Policy News Roundup: February 22, 2024

Key reads

Current and former ONDCP officials say Director Gupta has created a toxic environment

The Office of National Drug Control Policy (ONDCP) has faced significant staff turnover and discontent with Director Gupta. Seven former and current officials, as well as two people with knowledge of the office dynamics, described ONDCP as a “toxic” work environment and blamed Gupta, who they described as egocentric. Top officials and aides have resigned in recent months in large part because of Gupta’s leadership, creating a leadership vacuum and leading to dysfunction that has caused deadlines to be missed. Officials said Gupta put unrealistic pressure on his team to raise his public profile. Staff felt Gupta had unrealistic demands about travel accommodations and that trips centered around Gupta rather than ONDCP’s work. The officials believe Gupta has been harmed by not taking time to build key relationships with the White House, particularly with the Domestic Policy Council. Staff fear their issue was falling to the wayside as the West Wing juggles priorities. The White House emphasized appointing people in recovery to ONDCP, but some of these appointees said Gupta rarely listened to them and sometimes stigmatized people in recovery.

Source: Biden’s top man on the opioid epidemic has created a ‘toxic’ office environment (Politico)

Pediatricians could increase screening and treatment for substance use

The American Academy of Pediatrics recommends offering buprenorphine to teens with opioid use disorder (OUD), but only 6% of pediatricians have prescribed it, according to a survey. Buprenorphine prescriptions were declining as overdose deaths for 10-19-year-olds more than doubled. The survey showed that many pediatricians do not think they have the right training or personnel for this type of care, although pediatricians who do manage patients with OUD say they have not had to hire additional staff. Some pediatricians said they do not have enough patients to justify learning about this care or do not think it is a pediatrician’s job. Medical schools and pediatric residency programs are adding information to their curricula about substance use disorders, including how to discuss substance use with youth, but this is not fast enough to help young people currently struggling with addiction. Fentanyl and counterfeit pills are complicating efforts to stop youth overdoses. Pediatricians can help by stepping up screening for and having conversations about all types of substance use. Pediatricians could also prescribe more naloxone.

Source: More kids are dying of drug overdoses. Could pediatricians do more to help? (NPR)

CDC study finds overdose deaths associated with smoking now outpace those associated with injection

The Centers for Disease Control and Prevention released a study on trends in routes of substance use, using data from the State Unintentional Drug Overdose Reporting System in 27 states and D.C. From January-June 2020 to July-December 2022, the percentage of overdose deaths with evidence of smoking increased 73.7% (13.3% to 23.1%), and the percentage with evidence of injection decreased 29.1% (22.7% to 16.1%). The number of deaths with evidence of smoking increased 109.1%, and by 2022, smoking was the most commonly documented route of use in overdose deaths. Changes were most pronounced in deaths with illegally manufactured fentanyls (IMFs), with or without stimulants. Among deaths with only IMFs detected, the percentage with evidence of injection decreased 41.6%, while the percentage with evidence of smoking increased 78.9%. Similar trends were observed with both IMFs and stimulants detected. Strengthening public health and harm reduction services to address overdose risk with smoking and other non-injection routes might reduce deaths.

Source: Routes of Drug Use Among Drug Overdose Deaths — United States, 2020–2022 (Centers for Disease Control and Prevention)

Federal policy changes needed to eliminate barriers to contingency management

Contingency management (CM) is the only treatment consistently associated with reductions in stimulant use, but it is not available to most who need it. Barriers include attitudinal barriers; regulatory barriers around waste, fraud and abuse; and lack of adequate federal funding. A lack of clarity around tax obligations for both providers and patients may disincentivize participation. California and Washington have received Medicaid 1115 waivers allowing CM pilot programs, and at least three other states have applied. National implementation resources are needed to assure intervention fidelity. The federal government should educate the public, providers and policymakers on CM; expedite consideration of a safe harbor; issue guidance stating that CM reinforcers are not taxable income; eliminate the $75 cap on CM reinforcers; develop training and technical assistance; and prioritize funding for CM in American Indian/Alaska Native communities. States should apply for 1115 waivers to cover CM and explore alternative funding sources.

Source: Federal Policy Changes Must Occur To Provide A Lifesaving Stimulant Drug Intervention (Health Affairs)

A new high school in NYC will train students for health careers, including in behavioral health

Northwell Health and New York City Public Schools announced a partnership to design a career-focused high school that will help prepare students for well-paying careers in health care and address local education and health care talent needs. The school will open in 2025 and serve approximately 900 students. It is part of a first-of-its-kind $250 million initiative led by Bloomberg Philanthropies to create new health career-connected learning high schools in 10 communities across the country. Supported by an initial $24.9 million investment, Northwell and NYC Public Schools will co-develop the high school curriculum, which will offer academic programming, specialized health care classes, work-based learning and credentialing/certification opportunities. The school will support experience in nursing, diagnostic medicine, physical therapy and behavioral health (including social work).

Source: Northwell, NYC Public Schools announce Northwell School of Health Sciences (Northwell Health)

New Jersey allocates $95 million in opioid settlement funds

New Jersey Governor Murphy announced over $95 million from the Opioid Recovery and Remediation Fund for six programs addressing harm reduction, prevention and recovery support, treatment and housing. The funding includes $24 million over two years to expand harm reduction and substance use health services at Harm Reduction Centers; $17.505 million over three years to expand operations at Community Peer Recovery Centers; $9.025 million over three years to replace and add mobile medication units; $19.5 million over three years to scale remote referrals to enable 24/7 connections to care from vetted treatment providers and harm reduction services; $17 million over three years to bolster supported housing, including emergency shelter beds, short-term rental subsidies, transitional housing beds and permanent housing assistance; and $8.1 million over three years to expand the Keeping Families Together program, which supports parents with opioid use disorder through housing vouchers and rental subsidies, case management, linkage to community services and therapeutic supports.

Source: Governor Murphy Announces Allocation of $95 Million from New Jersey’s Opioid Recovery and Remediation Fund (Governor Phil Murphy)

Oregon leaders missed chances to use decriminalization to turn police encounters into opportunities for treatment

While there is evidence people with substance use disorder in Oregon are increasingly finding treatment, the failure to turn police encounters into on-ramps to treatment has been cited as evidence Measure 110 (decriminalization) is not working. Amid increasing overdose deaths, lawmakers are looking to restore criminal penalties for possession of substances. But Oregon’s political leaders played central roles in failing to deliver on the potential for law enforcement to connect people with services under Measure 110. The legislature, court system and bureaucracy under two governors ignored or rejected proposals as straightforward as designing a specialized ticket to highlight treatment information. They declined to fund a $50,000 online course that would have instructed police how to better use the new law and took no action on recommendations to get police talking with treatment providers after decriminalization passed. Leadership failures took away any chance for Oregon to truly test the measure’s potential.

Source: Oregon’s Drug Decriminalization Aimed to Make Cops a Gateway to Rehab, Not Jail. State Leaders Failed to Make It Work. (ProPublica)

Bill would allocate $8 million in opioid settlement funds a year to Washington tribes

The Washington state Senate recently approved a bill that would bring more state funding to tribes to address the opioid crisis. It would provide nearly $8 million total each year for the 29 federally recognized tribes in the state, drawn partly from the opioid settlements. Native Americans and Alaska Natives in Washington die of opioid overdoses at five times the state average. The rate in Washington is one of the highest in the U.S. and more than three times the rate nationwide. Many of the state’s Indigenous nations lack the funding or medical resources to address the crisis. A complicated jurisdictional maze means tribal police often cannot arrest non-tribal members on the reservation, which makes it difficult to keep outside dealers off their land. Tribes say the proposed funding is appreciated but insufficient. Tribes are expected to receive $7.75 million or 20% of the funds deposited into the opioid settlement account the previous fiscal year, whichever is greater, annually.

Source: Tribes in Washington are battling a devastating opioid crisis. Will a multimillion-dollar bill help? (Associated Press)

Proposed program in San Francisco would offer free recovery books at public libraries

The most stolen books from San Francisco public libraries are books about recovery. City officials now want to provide universal access to free substance use recovery books. San Francisco City Supervisor Matt Dorsey introduced legislation to expand a pilot program to distribute addiction recovery books for free at the city’s 28 public libraries. If approved, San Francisco would be the first city in the nation to do so. Books would be offered in all available languages, and those who want them would not be required to have a library card. A pilot version launched last April at the main library and two branches has distributed more than 3,200 books and spent about $40,000. The libraries have about 75 recovery books available at any given time. The branches ask for more every few months, but the main library has to replenish them every six weeks.

Source: San Francisco wants to offer free drug recovery books at its public libraries (Associated Press)

New wave of opioid crisis includes rise of deaths co-involving fentanyl and stimulants

A Millennium Health report based on urine drug test results from over 4 million patients between 2013 and 2023 found that 60% of specimens in 2023 from patients who have used fentanyl also contained methamphetamine, an 875% increase since 2015. Cocaine was detected in 22% of fentanyl-positive specimens in 2023. Heroin and prescription opioids continued to decline to 17% and 7%, a historic low for prescription opioid detection in specimens positive for fentanyl. A fourth wave of overdose deaths co-involving fentanyl with stimulants has emerged. Stimulants were co-involved in over 30% of fentanyl overdose deaths in 2021, up from less than 1% in 2010. Nearly 93% of specimens from patients who used fentanyl were positive for at least one additional substance and almost half contained three or more. Xylazine was detected in nearly 14% of fentanyl-positive specimens in 2023.

Source: Methamphetamine Use Reaches All-Time High in People Who Use Fentanyl with No Signs of Slowing, Adding Fuel to U.S. Fentanyl Crisis (Millennium Health)