Policy News Roundup: May 11, 2023

Key reads

Pediatric fentanyl deaths increased more than 30-fold 2013-2021

A study found that deaths from fentanyl among those under 20 years old increased more than 30-fold between 2013 and 2021. Nearly half of the deaths occurred at home. Fentanyl was implicated in nearly 5,200 of the almost 14,000 fatal pediatric opioid poisonings between 1999 and 2021. In 1999, approximately 5% of the 175 deaths from opioids were from fentanyl, compared to 94% of 1,657 opioid deaths in 2021. Between 2018 and 2021, the fentanyl mortality rate increased nearly threefold for adolescents 15-19 and six-fold among children 0-4. The study found 90% of the deaths were among teens 15-19, and nearly 7% were among kids under 5. Partnership to End Addiction’s Vice President of Prevention, Prevention Research and Analysis Linda Richter explains that the deaths are primarily unintentional. Among younger kids, access to pills or substances laced with fentanyl that are left within their reach is the main cause, while the deaths among older adolescents are often caused by a lack of awareness that the pill they intentionally took contained fentanyl. She outlines a multipronged approach to reduce deaths, including educating adults and teens about the proliferation and risks of fentanyl; educating parents about safe storage and disposal; increasing availability of fentanyl test strips; expanding access to and use of naloxone; and improving substance use prevention and treatment.

Source: U.S. Child Deaths From Fentanyl Jumped 30-Fold in Just 8 Years (HealthDay)

COVID telehealth prescribing flexibilities extended

The Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary rule that extends the COVID telemedicine flexibilities, including allowing remote prescribing of buprenorphine, for six months past the end of the public health emergency – through November 11, 2023. For any practitioner-patient telemedicine relationships that have been or will be established up to November 11, 2023, the full set of telemedicine flexibilities regarding controlled substances prescribing established during the public health emergency will be extended for one year – through November 11, 2024. The DEA received 38,000 comments on its proposed rules to revise the telehealth prescribing rules and is giving itself extra time to review the comments before issuing final rules.

Source: DEA, SAMHSA Extend COVID-19 Telemedicine Flexibilities for Prescribing Controlled Medications for Six Months While Considering Comments from the Public (Substance Abuse and Mental Health Services Administration)

HHS launches online guide to help people find support for mental health and substance use

The Department of Health and Human Services (HHS) launched FindSupport.gov, a website that will help Americans identify available resources, explore information about various treatment options and learn how to reach out to get support for issues related to mental health, drugs or alcohol. The user-friendly, online guide will help people navigate through common questions when starting their journey to better behavioral health, such as how to ask for help, how to help others and how to search for a health care professional or support program that meets their needs. It provides information on how to find treatment based on insurance status and how to set up an appointment. HHS also announced the HHS Children and Youth Resilience Challenge, which will provide $1 million for innovative community-led solutions to promote resilience in children and adolescents affected by the COVID pandemic and other disasters and promote positive strategies to help children and adolescents thrive. The challenge will include a proposal phase and a pilot phase for selected finalists.

Source: Secretary Becerra Announces New Initiatives at HHS Mental Health Summit to Strengthen Access to Mental Health Care (Department of Health and Human Services)

NYU and Brown to conduct first overdose prevention center study funded by the federal government

A new study by NYU Langone Health and Brown University’s School of Public Health will evaluate the impact of overdose prevention centers with a $1.4 million grant from the National Institute on Drug Abuse, the first time the federal government has funded a study of the centers. Researchers aim to enroll 1,000 adults who use drugs in New York City and Providence who have visited an overdose prevention center or used other drug-related services and track their health outcomes (including hospital visits, overdoses and enrollment in treatment) over time through monthly check-ins, longer surveys every six months, and medical records. The researchers will evaluate the costs to operate the centers, their impact on the surrounding neighborhood and their potential savings to the health care and criminal justice systems. International research has shown overdose prevention centers to be associated with fewer overdoses and emergency room visits and increased access to treatment, but the findings are not necessarily transferrable.

Source: NYU Langone, Brown launch NIH-funded study of overdose prevention centers (Politico)

Stop Fentanyl Overdoses Act reintroduced in Congress

Sen. Markey (D-MA) and Reps. Kuster (D-NH) and Blunt Rochester (D-DE) reintroduced the Stop Fentanyl Overdoses Act. It would expand testing for fentanyl and related substances and increase information-sharing by public health departments and law enforcement to identify public health threats and prevent overdoses; provide grants to compile overdose data and facilitate surveillance of seized substances by forensic labs; limit civil and criminal liability for individuals who administer naloxone; and establish a program to offer medications for opioid use disorder to incarcerated individuals. The measure would also provide grants to educate health care providers, criminal justice professionals and addiction treatment personnel on the current status of research on treatment for opioid use disorder; and require reports on naloxone access and affordability, international mail and cargo screening, and overdose prevention centers. Partnership to End Addiction endorsed the bill.

Source: With Fentanyl Overdoses On The Rise, Sen. Markey And Reps. Kuster And Blunt Rochester Announce Legislation To Combat Deadly Opioid Epidemic And Save Lives (Ed Markey)

Kroger settles opioid litigation with West Virginia

Kroger has agreed to pay West Virginia $68 million to settle claims that it fueled the opioid crisis through lax oversight of its pill sales, bringing the state’s years-long litigation over the opioid crisis to a close. The deal comes a month before the company had been set to go to trial against the state. All other companies sued by the state have already settled.

Source: Kroger to pay $68 million to settle West Virginia opioid claims (Reuters)

California AG warns tobacco companies their new menthol-alternative cigarettes violate flavor ban

California Attorney General Rob Bonta sent letters to R.J. Reynolds and ITG Brands LLC in April warning them that their new cigarettes appear to violate a state ban on flavored tobacco products. The letters warn that the packaging and promotional materials for nine reformulated versions of Camel, Newport and Kool cigarettes were likely against the law. The state determined that the products are “presumptively flavored under the California flavor ban law,” which includes menthol-flavored cigarettes, and gave the companies until June 23 to respond. The letters say the companies are promoting the new varieties as substitutes for menthol cigarettes and using similar marketing and packaging. Reynolds said it makes clear the cigarettes are non-menthol and that they are not flavored and comply with the law.

Source: California Says New Cigarettes Appear to Violate State’s Flavored Tobacco Ban (California Healthline)

State efforts can address the link between youth mental health and substance use

The National Governors Association released a publication on youth mental health and substance use. It explains mental health conditions as predictors of substance use and overdose risk in youth. It highlights efforts to mitigate the link between mental health conditions and substance use in youth, including preventing adverse childhood experiences and strengthening protective factors, ensuring access to high-quality services (such as early detection and linkage to care including through Medicaid’s Early and Periodic Screening, Diagnostic and Treatment benefit, and addressing behavioral health workforce shortages) and reducing substance use-related harms and preventing overdose (such as awareness campaigns, overdose education and naloxone distribution, and fentanyl test strip distribution). It provides examples of state efforts.

Source: Youth Mental Health And Substance Use (National Governors Association)

States and the federal government are taking action to address the rise of xylazine

In most states, public health departments and other agencies have issued alerts and communications about xylazine – either alerts for the purposes of awareness, or public health information for providers and people who use substances. Several state legislatures have also introduced bills related to xylazine, and governors’ offices have taken executive action, including to list xylazine as a scheduled drug and create testing requirements for xylazine during toxicology screenings. Some states have also decriminalized drug checking equipment and enhanced detection of emerging adulterants in the drug supply. State investments in trusted community programs providing low barrier wound care would help address xylazine. Federal agencies have also acted, including publishing research, issuing warnings and public safety alerts, issuing an import alert, sending information to providers and grantees and designating fentanyl adulterated with xylazine as an emerging threat. Congress is considering the TRANQ Research Act and the Combating Illicit Xylazine Act.

Source: State And Federal Actions To Respond To Xylazine (National Governors Association)

Regulations are not keeping up with the increasing potency of marijuana

The THC content of marijuana was commonly less than 1.5% decades ago, while some products today contain more than 90% THC. Many people are experiencing marijuana-related medical emergencies and psychological disorders linked to cannabis use. However, regulators have failed to keep up, and consumer protections are spotty in states that have legalized marijuana. The federal government does not regulate purity or potency, as it still bans marijuana outright. In addition to cannabis flower containing higher concentrations of THC than it used to, there are also now concentrates that are heated and inhaled through vaping or dabbing, which can be almost pure THC. Only Vermont and Connecticut have placed caps on THC content, and they exempt pre-filled vape cartridges. Some states cap the number of ounces or grams consumers are allowed to buy, but even a little marijuana can amount to a lot of THC.

Source: Legal Pot Is More Potent Than Ever — And Still Largely Unregulated (KFF Health News)

RJ Reynolds threatens to sue small vape shops selling flavored vapes

RJ Reynolds is threatening to sue small vape shops if they do not stop selling flavored vapes. The company sent letters to stores in New Jersey and Alabama giving the shops just a few days to confirm they will no longer sell flavored tobacco products. The letters warn that failure to comply could result in “legal action, and the costs, attorneys’ fees, and adverse publicity to which a lawsuit would subject [the vape shop].” The letters warn that the shops are violating local laws. One letter copies the county prosecutor, notifying local authorities of the violation. The letters highlight tobacco companies’ growing frustration with the Food and Drug Administration’s (FDA) scattershot enforcement. The FDA has only issued warning letters to a few manufacturers of flavored vape products. Reynolds’ focus on enforcing flavored tobacco bans is noteworthy, given that it has actively opposed flavor ban legislation across the U.S.

Source: RJ Reynolds is threatening to sue vape shops for selling flavored vapes (STAT)