate drug-checking. They note that while fentanyl test strips are highly effective and seen as a key component of harm reduction efforts, there has been little research on how to maximize their potential uses. Currently, test strips are mainly used to test drug samples for fentanyl, allowing people who use substances to make informed decisions about whether and how much to consume. The researchers call for also developing rapid fentanyl testing products that could be used on urine and hair, arguing that it would be valuable for supporting on-site clinical decision making. They note that with new harmful contaminants such as xylazine, it is critical to encourage implementation of promising practices while supporting research on implementation and expansion of additional drug-checking approaches.

Source: Top health officials call for more research to support fentanyl test strips (STAT)

Only a quarter of adolescent residential treatment facilities offer any buprenorphine

A study found that only one in four residential addiction treatment facilities for adolescents offer buprenorphine. Only one in eight offer buprenorphine for ongoing treatment. Using FindTreatment.gov, researchers identified 354 centers that offered treatment for “substance use,” in a “residential/24-hour residential” setting, for “children/adolescents.” Researchers called these facilities to inquire about treatment for a 16-year-old with a recent nonfatal fentanyl overdose. They found 160 (45%) of these facilities provided residential treatment to patients under 18. Of those, 39 (24%) said they offered buprenorphine to patients 16 and older, but only 20 (12.5%) said they offered buprenorphine for ongoing treatment. Twelve (7.5%) said they offered buprenorphine to adolescents under 16. Among the 121 facilities that did not offer buprenorphine to adolescents, 57 (47%) indicated that adolescents prescribed buprenorphine by their own clinician could stay on it at least temporarily, though some stated they would discontinue it before discharge, and 27 (22%) required that adolescents were not taking buprenorphine in order to be admitted. By comparison, 25% offered equine therapy, which is not evidence-based, and more than one-third offered 12-step programs.

Source: Only 1 in 4 adolescent treatment facilities offer buprenorphine for opioid use disorder (National Institute on Drug Abuse); Teens seeking addiction care unlikely to be offered standard medication (STAT)

ONDCP director visits West Virginia

Office of National Drug Control Policy Director Rahul Gupta traveled to West Virginia last week to discuss local and national efforts to address the opioid crisis. Gupta held a roundtable at West Virginia University to hear about local efforts to address the overdose crisis, break down barriers to care and eliminate stigma. He toured the Rockefeller Neuroscience Institute to see WVU’s groundbreaking research on addiction funded by the National Institute on Drug Abuse and spoke with patients recovering from addiction at the WVU Center for Hope and Healing. In Charleston, Gupta met with the West Virginia Association of Addiction and Prevention Professionals to discuss how state and federal partners can best work together to provide services and supports. He went on a walking tour with the Charleston Quick Response Team, which he helped create during his time as the state’s chief health officer. Gupta held a roundtable with officials at the State Capitol to discuss high-impact, evidence-based policies. He also held a discussion at the West Virginia School of Osteopathic Medicine about addiction, trauma and mental health.

Source: ONDCP Director Dr. Gupta Visits West Virginia to Meet with Leaders on the Front Lines of the Overdose Epidemic (Office of National Drug Control Policy)

CMS announces primary care model to support care coordination, including with behavioral health services

The Centers for Medicare and Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested in eight states. MCP seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary care clinicians with tools to form partnerships with specialists and leveraging community-based connections to address patients’ health and health-related social needs. The goals are to ensure patients receive primary care that is integrated, coordinated, person-centered and accountable; create a pathway for primary care practices, especially small, independent, rural and safety net organizations, to enter into value-based care arrangements; and improve the quality of care and health outcomes of patients while reducing expenditures. MCP will run from July 1, 2024 to December 31, 2034. CMS will work with participants to address priorities specific to their communities, including care management for chronic conditions, behavioral health services and health care access for rural residents.

Source: CMS Announces Multi-State Initiative to Strengthen Primary Care (Centers for Medicare and Medicaid Services)

HRSA announces pediatric specialty loan repayment program, including for youth behavioral health providers

The Health Resources and Services Administration launched the new Pediatric Specialty Loan Repayment Program, a $15 million investment to recruit and retain clinicians who provide health care to children and adolescents. In exchange for three years of service working in a health professional shortage area or medically underserved area, or providing care to a medically underserved population, the Pediatric Specialty Loan Repayment Program provides up to $100,000 to eligible clinicians providing pediatric medical subspecialty, pediatric surgical specialty or child and adolescent behavioral health care, including substance use prevention and treatment services. The program aims to increase access to pediatric subspecialty care, including behavioral health in school-based settings.

Source: HHS Announces New $15 Million Loan Repayment Program to Strengthen the Pediatric Health Care Workforce (Department of Health and Human Services)

States move forward with settlements with opioid companies

The $17.3 billion in opioid settlement agreements with Teva, Allergan, CVS and Walgreens were finalized. Following state/subdivision sign-on periods, the companies committed to the deal. Money is expected to start flowing to states and localities by the end of 2023. Teva’s settlement will prevent all opioid marketing and ensure systems are in place to prevent substance misuse. Allergan is required to stop selling opioids for the next 10 years. CVS and Walgreens are required to monitor, report and share data about suspicious activity related to opioid prescriptions. The settlement with Walmart is still being finalized. Separately, Teva agreed to pay Nevada, which did not join the nationwide settlement, $193 million to settle claims that its marketing practices fueled addiction. Walgreens settled with New Mexico, which also did not join the national settlement, for $500 million over claims that it helped fuel addiction by failing to stop illegal pill sales. The Cherokee Nation sued distributor Morris & Dickson over claims that it fed the addiction crisis by not stopping suspicious shipments of painkillers to Oklahoma pharmacies.

Source: Teva, Allergan, CVS, and Walgreens Finalize Opioid Settlement Agreements (Delaware News); Teva to pay Nevada $193 million over role in opioid epidemic (Reuters); Walgreens reaches $500 million deal with New Mexico over opioid crisis (Reuters); Opioid distributor, already facing license revocation, sued by tribe (Washington Post)

States increasingly decriminalizing fentanyl test strips

This spring, Ohio joined at least 20 other states that have formally decriminalized fentanyl test strips since Rhode Island became the first to do so in 2018. Pennsylvania, South Dakota and Mississippi also followed suit this year. The strips are still considered illegal in some states, however, having been outlawed under drug paraphernalia laws dating back to the 1970s-era war on drugs. Every state but Alaska had an anti-paraphernalia law by the mid-1980s, making materials used for testing and analyzing illicit substances illegal. Increasingly, the strips are being seen as potentially life-saving. Kansas recently enacted a bill that decriminalized the strips starting July 1. Montana and other states are considering similar legislation. Texas’s governor recently dropped opposition to decriminalizing the strips. Prosecution for possessing the strips does not appear to be occurring anywhere in the U.S. Drug paraphernalia possession is a minor offense in most states, and law enforcement may now be more attuned to the strips’ lifesaving potential.

Source: Life-saving fentanyl test strips still illegal in some states under ’70s-era war on drugs law (Associated Press)

Oklahoma launches harm reduction vending machines

The Oklahoma Department of Mental Health and Substance Abuse Services launched a new harm reduction campaign to bring lifesaving resources to residents. Vending machines containing naloxone and fentanyl test strip kits will soon be available in highly trafficked areas in communities. The campaign kicked off with the distribution of more than 40 vending machines placed in strategic zip code locations where overdose prevalence is high.

Source: ODMHSAS Unveils Harm Reduction Campaign With Life-Saving Vending Machines (Oklahoma Department of Mental Health & Substance Abuse Services)

Baltimore mobile health clinic provides harm reduction-based treatment

Baltimore’s Healthcare on the Spot program is a mobile health clinic housed in a retrofitted van, through which doctors and nurses meet with patients, write prescriptions (including for buprenorphine), and provide wound care, hepatitis C treatment, naloxone and more, free of charge. The clinic exemplifies a shift toward harm reduction, offering potentially lifesaving services to people who use opioids without requiring abstinence. Most patients in the program continue using substances, but the vast majority report using less. The clinic coordinates with several pharmacies across the city. Patients do not need an ID or health insurance to enroll. Baltimore launched a needle exchange program in 1994. In recent years, officials have focused on expanding access to naloxone while reducing low-level narcotics and drug paraphernalia arrests. Another mobile treatment program parks outside the city’s jail and offers buprenorphine prescriptions to people getting released.

Source: Abstinence not required: How a Baltimore drug treatment program prioritizes saving lives (Associated Press)

More medical school and residency training on addiction is needed

Patrice Harris (former American Medical Association president), Josiah Rich (Brown University) and Joshua Sharfstein (Johns Hopkins Bloomberg School of Public Health) argue that more training on addiction is needed in medical schools and residency programs. The Consolidated Appropriations Act, 2023 required all doctors to receive eight hours of education on substance use disorder (SUD) before prescribing controlled substances, but doctors need a foundational education on SUD, starting in medical school and continuing through residency. Few medical schools provide teaching sessions or clinical experiences in SUD treatment. The Accreditation Council for Graduate Medical Education, responsible for residency training, requires all programs to provide instruction and experience in pain management for the specialty, including recognition of the signs of SUD. This is only a facet of what is needed, however. Few programs have experiential training using medications for addiction treatment. Medical schools and residency programs are unlikely to substantively increase their efforts unless the council and Association of American Medical Colleges require it.

Source: Opinion | Addiction can be treated. Doctors need to learn how. (Washington Post)

Study shows spike in overdose deaths after police arrests of dealers

A study found that police drug busts are associated with large spikes in overdose deaths and spikes in 911 calls and naloxone use. The study does not draw a direct, causal link between police actions and overdose deaths, but it demonstrates a strong association. Authors suggest this may be because when police arrest dealers, their regular customers, facing withdrawal, find other dealers, who may sell substances that contain higher levels of fentanyl and adulterants like xylazine or lidocaine. For people accustomed to a consistent supply from a consistent dealer, using newly sourced substances can be dangerous. Similarly, when people who use opioids lose access, even brief periods of abstinence can trigger withdrawal symptoms and reduced tolerance. Police activity targeting stimulants was associated with only a slight increase in overdoses, likely because stimulants are less likely to directly kill people. The slight uptick in overdoses and 911 calls following stimulant arrests may result from supply disruptions that lead people who use stimulants to seek substances from other sources, not knowing that they may be tainted with fentanyl.

Source: ‘The drug bust paradox’: Study shows opioid deaths double after police action (STAT)