Policy News Roundup: June 3, 2021

Key reads

Most buprenorphine prescriptions are written by a small number of providers

A study found that most prescriptions for buprenorphine are written by a small number of health care providers. It found that half of all patient-months of buprenorphine treatment in 2016-2017 were prescribed by just 4.9% of providers who prescribed buprenorphine during the period. Primary care physicians accounted for over 60% of the high-volume prescribers. The monthly caseload for most those providers was still well below the current patient limit of 275. The study suggests that targeted efforts to encourage more current prescribers to become high-volume prescribers and to encourage existing high-volume prescribers to safely and effectively treat more patients may help increase buprenorphine treatment capacity.

Source: Most Prescriptions for Opioid Addiction Medication Buprenorphine Are Written by a Small Number of Providers (RAND)

Purdue's restructuring plan is cleared for a vote

The federal bankruptcy judge overseeing Purdue’s case indicated that he would permit Purdue’s restructuring proposal to be put to a vote by thousands of plaintiffs. The plan includes a blanket release from civil lawsuits for the Sacklers, a contentious issue. The Sacklers have agreed to relinquish ownership and contribute $4.5 billion, mostly going to an opioid abatement trust fund to be disbursed to states and municipalities to support prevention and treatment. Purdue is expected to mail out information packets soon that describe the plan to claimants, with voting to conclude by July 14 and a final confirmation hearing scheduled for August 9. No matter how claimants vote, ultimate approval is up to the judge. The reconstituted company would fund about a half-dozen trusts, including ones for Tribes, adults, and children. Individual claimants would receive relatively paltry compensation. Exception for a group of two dozen states and a coalition of school districts, almost all plaintiff groups have said the plan is fit to be put to a vote. There is concern that continuing the lawsuit could result in a delay and less funding than the current settlement.

Source: Judge Clears Purdue Pharma’s Restructuring Plan for Vote by Thousands of Claimants (New York Times)

White House releases its FY 2022 budget request

The Biden-Harris Administration released their FY 2022 budget proposal, which includes historic investments in efforts to address the addiction crisis. The proposal will support implementation of the administration’s drug policy priorities through a $41 billion investment for National Drug Control Program agencies, a nearly $670 million increase over 2021. It devotes a historically high percentage of drug control resources to evidence-based treatment, harm reduction, prevention and recovery services. The budget includes $10.7 billion for HHS to address the crisis, with targeted investments for populations at greatest risk for overdose and addiction. This includes increased funding for the State Opioid Response Grants and the Substance Abuse Prevention and Treatment Block Grants, including a new 10% set-aside for recovery services. The budget also supports increased access to treatment services including medications for addiction treatment, prison-based treatment and alternatives to incarceration, and housing and employment assistance for individuals in treatment and recovery. The proposal also invests in prevention through funding for mental health services; school-based prevention; strengthening oversight of youth tobacco use; and services to address social determinants of health that are risk factors for addiction.

Read Partnership to End Addiction’s statement on the budget proposal here.

Source: National Drug Control Budget: FY 2022 Funding Highlights (White House)

Bill to overhaul behavioral health crisis response system introduced

Sens. Cortez Masto and Cornyn introduced the Behavioral Health Crisis Services Expansion Act to overhaul the current approach to responding to behavioral health crises by creating a continuum of crisis services through the nationwide adoption of services that stabilize patients in crisis and direct them to the most appropriate treatment options. The bill would direct HHS to ensure that the national definition of behavioral health crisis care includes universally available 24/7 crisis hotlines and call centers,  behavioral health urgent care facilities, 23-hour crisis stabilization and observation beds, and short-term crisis residential options. The bill would also provide coverage of crisis services for all patients no matter where they get their health insurance, provide funding for the development of crisis services in communities and establish a panel of experts to improve coordination among 911 dispatchers and 988 crisis hotline call centers.

Source: Cortez Masto & Cornyn Introduce Bipartisan Legislation To Overhaul Nationwide Mental Health Crisis Response (Catherine Cortez Masto)

New fact sheets released on state mental health and substance use data

KFF released updated fact sheets examining national and state-level data on mental health and substance use both before and during the pandemic. Mental health outcomes, access and coverage vary by state. Drug overdose deaths increased during the pandemic, primarily driven by synthetic opioids. States with the highest overdose deaths rates in the 12-month period ending September 2020 were Washington, D.C., West Virginia, Delaware, Kentucky and Ohio. States with the lowest were South Dakota, Nebraska, Iowa, North Dakota and Texas. The state fact sheets include information on mental distress during the pandemic, mental illness prevalence, substance use and related deaths, suicide, workforce, unmet need and barriers to care, private insurance and Medicaid.

Source: Mental Health and Substance Use State Fact Sheets (Kaiser Family Foundation)

Critical Indiana syringe services program to be forced to close

Scott County, Indiana, commissioners voted 2-1 this week to close the syringe service program credited with helping to end its HIV outbreak in 2015. While the program has reduced overdose deaths and prevented new cases of HIV in one of the country’s biggest HIV hotspots, the commissioners suggested that the access to needles is leading to more overdoses and that the program makes it easier to misuse substances. Health officials are dismayed by the decision, which requires the program to be phased out by the end of the year. They are concerned they could see a spike in HIV and hepatitis C cases, as is happening in West Virginia as elected officials there crack down on needle exchanges. The loss of the program’s HIV and hepatitis C testing, food, and connections to health insurance, housing, treatment and recovery options will also harm the 170 people the program helps per month.

Source: Indiana Needle Exchange That Helped Contain An HIV Outbreak To Be Shut Down (NPR)

New York counties file lawsuit against McKinsey

New York City and 21 counties in New York State are suing consulting firm McKinsey, accusing the company of contributing to the opioid crisis by helping create strategies to increase opioid sales. McKinsey agreed to more than $600 million in settlements with all 50 states earlier this year, and the company said that it believed that having settlements with states resolved any claims brought by municipalities, as the funds provided will be used by state governments to support communities throughout the states.

Source: NYC, NY counties file against McKinsey over opioid crisis (Associated Press)

New York passes law ensuring access to medications for opioid use disorder in jails and prisons

New York passed legislation (A. 533/S. 1795) last week that will ensure people incarcerated within the state have access to medications for opioid use disorder. Advocates expect Gov. Cuomo to sign the bill. Once signed, implementation can begin immediately, as the state budget already includes millions of dollars that state and county jails can use to implement MOUD programs. Prisons and jails will be required to facilitate access to MOUD during incarceration and support individuals in continuing treatment when transitioning out of incarceration.

Source: NY Assembly Passes Bill Ensuring Prisoners Access to Methadone, Bupe (Filter)

Fentanyl test strips should be destigmatized and more widely available

Despite evidence of the utility of fentanyl test strips, they are not widely accepted. It is important to destigmatize them and increase their distribution and availability. Fentanyl test strips are distributed mainly at harm reduction sites or through a distributor’s website, but can be sold at any bodega or dollar store. They are inexpensive, easy to use and can be carried in a wallet or purse. Fentanyl test strips can alert people who may otherwise not know that their substances contain fentanyl, which can help prevent overdoses by leading people to avoid using the substance, to carry naloxone, or to avoid using it alone. Stigma has created barriers to the test strips, but there is increased need for them due to fentanyl’s increasing presence in substances and prevalence in overdose deaths. The tide is shifting in the Biden administration, with the CDC and SAMHSA recently announcing that federal funding can be used to purchase the strips. However, legality still varies by state.

Source: Fentanyl Test Strips Empower People And Save Lives – So Why Aren’t They More Widespread? (Health Affairs)

New campaign launched to advocate for mental health services in schools

Inseparable, along with several partner organizations (National Center for School Mental Health, NAMI, Healthy Schools Campaign, Bring Change to Mind, Well Being Trust, Active Minds, Jed Foundation, Kennedy Forum, Mindful Philanthropy and the Trevor Project) launched the Hopeful Futures Campaign to advocate for comprehensive mental health services in schools. They outline core features of a comprehensive school mental health system (i.e., early identification; school-based mental health services; trained educators, staff, and mental health professionals; and school-community partnerships) and best practices (i.e., data, evidence-based interventions, needs assessment and resource mapping, and sustainable funding). The campaign has a three-pronged strategy: policy advocacy, securing funding and technical assistance.

Source: Hopeful Futures Campaign