Policy News Roundup: May 30, 2024

Key reads

Safe smoking supplies face pushback, despite reducing harm

For years, a Morgantown, West Virginia, health clinic has given people who use substances small glass pipes along with sterile needles and other supplies, as smoking can limit infected wounds and the spread of diseases that come with injecting. Some public health advocates and people who use substances believe smoking fentanyl may also lessen the chances of fatal overdose compared with injecting it. But starting June 2, it will be illegal for state-authorized syringe exchange groups to supply people who use substances with smoking paraphernalia under a law passed by West Virginia lawmakers that will ban clinics from giving away pipes, tin foil and other supplies used to consume illicit substances. The law is part of a broader resistance in communities where critics assert that distributing “safer smoking” supplies encourages substance use and could make fentanyl more appealing to people who are starting to use it. The pushback underscores long-standing tensions over harm reduction strategies. Programs in places like Idaho, Oregon and New York have also faced pushback and/or been curtailed.

Source: Fentanyl users get free smoking gear in some cities. Now there’s pushback. (The Washington Post)

Baltimore faces unprecedented overdose crisis

In the past six years, nearly 6,000 people have died from overdose in Baltimore. The death rate between 2018 and 2022 was nearly double that of any large city. When fentanyl deaths began to rise, Baltimore’s initial response was hailed as a national model. The city set ambitious goals, distributed Narcan widely and ramped up harm reduction services, experimented with ways to steer people into treatment and expanded public awareness campaigns. Then, however, city leaders became preoccupied with other crises, including gun violence and the COVID pandemic, and efforts to fight overdoses stalled. Health officials began sharing less data, officials have set fewer and less ambitious goals for overdose prevention efforts, and the task force managing the crisis that used to meet monthly met only a couple of times a year. Fewer people are being revived by emergency workers, are getting medications for opioid use disorder through Medicaid and are in publicly funded treatment programs.

Source: Almost 6,000 Dead in 6 Years: How Baltimore Became the U.S. Overdose Capital (The New York Times)

FDA launches OUD awareness campaign for prescribers

The Food and Drug Administration is launching a new campaign, Prescribe with Confidence, to help raise awareness about opioid use disorder (OUD) and to provide resources for clinicians. The campaign began with months of data collection and listening to the needs of primary care clinicians. Information overload has been one of the major barriers to consider prescribing medications for OUD, and the campaign provides recommended resources from government agencies and trusted organizations on a website for busy clinicians. The goal is to increase the number of health care practitioners who can recognize OUD and prescribe medications for OUD when indicated. There are materials, mentors and training available to help prescribers get started.

Source: Treatment Using Medication for Opioid Use Disorder Can Save Lives (Food and Drug Administration)

House Agriculture Committee passes provision to close hemp product loophole

The House Agriculture Committee approved an amendment to the new Farm Bill to close the loophole created by the 2018 Farm Bill that allowed the proliferation of a gray market for intoxicating hemp-derived products. The amendment would ban intoxicating hemp-derived and synthetized cannabinoid products. It would federally ban all hemp-derived products like delta-8 THC, semi-synthetic cannabinoids like HHC and synthesized products like THC-O. It would reformulate the definition of “hemp” introduced in the 2018 Farm Bill to distinguish between “hemp grown for cannabinoid extraction” used for producing non-intoxicating substances and “industrial hemp” used for non-cannabinoid purposes like food, fiber and research, contrasting with the 2018 all-inclusive definition. The 2024 Farm Bill draft is still in its early stages, and the Senate has yet to release its own full version, so it is unclear what will be in the final bill.

Source: House Committee Approves Farm Bill Amendment To Ban Delta-8 THC (Forbes)

AATOD rallies against Modernizing Opioid Treatment Access Act

The American Association for the Treatment of Opioid Dependence, the national advocacy group representing methadone clinics, held its conference last week. Opposition to the Modernizing Opioid Treatment Access Act, which would allow any board-certified addiction doctor or addiction psychiatrist to prescribe methadone directly to patients, was a theme throughout the conference. The conference also touched on issues including the highly toxic drug supply, increased use of methamphetamine and cocaine alongside opioids and a rise in problem gambling, but much of the conference centered explicitly on the ramifications of the bill or on methadone clinics’ shaky political footing more broadly. The conference was titled “So much more than medication,” which mirrors the rhetoric of “Program, Not a Pill,” a lobbying campaign that aims to fight efforts to make methadone available outside methadone clinics. One session focused extensively on the legislation and how to work against it.

Source: At Las Vegas conference, methadone clinics blast idea of doctors prescribing directly (STAT)

San Francisco pilot program connects unhoused people with MOUD

A new pilot program in San Francisco aims to connect unhoused people with prescription medication to treat fentanyl addiction via telehealth at night. A street care team with the San Francisco Department of Public Health provides real-time telehealth sessions with a doctor who can prescribe buprenorphine or methadone daily from 7pm to 3am. To ensure the prescription is filled and taken, the program offers a place to sleep overnight when accommodations are available, as well as medical and service support with a case worker. In the first four weeks of the pilot in March, over 55 people started medications for opioid use disorder or entered residential treatment. Telehealth visits were provided for 173 people and over 134 buprenorphine prescriptions issued, with 33% of those prescriptions filled.

Source: SF tests real-time opioid addiction prescriptions (Axios)

States can use data on core measures to improve OUD treatment

State officials can increase access to opioid use disorder (OUD) treatment by applying a set of core measures that help assess effectiveness of systems and support data-driven policy decisions. Most of the measures are included in federal reporting requirements for Medicaid programs, including the behavioral health core set, 1115 waivers and Medicaid health homes. Most states report on at least one core measure. Forty-nine reported on follow-up care for people with substance use disorder (SUD) who had emergency department visits. Forty-seven reported on initiating and engaging in OUD treatment after diagnosis. The least reported was assessing for SUD using standardized screening tools (two states). Over half of states report most of the measures. All states should strive to report on the full set of measures and develop a strategy to integrate data into efforts to improve OUD treatment systems. Some states have used core measures to expand access to treatment, replicate successful programs, enhance treatment quality, improve health equity and assess the impact of changes.

Source: Most States Already Collect Data That Can Help Improve Opioid Use Disorder Treatment (Pew)

Daily/near daily use of marijuana surpasses daily/nearly daily use of alcohol for the first time

A study found that the per capita rate of reporting past-year marijuana use increased 120% between 2008 and 2022, and days of use reported per capita increased by 218%. There was a 15-fold increase in per capita rate of reporting daily or near daily use between 1992 and 2022. In 1992, there were 10 times as many daily or near daily alcohol as marijuana consumers (8.9 vs. 0.9 million). In 2022, for the first time, there were more daily or near daily consumers of marijuana than alcohol (17.7 vs. 14.7 million). Far more people drink, but high-frequency drinking is less common. In 2022, the median drinker reported drinking on 4-5 days in the past month, versus 15-16 days in the past month for marijuana. In 2022, past-month marijuana consumers were almost 4 times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%).

Source: Changes in self-reported cannabis use in the United States from 1979 to 2022 (Addiction)

The number of alcohol deaths rivals the number of overdose deaths

The death rate from conditions directly attributable to alcohol consumption (such as alcohol-associated liver diseases) increased 70% between 2012 and 2022, accounting for 51,191 deaths in 2022. Alcohol deaths in 2022 were highest among people 45-64, American Indian/Alaska Native (AI/AN) people and males. Deaths are rising fastest among adults 26-44, AI/AN people and females. Rural areas have a higher rate of alcohol deaths and experienced greater growth in rates over the past decade. The number of alcohol-related deaths rises to 105,308 under a broader definition that counts deaths where alcohol-induced conditions are either the underlying cause or a contributing factor. This exceeds the number of opioid (83,437) and suicide (49,594) deaths, which also use this broader definition. Factors contributing to the increases in alcohol deaths may include increases in drinking, low treatment rates and barriers to treatment, and limited patient understanding of what constitutes problematic drinking.

Source: A Look at the Latest Alcohol Death Data and Change Over the Last Decade (KFF)

Mental health crisis requires new solutions

Despite increased attention in recent years, the mental health crisis has not gotten better because the system remains ill-equipped to address it. In most cases, issues under the “mental health” umbrella cannot be solved by the health care system alone. Amid growing public intolerance for unhoused individuals and public substance use, more of the response to the mental health crisis is shifting to law enforcement, but social supports and treatment are needed to address these issues. There are several distinct problems that are part of the mental health crisis — the youth mental health crisis, serious mental illness, more general mental health disorders and substance use and addiction. Each requires a different solution, but they often compete for limited resources. Some of the mental health crisis is due to increasing unhappiness and loneliness, exacerbated by the pandemic. This is a societal problem that requires solutions beyond the mental health treatment system.

Source: 1 big thing: Mental health stagnation (Axios)