Policy News Roundup: August 17, 2023

Key reads

Two-thirds of adults say they or a family member has experienced addiction or overdose

A KFF poll found that two-thirds of adults say they or a family member have been addicted to alcohol or drugs, experienced homelessness because of addiction, had an overdose that required hospitalization or died from an overdose. Addiction affects people across race, income and geography. Only 46% of families that experienced addiction say the person got treatment, with the percentage higher among White than Black and Hispanic adults. The majority of families affected by addiction say it has impacted family relationships, mental health and finances. Many are also worried someone in their family will experience addiction, unintentionally consume fentanyl and/or overdose. Respondents overwhelmingly support addiction treatment centers in their community (90%) and making naloxone more freely available at bars, health clinics and fire stations (82%). Partnership to End Addiction’s Robyn Oster noted that despite the clear impact of addiction on families, support services for families are often lacking and underfunded, and stressed the need to expand access to quality treatment, harm reduction and recovery services, and make them more affordable.

Source: Two-Thirds of Americans Say Their Lives Have Been Affected by Addiction: Poll (HealthDay)

Despite guidelines, some localities are still choosing to spend settlement funds on law enforcement

Even though opioid settlements outline core strategies for prevention and treatment, there are debates over the best use of the money, including the role of law enforcement. State and local governments are designating millions of dollars for naloxone, treatment medications and wound care vans, but law enforcement departments are receiving funds for policing resources like new cruisers, overtime pay for narcotics investigators, phone-hacking equipment, body scanners to detect substances on inmates and restraint devices. Sheriffs and police officials comprise less than a fifth of members on state/local task forces tasked with allocating funding, but public sentiment in many communities favors targeting drug dealers. In many areas of the country, the lines between law enforcement and health care can be somewhat blurred, as police and sheriffs’ departments are also emergency responders, trained to administer naloxone, and can provide treatment in jails. Public health officials and addiction treatment specialists are also concerned about money going toward grants for faith-based programs that prohibit medications for addiction treatment.

Source: Should Opioid Settlement Money Be Spent on Law Enforcement? (The New York Times)

SAMHSA awards more than $88 million to behavioral health grants

The Substance Abuse and Mental Health Services Administration awarded more than $88 million to behavioral health grant programs. This includes $42.4 million for Project AWARE (school-based mental health programs), $17.5 million for the National Child Traumatic Stress Initiative (treatment and services for children, adolescents and families who have experienced traumatic events), $4.6 million for Transforming Lives Through Supported Employment (increase employment for individuals with co-occurring mental health and substance use disorder) and $4.7 million for Assertive Community Treatment (for transition-aged youth and adults with serious mental illness or serious emotional disturbance). It also includes $15.3 million for Grants for the Benefit of Homeless Individuals (treatment and services for individuals and families with addiction or co-occurring mental health and substance use disorder who are experiencing homelessness), $3 million for Provider’s Clinical Support System grants (training, guidance and mentoring on use of medications for addiction) and $1.4 million for the Improving Access to Overdose Treatment program (expands access to overdose reversal medications, trainings for prescribing and expanding access to naloxone).

Source: The Biden-Harris Administration Awards More Than $88 Million in Grants that Safeguard Youth Mental Health and Expand Access to Treatment for Substance Use Disorders (Substance Abuse and Mental Health Services Administration)

White House requests additional $800 million to address the overdose crisis

President Biden submitted a supplemental funding request that urges Congress to help strengthen efforts to address the overdose crisis. In the request submitted to Congress, Biden asked for nearly $800 million for the Department of Health and Human Services, the Department of Homeland Security (DHS) and the Department of Justice (DOJ) to reduce the supply of illicit substances like fentanyl and to expand access to addiction care. The request would provide $350 million to the Substance Abuse and Mental Health Services Administration for the State Opioid Response grant program, including $50 million for Indian Health Service prevention, treatment, recovery and harm reduction services. The request also includes $323 million for DHS to continue to expand deployment of Non-Intrusive Inspection Systems, with a primary focus on fentanyl detection at ports of entry. It includes $116 million for other DHS and DOJ activities to counter drug trafficking.

Source: To Advance President Biden’s Strategy to Beat the Overdose Epidemic, White House Requests Additional Funding That Will Support Efforts to Target Drug Trafficking and Expand Access to Addiction Care (Office of National Drug Control Policy)

CMS warns states about potential violations in Medicaid redeterminations

The Centers for Medicare and Medicaid Services (CMS) sent letters to state Medicaid officials in all 50 states and D.C. warning that they may be running afoul of federal requirements in their Medicaid redeterminations that have re-started after the pandemic. The letters identified three key areas for concern – high rates of people losing Medicaid because of paperwork problems, long call center wait times and slow application processing. Thirty-six states were flagged as falling short on at least one of the criteria, including five on all three. More than half of states were flagged as having high rates of people who lost benefits for procedural reasons. CMS said the data indicate people may not be receiving renewal notices, are unable to understand them or are running into challenges submitting renewal forms. Sixteen states were flagged for having long call center wait times and high call abandonment rates. Sixteen were also flagged because a large number of applications based on income were not processed within the required 45-day window.

Source: Biden administration warns states as millions lose Medicaid (Politico)

Supreme Court blocks Purdue settlement from moving forward until it hears case

The Supreme Court blocked Purdue from going forward with bankruptcy proceedings, pausing the settlement and agreeing to take up the case and hear arguments in December. The Department of Justice’s U.S. Trustee has called the settlement plan unprecedented for its arrangement that would offer the Sackler family broad protection from opioid-related civil claims. The Trustee noted that lower courts have divided on when parties can be released from liability for actions that cause societal harm.

Source: Supreme Court blocks $6 billion Purdue Pharma opioid settlement and will hear case this fall (CNN)

2023 state legislation so far focused on naloxone, harm reduction and marijuana

The American Society of Addiction Medicine (ASAM) issued a mid-year report on policy trends across states in 2023 (through June). There were 527 addiction medicine-related bills introduced in 45 states, compared to 451 this time last year. ASAM said 13% were enacted, compared to 17% last year. In 2023, the top three policy areas of interest for state lawmakers were naloxone access, harm reduction and cannabis reform. Last year, they were cannabis reform, harm reduction and criminal justice reform/access to treatment. Many states expanded naloxone access through a variety of different methods (such as requiring it in schools, standing orders, allowing prescribing to family members, requiring emergency medical services and/or law enforcement naloxone training, and Good Samaritan provisions). Six states clarified laws relating to drug paraphernalia to explicitly decriminalize fentanyl test strips. Three states enacted legislation establishing new legal marijuana programs. Thirty-three bills were introduced (five passed) related to parity and insurance reform. Many states introduced legislation on telehealth, and a few enacted legislation on treatment in correctional facilities. Thirty-eight bills were introduced in 12 states to revise criminal penalties for controlled substances.

Source: ASAM Releases 2023 Mid-Year Legislative Report; 2023 Mid-Year Report: Trends in State Legislation (American Society of Addiction Medicine)

Oregon enacts behavioral health bills

Oregon Governor Kotek signed into law six bills to address the behavioral health crisis. SB 238 requires the Oregon Health Authority, State Board of Education and Alcohol and Drug Policy Commission to develop curricula for school districts related to dangers of synthetic opioids. SB 1043 requires hospitals, sobering facilities and detox facilities to provide two doses of naloxone to specified patients upon discharge/release. HB 2395 expands access to naloxone, including by allowing law enforcement officers, firefighters, emergency medical services providers, educators, school administrators and others to store and administer it. HB 2513 strengthens Measure 110 by increasing staffing and improving application processes to speed up approval and get funds out the door, centralizing the support hotline to get people connected to services more efficiently and improving program data collection and accuracy. HB 2757 establishes the 988 Trust Fund for improving the statewide coordinated crisis system. HB 3610 establishes the Task Force on Alcohol Pricing and Addiction Services to report on alcohol addiction and prevention, distribution of resources and overall funding for alcohol addiction treatment, cost of alcohol addiction and additional funding options for treatment.

Source: Governor Kotek Hosts Signing Ceremony for Behavioral Health Bills (State of Oregon Newsroom)

State lawmakers turn attention to high-potency marijuana products

As state lawmakers attempt to address concerns about rising marijuana-related poison control calls, emergency department visits and psychosis diagnoses in states with legal marijuana, they have zeroed in on cannabis’s most extreme forms. These are a new generation of raw flower with THC concentrations of 20% or higher and concentrated products, like extracts and vape oils, which usually have at least 60% THC. The drive for regulation is not from the groups who opposed legalization in the first place, but from many of the Democrats who pushed for it and now want lawmakers to “follow the science.” Research into regular-potency marijuana is still in early stages, and studies on high THC concentrations are further behind, creating challenges for regulators. Early legalization states should have been test cases, but data-keeping has been spotty. There is no consensus on what level of THC classifies as high potency, and the market is flooded with synthetic THC that makes impacts even more difficult to assess. This year, more than a third of the $34 billion in expected cannabis sales will come from products high in THC, creating high stakes for industry and states relying on the tax revenue.

Source: High-Potency Pot Market Worth Billions Draws Regulator Scrutiny (Bloomberg)

Harm Reduction Therapeutics to donate 200,000 naloxone doses

Nonprofit Harm Reduction Therapeutics is celebrating the recent approval for its over-the-counter naloxone, RiVive, by giving away 200,000 doses to Remedy Alliance, an organization devoted to affordable naloxone access. The donation represents roughly 10% of the company’s expected annual production. RiVive will be sold for as much as 40% less than Narcan, meaning that a typical two-pack of RiVive could go for as little as $30, compared to a typical Narcan price of $50. RiVive comes in a 3 mg dose, compared to Narcan’s 4 mg, Kloaxxado’s 8 mg and Zimhi’s 5 mg. Harm Reduction Therapeutics says RiVive’s smaller dose allows more flexibility for people attempting to reverse an overdose. While it can be administered as many times as necessary, studies show large doses are not necessarily more effective at reversing overdoses. Smaller doses can help avoid the severe withdrawal symptoms many experience upon being revived from an overdose.

Source: Nonprofit naloxone maker celebrates FDA approval by donating 200,000 doses (STAT)

Overdose crisis needs a public health and harm reduction response

National addiction recovery advocate Ryan Hampton explains that the focus of drug policy right now should be preventing as many fatal overdoses as possible, not a repeat of drug war approaches that focus on punishment and retribution. Wide availability of harm reduction services such as syringe exchange programs, naloxone, drug checking equipment and safer use spaces, without shame or judgement, would save lives. Naloxone should be free and available and accessible everywhere, for everyone, without barriers. We should think about naloxone the same way we think about EpiPens, defibrillators, vaccines and testing. Cities where substance use is more concentrated can benefit from overdose prevention centers. Rural areas need mobile harm reduction programs. Rhode Island’s overdose deaths fell after it implemented mobile outreach programs that distributed harm reduction supplies, increased the availability of naloxone, expanded access to treatment in jails and prisons, supported community centers that offer peer-based recovery support services and created a new evidence-based prevention curriculum for schools. The state will be opening overdose prevention centers.

Source: We Can Prevent Overdose Deaths If We Change How We Think About Them (TIME)