Policy News Roundup: July 22, 2021

Key reads

Denying addiction care in emergency departments can violate federal law

A Legal Action Center report found that hospitals that fail to provide addiction care in their emergency departments such as screening and diagnosis, medications, and treatment referral facilitation could face legal liability. Hospitals may violate the Emergency Medical Treatment and Labor Act when they do not conduct a medical screening examination for people who come to the ED with a substance use-related condition and provide stabilization services for patients with a substance use disorder. They may also violate the Americans with Disabilities Act and the Rehabilitation Act when their EDs deny evidence-based practices for SUD based on unfounded stereotypes rather than legitimate medical considerations. Finally, they may violate Title VI of the Civil Rights Act when they deny evidence-based practices in the ED because of a patient’s race or ethnicity, or when their denial or adoption of these practices has a racially disparate impact.

Source: New Report from the Legal Action Center Finds that Denying Necessary Care for Substance Use Disorders in Emergency Departments Can Violate Federal Law (Legal Action Center)

Fall in life expectancy in 2020 driven in part by rising overdose deaths

CDC provisional life expectancy estimates for 2020 found that in 2020, life expectancy at birth for the U.S. population declined by 1.5 years from 2019, the largest one-year decline since World War II. The decline was primarily due to increases in mortality due to COVID-19 (73.8% of the negative contribution), unintentional injuries (11.2%), homicide (3.1%), diabetes (2.5%), and chronic liver disease and cirrhosis (2.3%). Increases in unintentional injury deaths in 2020 were largely driven by overdose deaths, and these deaths may so far be underestimated due to lags in data. Black and Hispanic Americans experienced the greatest declines in life expectancy.

Source: Provisional Life Expectancy Estimates for 2020 (Centers for Disease Control and Prevention); U.S. Life Expectancy Fell By 1.5 Years in 2020, The Biggest Drop Since WWII (NPR)

American Rescue Plan funds announced for behavioral health crisis response services in Medicaid

The Centers for Medicare & Medicaid Services (CMS) announced a funding opportunity through the American Rescue Plan to help states strengthen system capacity to provide community-based mobile crisis intervention services for those with Medicaid. The $15 million funding opportunity is available to state Medicaid agencies for planning grants to support developing these programs. Services may include screening and assessment, stabilization and de-escalation, and coordination of referrals after initial treatment. Grant funds can be used to support assessments of current services, strengthen capacity and information systems, ensure that services can be accessed 24/7/365, provide behavioral health care training for multi-disciplinary teams, or seek technical assistance to develop State Plan Amendments, demonstration applications, or waiver program requests under Medicaid.

Source: CMS Addresses Substance Use, Mental Health Crisis Care for Those with Medicaid (Department of Health and Human Services)

NIH leaders stress the importance of language in reducing stigma

NIH leaders describe in a perspective piece how using appropriate language to describe mental health and substance use disorder can help reduce stigma and improve how people are treated in health care settings and throughout society. More than a decade of research shows that stigma contributes significantly to negative health outcomes and can pose a barrier to seeking treatment. The authors describe how stigma-related bias among clinicians can contribute to a treatment-averse mindset and to flawed clinical care. Internalized “self-stigma,” they write, can lead to lower self-esteem and self-worth and may exacerbate symptoms and create barriers to treatment. The authors advocate for using scientifically accurate language and terms that centralize the experience of patients is key to reducing stigma. A shift in language, they say, is crucial for mobilizing resources toward addiction services and eroding prejudices that keep people from care.

Source: Words matter: language can reduce mental health and addiction stigma, NIH leaders say (National Institute on Drug Abuse)

ONDCP awards funding for HIDTA

The Office of National Drug Control Policy announced $13.6 million in fiscal year 2021 discretionary funding for the High Intensity Drug Trafficking Area (HIDTA) program, adding to the $274 million provided in base funding released earlier this year. The new allocation will support 63 discretionary projects in 25 regional HIDTAs and the National HIDTA Assistance Center. It will include $3.4 million to bolster public health and public safety partnerships and collaborations, $2.9 million to combat evolving or emerging drug threats in 15 regional HIDTAs, $5.8 million to enhance the efficiency and effectiveness of 23 regional HIDTAs and $1.5 million for six newly designated counties across four regional HIDTAs.

Source: ONDCP Awards $13.6 Million for High Intensity Drug Trafficking Areas (White House Office of National Drug Control Policy)

States announce $26 billion settlement plan with drug distributors and Johnson & Johnson

The country’s three major drug distributors (Cardinal, AmerisourceBergen, McKesson) and Johnson & Johnson reached a $26 billion deal with states that would release the companies from all legal liability in the opioid crisis. The offer will now go out to states and municipalities for approval. If enough formally sign on, billions of dollars from the companies could begin to be released to communities for abatement. The states and cities would drop thousands of lawsuits against the companies and pledge not to bring future action. The settlement only binds the four companies, leaving unresolved thousands of other lawsuits against manufacturers and drugstore chains. Under the agreement, the distributors would make payments over 18 years, and J&J would pay $5 billion over 9 years. The distributors would establish an independent clearinghouse to track and report shipments, a new mechanism intended to make data transparent and send up red flags immediately when outsized orders are made.

Source: Drug Distributors and J.&J. Reach $26 Billion Deal to End Opioids Lawsuits (New York Times)

15 states reach a deal with Purdue

Fifteen states have reached an agreement with Purdue that could pave the way toward settlement of thousands of opioid cases. The states decided to drop their opposition to Purdue’s bankruptcy reorganization, in exchange for a release of millions of documents and an additional $50 million from the Sackler family. They join about half of the states, which had previously approved the plan. The Sacklers originally proposed paying $3 billion in cash and resisted releasing the full trove of documents, but Purdue and the Sacklers will now release some 33 million documents, and the money has risen to $4.5 billion, plus an additional $225 million in a civil settlement with the Justice Department. The settlement includes no finding of liability or wrongdoing. The Sacklers will have nine years to make payments, but the new agreement includes an enhanced schedule. Voting by creditors ends July 14, and certification of the plan following a hearing in August is now widely expected, though nine states and Washington, D.C., continue to oppose the agreement. Two Justice Department divisions also submitted court filings opposing the plan, suggesting that releasing the Sacklers from liability is impermissible and that the plan violates the constitutional right to due process for those with potential opioid claims.

Source: 15 States Reach a Deal With Purdue Pharma, Moving Toward a $4.5 Billion Opioids Settlement (New York Times); Justice Department Blasts Purdue Pharma’s Bankruptcy Plan (NPR)

Rhode Island approves safe injection sites

Governer Daniel McKee of Rhode Island signed into law a proposal to create safe injection sites, making the state the first to enact a statewide measure. The legislation establishes a two-year pilot program to create “harm reduction centers,” which are resources that provide health screening, disease prevention and recovery assistance where people may safely consume pre-obtained controlled substances. The goal is to provide clean needles to curtail the spread of infectious diseases, test drugs and provide a bridge to medical and addiction treatment. The law requires approval of a center by the city or town council in which it is proposed. The funding would come from foundations or private donations, as the legislation does not earmark any public or taxpayer dollars, but as the first, the state is well-positioned to receive private funding.

Source: RI Gov. McKee signs legislation allowing safe-injection sites into law (The Providence Journal)

Drug- and alcohol-related deaths in jails have skyrocketed

Drug and alcohol-related jail deaths have skyrocketed in recent years, according to a Bureau of Justice Statistics report. Experts say the spike goes hand-in-hand with the continued criminalization of substance misuse in the U.S. and lack of treatment. Deaths spiked 381% 2000-2018, the largest increase of any cause. The time period also coincided with increased opioid use and large numbers of substance-related arrests, mainly for possession. Improving systems of treatment can prevent these deaths, reduce recidivism, and end stigma against substance use disorder. The first step is addressing over-policing and under-treatment of substance use. Forced withdrawal or overdosing in jail without proper or immediate access to care can be deadly. In addition to decriminalizing substance use, medically supervised withdrawal and access to services for other health needs while incarcerated could address these issues, along with educating incarcerated individuals, providing naloxone and providing medications for opioid use disorder during incarceration and upon release.

Source: Spike in drug, alcohol related jail deaths puts spotlight on fallout from ‘war on drugs’ (ABC)

Most states are not prepared to implement 988 crisis response services

A Kennedy Forum analysis found that only three states (Colorado, Nevada, Washington) have passed adequate legislation to facilitate 988, the nationwide hotline intended for Americans to connect with suicide prevention and crisis counselors. Congress mandated a deadline of July 16, 2022, for 988 to be available nationwide. States are running out of time to fund and implement important components of the system, including 24/7 call centers staffed by mental health professionals, mobile response teams and crisis stabilization services that connect people to follow-up care. Congress has authorized states to pass user fees on telephone lines to fund these services, but few states have acted. California, Kentucky, New Jersey and Massachusetts have legislation pending that includes user fees. Virginia has passed legislation, but with limited user fees that will not fund vital system components. Utah, Illinois and Indiana passed legislation with no user fees. Nebraska, Texas, Alabama, New York and Oregon passed legislation without user fees but created studies or exploratory commissions. Thirty-four other states and Washington, D.C, have taken no steps to advance 988.

Source: Countdown: States Have One Year to Facilitate 988, the Nation’s First Mental Health Crisis Line (Kennedy Forum)