Policy News Roundup: November 9, 2023

Key reads

E-cigarette use declined among high schoolers, but tobacco product use increased among middle schoolers in 2023

In 2023, 10% of middle and high school students currently used tobacco products. The Centers for Disease Control and Prevention found 22.2% reported ever using any tobacco product. Current e-cigarette use among high schoolers declined from 14.1% to 10% from 2022 to 2023. There were also statistically significant declines in current use of any tobacco product, cigars and any combustible tobacco product among high schoolers. There were statistically significant increases in current use of any tobacco product and multiple tobacco products among middle schoolers. E-cigarettes remained the most commonly used tobacco products among youth. Among students who had ever used an e-cigarette, 46.7% reported current use. Among students who currently use e-cigarettes, 25.2% used e-cigarettes daily and 34.7% frequently. Disposable e-cigarettes were the most common device type used. The CDC found 89.4% used flavored e-cigarettes, with fruit and candy being the most common. The most commonly reported brands were Elf Bar, Esco Bars, Vuse, JUUL and Mr. Fog.

Source: Tobacco Product Use Among U.S. Middle and High School Students — National Youth Tobacco Survey, 2023 (Centers for Disease Control and Prevention)

Advocates and lawmakers want to expand access to methadone, but OTPs continue to push back

Many argue methadone should be made more broadly available beyond specialized opioid treatment programs (OTPs), prescribed by physicians and dispensed at pharmacies. While the Biden administration has proposed a rule to build off temporary pandemic-era flexibilities that loosened restrictions on take-home doses, not all OTPs and states have embraced the idea. Rep. Norcross (D-NJ) and Sen. Markey (D-MA) introduced legislation that would allow physicians and psychiatrists board-certified in addiction medicine to prescribe methadone from their offices. They want the bill included in the SUPPORT Act reauthorization. However, it faces pushback from OTPs and AATOD, the trade organization representing them. AATOD President Mark Parrino argues such a move would lead to more methadone overdoses and diversion and that physicians’ offices are not equipped to provide counseling and other services. Addiction doctors, experts and the lawmakers argue OTPs have a business interest in ensuring they are the only ones who can dispense methadone. Norcross said the debate has become so heated that he cut off communication with AATOD after two years of negotiations. There are higher hopes for Senate action. Markey serves on the Health, Education, Labor and Pensions Committee, which has jurisdiction over SUPPORT Act reauthorization, and several members of the committee, including Chairman Sanders (I-VT), have co-sponsored the legislation.

Source: Methadone access becomes flashpoint in fight over opioid crisis (Roll Call)

Senate Finance advances package containing mental health provisions

The Senate Finance Committee released and unanimously advanced the Better Mental Health Care, Lower-Cost Drugs And Extenders Act. Proposed policies include expanding the number of mental health and addiction providers participating in Medicare, including psychologists, clinical social workers, marriage and family therapists and mental health counselors in rural and underserved communities; expanding the use of licensed clinical social workers and occupational therapists under Medicare; funding primary care physicians to deliver behavioral health and primary care to Medicare beneficiaries in the same setting; and improving access to Medicare mental health services delivered through telehealth. They also include requiring Medicare Advantage plans to have up-to-date and accurate provider directories and protecting beneficiaries from paying out-of-pocket costs when relying on an incorrect directory; improving mental health and addiction care for youth enrolled in Medicaid and CHIP; and improving integration of mental health and addiction services with primary care for youth enrolled in Medicaid and CHIP.

Source: Wyden, Crapo Release Discussion Draft of Mental Health, PBMs Package Ahead of November 8 Markup (United States Senate Committee on Finance)

CMS releases rules that would expand Medicare behavioral health services

The Centers for Medicare and Medicaid Services (CMS) released several rules that expand access to behavioral health care in Medicare. One rule implements the Consolidated Appropriations Act (CAA), 2023 provisions that created a new benefit category for intensive outpatient services for behavioral health. The rule also clarifies that Medicare covers partial hospitalization for substance use disorder (SUD). CMS also issued a rule that increases payment for crisis care, SUD treatment and psychotherapy. CMS is finalizing implementation of several telehealth-related provisions of the CAA, 2023, including delaying the requirement for an in-person visit within six months of initiating mental health telehealth services. CMS is also implementing the CAA, 2023 provision that provides for Medicare Part B coverage and payment for services of marriage and family therapists (MFTs) and mental health counselors (MHCs). It is finalizing a proposal to allow addiction counselors or drug and alcohol counselors who meet the MHC requirements to enroll in Medicare as MHCs. CMS also proposed a rule that will add a new facility type, Outpatient Behavioral Health, that includes several behavioral health provider types (such as MFTs, MHCs, addiction medicine counselors and opioid treatment providers) to Medicare Advantage network adequacy requirements.

Source: CMS Makes Hospital Prices More Transparent and Expands Access to Behavioral Health Care; CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-FC); CMS Finalizes Physician Payment Rule that Advances Health Equity; Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule; Biden-Harris Administration Proposes to Protect People with Medicare Advantage and Prescription Drug Coverage from Predatory Marketing, Promote Healthy Competition, and Increase Access to Behavioral Health Care in the Medicare Advantage Program; Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Plan Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, and Health Information Technology Standards (Centers for Medicare and Medicaid Services)

Over 300 organizations and Sen. Cassidy push for SUPPORT Act reauthorization

Sen. Cassidy (R-LA), ranking member of the Senate Health, Education, Labor and Pensions (HELP) Committee, released a statement bringing attention to the over 300 mental health and addiction organizations (including Partnership to End Addiction) that called on HELP to take up and reauthorize the SUPPORT Act. He said that thousands of Americans are dying each month from overdoses and HELP needs to hold a markup to reauthorize the SUPPORT Act to evaluate, improve and fund life-saving programs. He noted that missing the deadlines puts vital resources in jeopardy and that he appreciates the support from the advocates expressing the urgency of the problem. He said that even if there are some differences in opinion on specific policies to include, everyone agrees HELP needs to get the SUPPORT Act reauthorization done.

Source: Ranking Member Cassidy Continues Push to Reauthorize Expired SUPPORT Act Amid Calls from 300+ Groups to Take Action (U.S. Senate Committee on Health, Education, Labor & Pensions)

Ohio becomes 24th state to legalize adult-use marijuana

Ohio approved a marijuana legalization referendum on the ballot on Tuesday, making Ohio the 24th state to legalize adult-use marijuana. The law allows adults 21+ to possess up to 2.5 ounces of marijuana and grow up to six plants. It creates a Division of Cannabis Control to regulate the adult-use market. The regulations give existing medical operators first dibs on the adult-use market but also allow licensing additional operators depending on market needs. Marijuana will be taxed at 10%. The measure is statutory, not a constitutional amendment, so lawmakers can amend or even repeal it, though given the strong margin of passage, advocates do not think lawmakers will try to repeal it. Approval of the measure will put pressure on neighboring Pennsylvania, West Virginia, Kentucky and Indiana. Sales are slated to start by the end of 2024 if the measure is implemented as written, but with the GOP-dominated legislature critical of the initiative, there could be a lengthy legislative battle that delays implementation.

Source: Ohio becomes 24th state to embrace weed legalization (Politico)

Washington corrections program allows women to stay with their babies and receive support

The Washington Department of Corrections’ Residential Parenting Program allows pregnant women to stay with their babies and get support. For nearly 25 years, the prison has included one of only a handful of prison nurseries in the country, and it is the only one with a licensed Early Head Start child care center. The incarceration of women has exploded in recent decades, and drug and property crimes account for most of the offenses. To qualify, individuals must be pregnant upon entering the facility, in minimum custody and have committed neither violent crimes nor crimes against children. Their sentence must be less than 30 months from their due date. Once in the program, they must participate in pre- and post-natal programs, like child development, parenting and family skills and self-esteem and self-care. The criteria dampen programs’ usefulness, with many slots empty. The article quotes Partnership to End Addiction’s Postdoctoral Fellow in Addiction Research and Evaluation, Minerva Francis, who notes the importance of talking with children about family history of addiction in a non-judgmental and informative way, because such conversations can delay onset of substance use.

Source: New mothers can stay with their babies at this Washington prison (Crosscut)

Ohio county has worked for a decade to build a comprehensive addiction treatment and recovery system

Hancock County, Ohio, has built a comprehensive treatment/recovery system. When the opioid crisis began, the county’s system included only some outpatient services and 12-step meetings. But officials then created a plan with the federally funded Addiction Technology Transfer Center that stressed recovery and community. Since implementation began a decade ago, Hancock County has brought in more than $19 million in grants, with other funding from a county tax and the state. It has launched a drug court. The University of Findlay launched classes on addiction, which can lead to an entry-level certificate. There are three recovery homes and a community center. The county launched a needle exchange and distributes naloxone and test strips. At the Family Resource Center, the quick response team checks on and provides resources to overdose survivors and people being released from incarceration. Hancock’s network amounts to a “no wrong-door” system, which echoes experts’ recommendations for use of settlement funds.

Source: As billions roll in to fight the US opioid epidemic, one county shows how recovery can work (Associated Press)

Possession of any drug checking equipment is only legal in half of states

The Network for Public Health Law conducted a 50-state review of the legality of drug checking equipment as of August 2023. It is clearly legal to possess all drug checking equipment in 27 states. In 13 additional states, possession of fentanyl testing equipment is clearly legal. Three states permit equipment for testing all synthetic opioids. Kansas permits only testing equipment for fentanyl, fentanyl analogs, ketamine and GHB. In eight states, possession of all drug checking equipment is a crime, typically because the law defines paraphernalia as including testing equipment and criminalizes possession of paraphernalia. Twenty-four states permit free provision of all drug checking equipment to adults, while 11 permit it only for fentanyl testing, three for synthetic opioids and two for fentanyl, fentanyl analogs, ketamine and GHB. Twelve states prohibit free distribution of all drug checking equipment. In approximately 13 states, syringe service programs are permitted to distribute drug checking equipment even if such distribution is not otherwise permitted. The Good Samaritan laws in 39 states provide protection from criminal action related to drug checking equipment.

Source: Legality of Drug Checking Equipment in the United States (Network for Public Health Law)

DC mayor proposes reviving '90s-era approach to open-air drug markets

In 1989, Washington, D.C. passed an anti-loitering law that allowed police to establish “illegal drug zones,” set a curfew for juveniles, and beefed up pretrial detention. Now, Mayor Bowser is recycling the same ideas, as D.C. confronts a violent crime problem. The proposal to revive those “anti-loitering” and “drug-free zones” would allow police to cordon off temporary zones for five days where anyone congregating to use, buy or sell drugs can be arrested if they do not leave. It is a throwback to a ‘90s-era approach of cracking down on open-air drug markets. Now, however, the major drivers of violent crime are not tied to drugs as they once were, and Bowser may encounter resistance because of the policy’s history of drawing legal challenges and racial profiling concerns. Bowser has also called on the council to pass her Safer Stronger legislation, which would expand pretrial detention for juveniles and adults charged with violent crimes.

Source: D.C. mayor resurrects old policy to target open-air drug markets (The Washington Post)

Public health groups place ad in support of menthol cigarette and flavored cigar bans

Eighty national public health groups, including the American Heart Association, American Medical Association, American Academy of Pediatrics and American College of Preventative Medicine, placed a full-page ad in Sunday’s edition of The Washington Post in support of a federal ban on menthol in cigarettes and all flavored cigars. It said, “The answer is clear. Saving lives starts by ending the sale of menthol cigarettes and all flavored cigars. Smoking kills nearly half a million people in the United States each year, and these addictive, deadly products are a big part of the problem. The FDA and White House have our full support to release lifesaving rules prohibiting menthol cigarettes and all flavored cigars.” Public health groups are urging the Office of Management and Budget to act quickly and expedite the review of the proposed rules so the final regulations can be issued by the end of the year.

Source: Dozens of health organizations pledge ‘full support’ for federal ban on menthol cigarettes and flavored cigars (CNN)