Policy News Roundup: May 16, 2024

Key reads

Provisional data shows overdose deaths decreased, but remained high, in 2023

Provisional data from the Centers for Disease Control and Prevention predicts 107,543 overdose deaths in 2023, a 3.1% decrease from 2022 and the first decrease in five years. About 3,500 fewer people died from an overdose in 2023 than 2022. However, the 3% drop is far less substantial than the surges that pushed overdose deaths to record levels in recent years – 30% between 2019 and 2020 and another 15% from 2020 to 2021. Overdose deaths in 2023 were still almost twice as high as they were five years ago. Synthetic opioids were involved in nearly 70% of overdose deaths in 2023, though there were about 1,500 fewer overdose deaths involving synthetic opioids in 2023 than 2022. However, overdose deaths involving methamphetamine and cocaine increased (2% and 5%) and accounted for about a third and more than a quarter of all overdose deaths, respectively, in 2023. Overdose deaths increased at least 27% in states such as Washington and Oregon, while they dropped by at least 15% in other states, including Nebraska, Kansas, Indiana and Maine.

Source: US drug overdose deaths decreased in 2023 for the first time in five years (CNN)

CARE Act reintroduced in Congress

Sens. Warren (D-MA) and Baldwin (D-WI) and Reps. Raskin (D-MD), Kuster (D-NH), Trone (D-MD) and Pettersen (D-CO) led 86 lawmakers to reintroduce the Comprehensive Addiction Resources Emergency (CARE) Act. The bill would provide state and local governments with $125 billion in federal funding over 10 years, including nearly $1 billion per year for tribal governments and organizations. The CARE Act is modeled after the 1990 Ryan White Act, which provided funding to help overhaul the response to the HIV/AIDS crisis. The $125 billion in CARE Act funding would go to states, localities and tribes with the highest overdose levels; enhance biomedical research and public health surveillance, including data collection on overdoses; improve and expand training for health professionals on substance use disorder; support expanded and innovative service delivery, including treatment, recovery and harm reduction services; and expand access to naloxone. The bill is supported by over 100 mental health, addiction and social service organizations.

To urge your members of Congress to support this bill, send them a letter through our action alert here.

Source: Warren, Baldwin, Raskin, Kuster, Trone, Pettersen, 86 Lawmakers Reintroduce Landmark Bill to Combat Substance Use Epidemic (Elizabeth Warren)

SAMHSA releases national strategy on maternal mental health

The Substance Abuse and Mental Health Services Administration Task Force on Maternal Mental Health released a national strategy and recommendations to address maternal mental health and substance use issues. The Report to Congress and accompanying National Strategy to Improve Maternal Mental Health Care are part of a broader effort to address women’s overall health and maternal health in particular. The national strategy focuses on five pillars – building a national infrastructure that prioritizes perinatal mental health and well-being, with a focus on reducing disparities; making care and services accessible, affordable and equitable; using data and research to improve outcomes and accountability; promoting prevention and engaging, educating and partnering with communities; and lifting up the voices of people with lived experience. Each pillar has supporting priorities and recommendations.

Source: Biden-Harris Administration Announces Maternal Mental Health Task Force’s National Strategy to Improve Maternal Mental Health Care Amid Urgent Public Health Crisis (Substance Abuse and Mental Health Services Administration)

Over 115 million fentanyl pills seized in 2023

A study funded by the National Institute on Drug Abuse comparing regional trends in fentanyl seizures found that the percentage of seizures in pill form in the U.S. increased from 10.3% in 2017 to 49% in 2023, with 115.6 million individual pills seized in 2023. The study also found a significant increase in the number and weight of fentanyl-containing powder seizures between 2017 and 2023. Although fentanyl seizures were historically less common in the Western U.S., the analysis found that this region now accounts for most seizures of fentanyl overall, as well as total weight of fentanyl seized. The proportion of fentanyl pill seizures to the overall number of fentanyl seizures was also highest in the West, with 77.8% of seizures in the West being in pill form in 2023. Continued monitoring of regional shifts in the fentanyl supply can help inform targeted prevention and public health response.

Source: Over 115 million pills containing illicit fentanyl seized by law enforcement in 2023 (National Institute on Drug Abuse)

Minnesota requires UnitedHealthcare to ensure parity compliance

The Minnesota Department of Commerce announced a settlement in the form of a Consent Order with UnitedHealthcare (UHC) that requires UHC to revamp its policies and procedures to ensure parity in its coverage of mental health care. The Consent Order alleges UHC violated the state’s parity laws by evaluating mental health/substance use disorder claims more stringently than claims for other types of medical care. It alleges that UHC did not demonstrate comparability in reimbursement rates between medical/surgical and mental health/substance use disorder providers for certain billing codes; did not maintain accurate and complete provider directories; did not properly document utilization review-related data; did not advise insureds/enrollees of their appeal rights for denied care; posted prior authorization data on its public website that was untimely or inaccurate; and applied some formulary design restrictions more stringently for mental health prescription drugs. The Order includes a $450,000 fine, the third and largest civil penalty the department has assessed against an insurance carrier in the past 12 months related to parity.

Source: MN Department of Commerce consent order requires UnitedHealthcare to revamp processes for mental health coverage to comply with parity laws (Minnesota Commerce Department)

Kansas enacts overdose Good Samaritan law

Kansas Governor Kelly signed into law a bill that provides legal protections for those who seek or provide medical assistance to a person suffering a medical emergency related to substance use. The Good Samaritan Law will prevent those suffering an overdose and bystanders who seek the help of emergency services from being prosecuted for possession or use of substances. Kansas was one of only two states without an overdose Good Samaritan law, now leaving Wyoming as the only state without one. Kelly also signed a bill that toughens the penalties for those involved in the manufacturing and distribution of fentanyl and applies a special sentencing rule to the crime of unlawful distribution of fentanyl-related controlled substances. It enhances penalties for aggravated endangerment of a child related to fentanyl and related paraphernalia.

Source: Governor Kelly Signs Good Samaritan Bill (Kansas Office of the Governor)

Vermont legislature passes bill allowing overdose prevention site

The Vermont legislature passed a bill that would allow the state to establish the first center for people to safely use illicit substances. The bill now goes to Governor Scott, who has signaled he will veto it. Legislative leaders say they expect to have the votes to override Scott’s opposition. The bill instructs the health department to set guidelines for an overdose prevention site by September, after which one could open, most likely in Burlington. The original draft of the bill called for two sites to open, using money from a new tax on prescription drugs. But subsequent versions cut the $2 million for the pilot program in half and instead use funds from the opioid settlements. Burlington leaders have expressed strong support for such a center. The bill would provide broad protection from liability for center staff who help people use substances or prevent overdoses. It would call for officials to track whether the center helps reduce deaths, gets more people into substance use treatment and reduces litter from discarded needles.

Source: Overdose-Prevention Site Bill Heads to Gov. Scott’s Desk (Seven Days)

Pennsylvania makes xylazine a Schedule III substance

Pennsylvania Governor Shapiro will sign legislation to criminalize the intentional misuse of xylazine, after the bill received approval from the state House and Senate last week. Under the bill, xylazine would be listed as a Schedule III drug under the state’s controlled substance law, formalizing an order that Shapiro issued last year. The illicit use of Schedule III drugs carriers a penalty of imprisonment of up to five years. The law would require that xylazine be stored safely when used professionally, to prevent theft or improper access.

Source: Pennsylvania will make the animal sedative xylazine a controlled substance (Associated Press)

Local governments struggle to distribute opioid settlement funds

Advocates worry that chunks of opioid settlement funds may be used in ways that do not make a dent in the crisis. They say local governments may not have the bandwidth to take the right steps to identify their communities’ needs and direct their funding shares to projects that use proven methods to prevent deaths. States only used a sliver of tobacco settlement money on tobacco-related efforts. Funding in this settlement is also going to local governments. With money rolling out for at least 14 more years, there is time for towns to use it appropriately, and there are resources to help. Experts say the goal is to help those who use opioids to get treatment, to help make it less likely people who use opioids will overdose and to create an environment for people not to use them in the first place. Few states require local governments to complete reports on funding. Many localities have not spent their allocated funds yet. Some have allocated funds to police departments. Some localities are giving their money to states or partnerships rather than dictate the spending themselves.

Source: Local governments struggle to distribute their share of billions from opioid settlements (Associated Press)

Buprenorphine and naloxone accessibility limited by pharmacy barriers

Recent changes, including allowing tele-prescribing of controlled substances, eliminating the buprenorphine waiver requirement and approving over-the-counter naloxone sales, combined with the effective use of opioid settlement funds, can improve our overdose response strategy, but only if we address pharmacy-level barriers to care. Red flag warnings for suspicious orders must be closely tracked by pharmacies. They are not appropriate for medications for opioid use disorder (MOUD) prescriptions, but perceived noncompliance can trigger Drug Enforcement Administration investigation and consequences such as increased oversight, suspension/revocation of license and civil/criminal penalties. The opioid settlements also require close monitoring and set thresholds. Pharmacists may consequently limit the prescriptions they fill or keep their supply low. Stigma can lead pharmacists to decline MOUD prescriptions and limit naloxone availability. Pharmacies report that reimbursement rates do not fully cover the price of buprenorphine. State and federal regulators, as well as pharmacies, must work to address these barriers.

Source: How Our Overdose Crisis Response Is Delayed At The Pharmacy (Health Affairs)