Policy News Roundup: December 8, 2022

Key reads

Reports of youth marijuana use in the National Poison Data System have soared

A study of nearly 339,000 cases of intentional misuse of substances among children and teens in the National Poison Data System 2000-2020 found that marijuana misuse among those 6-18 has increased 245% since 2000, coinciding with a wave of legalization in many states. Adolescents are moving away from smoking marijuana and toward alternative modes of consumption, like edibles. Linda Richter, Partnership to End Addiction’s vice president for prevention research and analysis, said the study adds to the growing research showing the harms of marijuana to youth, particularly as products resemble candy, come in enticing flavors and have high concentrations of THC. The proliferation of such products normalizes use and reduces perception of risk among young people, and products should be kept out of children’s sight and reach. Child alcohol misuse steadily declined between 2000 and 2020. While cough medicine containing dextromethorphan was responsible for the most cases, misuse has declined since its peak in 2006.

Source: As Alcohol Abuse Declines Among Teens, Marijuana Abuse Soars (HealthDay)

Congress is pushing for addiction legislation before the end of the year, but it is insufficient

Congress appears poised to let this session end without enacting significant reforms to the addiction prevention and treatment system, despite it seemingly being a bipartisan issue. Several measures to expand access to treatment and increase funding could become part of a year-end spending package, but advocates charge that lawmakers have their sights set too low. While some of the provisions under consideration would represent progress, there is not the same urgency as there was a few years ago and compared to other emergencies. Provisions that could be included include the Medicaid Reentry Act, a set-aside for recovery services, eliminating the requirement for individuals to have addiction for at least a year before receiving methadone, as well as the MAT Act (which would allow all prescribers to treat patients using buprenorphine) and the MATE Act (which would require health providers to train staff on managing patients with substance use disorders). The Opioid Treatment Access Act is not likely to be included. Congress could attach addiction provisions to the spending bill, but if they cannot reach an agreement, they could pass a year-long continuing resolution that effectively maintains the status quo.

Source: Congress has its sights set too low on addiction, advocates charge (STAT)

HHS marks one-year anniversary of Overdose Prevention Strategy

The Department of Health and Human Services (HHS) marked the one-year anniversary of its Overdose Prevention Strategy by announcing the progress the nation has made since, showing expanded treatment capacity, lives saved from overdose and commitment to long-term recovery supports. The Centers for Disease Control and Prevention announced that every state, local and territorial awardee of the Overdose Data to Action cooperative agreement can use a portion of funds to purchase naloxone. The Food and Drug Administration recently published a Federal Register Notice stating that certain naloxone products have the potential to be safe and effective for over-the-counter use. HHS also released a study finding an acceleration in the growth of waivered clinicians in the early months after revised Practice Guidelines that removed the training requirement and the need for clinicians to certify their ability to provide/refer for counseling and other ancillary services to prescribe buprenorphine to up to 30 patients.

Source: One Year After Releasing its Groundbreaking Overdose Prevention Strategy, HHS Announces New Data Showing Nation Has Expanded its Ability to Treat Addiction and Save Lives (Department of Health and Human Services)

Senate Finance Committee releases parity discussion draft

The Senate Finance Committee released a discussion draft including policies aimed at improving parity in Medicare and Medicaid. Policies include strengthening the accuracy of provider directories in Medicare Advantage plans; strengthening requirements for Medicaid to maintain regularly updated provider directories that include information on accessing behavioral health care; and directing a study of the difference in enrollee cost-sharing and utilization management between behavioral health and non-behavioral health services in Medicare Advantage and compared to traditional Medicare. They also include requiring Medicare to provide guidance to health care providers detailing the extent to which Medicare beneficiaries with addiction can receive partial hospitalization services, and directing a report on Medicaid payment rates for behavioral health services compared to medical/surgical services. This draft is the fifth and final the Committee has released since kicking off its mental health initiative (see summary of all provisions).

Source: Wyden, Crapo, Bennet, Burr Release Mental Health Parity Discussion Draft (United States Senate Committee on Finance)

Emergent seeking FDA approval for first OTC naloxone nasal spray

Emergent BioSolutions is seeking approval from the Food and Drug Administration (FDA) for an over-the-counter naloxone nasal spray. The FDA will review the product on a priority basis and make its decision by March 29. If approved, it would be the first non-prescription version of naloxone. There are currently legal barriers limiting access to naloxone in some states, and naloxone is not always available to those most at risk of an overdose even in states with fewer legal barriers.

Source: U.S. FDA to review Emergent’s OTC opioid overdose drug on priority (Reuters)

Senators push for eased methadone rules but face pushback from OTPs

Rep. Norcross (D-N.J.) and Sen. Markey (D-Mass.) are pushing legislation that would enable addiction treatment physicians to prescribe methadone at local pharmacies for stable patients, with some allowed to take home as much as a one-month supply. AATOD, a trade group that represents opioid treatment programs, says loosening the rules is misguided and that lax oversight of patients by doctors helped create the opioid crisis. Markey says the clinics are just trying to protect their business interests. The House version was folded into a mental health bill that overwhelmingly passed in June, but it has yet to be brought up for consideration in the Senate. It has bipartisan support, with Sens. Paul (R-Ky.) and Braun (R-Ind.) as cosponsors. The bill’s sponsors are looking to attach it to a must-pass bill such as year-end spending. Markey said the biggest impediment to doing so is the AATOD’s lobbying.

Source: The under-the-radar battle over opioid addiction treatment legislation (Washington Post)

Final push for cocaine sentencing reform hits roadblocks

In the final weeks of the legislative session, there is a push for reducing the federal sentencing disparity between crack and powder cocaine offenses, but it is not proving easy. There was discussion about attaching a potential agreement onto the National Defense Authorization Act, but that did not happen, leaving a broader end-of-the-year spending deal as the last option. While advocates want to see the sentencing disparity completely eliminated, citing legislation (EQUAL Act) that passed the House last year by an overwhelming margin, current talks surround reducing the ratio from the current 18:1 to 2.5:1. Language from Sen. Grassley (R-Iowa) about the role of the Department of Justice when it comes to applying the change retroactively is a sticking point. After Democrats rejected Grassley’s proposal, negotiators are now discussing removing retroactivity altogether, but that is not expected to go over well with advocates.

Source: Cocaine sentencing reform hits ‘tough negotiation moment’ (Politico)

New Mexico announces opioid settlement with Kroger

New Mexico reached a settlement in opioid litigation against Kroger, in a deal that will deliver nearly $60 million to the state and local communities to fund opioid abatement efforts within the next 90 days. Kroger was one of three pharmacy defendants that went to trial against the state in September. The attorney general plans to announce other settlements with pharmacy operators Albertsons, CVS and Walmart in the coming weeks. The state wrapped up its two-month-long trial against Walgreens in October. A decision is expected from the court in that case in the coming weeks.

Source: Attorney General Balderas Announces $58.5 Million Opioid Settlement With Smith’s Food & Drug Parent, The Kroger Co. (New Mexico Attorney General)

Xylazine leading to rise of wounds in Philadelphia

The spike in wounds among people who use substances in Philadelphia reflects the surge in the local supply of xylazine. “Tranq” was found in more than 90% of heroin and fentanyl samples in 2021, accompanied by a wave of wounds. Emergency department visits in Philadelphia for skin and soft tissue injuries quadrupled between 2019 and 2021. They are not the same type of wounds that occur from injecting substances generally, sprouting on skin far from where people inject and developing even in people who snort or smoke. They are not caused by an infection but can get infected if not taken care of. Xylazine is also complicating overdose response and withdrawal and can knock people out for hours, leaving them vulnerable. There are signs that xylazine is spreading, though a lack of testing is limiting detection. Because they are often treated poorly in the health care system, there is concern that people who use substances will not seek help until wounds have advanced to a dangerous point. There is a lack of research and understanding of xylazine.

Source: In Philadelphia, ‘tranq’ is leaving drug users with horrific wounds. Other communities are bracing for the same (STAT)

Hochul administration rejects recommendation to invest opioid settlement funds in overdose prevention centers

New York Governor Hochul’s administration is rejecting a recommendation from a state advisory panel to invest opioid settlement funds in overdose prevention centers. The Office of Addiction Services and Supports (OASAS) sent a letter to the state Opioid Settlement Fund Advisory Board saying the recommendation violates state and federal laws, rules and/or regulations. When the board held its vote on the plan in October, the governor’s representatives did not raise any objections to the investment in overdose prevention centers or harm reduction more broadly. OASAS said that to the “extent practicable,” the Hochul administration will implement the recommendations that do not violate the law or state constitution, do not create recurring costs the state would need to cover and are in compliance with court orders. The administration is rejecting a recommendation calling for money to go to the health department for harm reduction.

Source: Hochul administration rejects investments in overdose prevention centers (The Capitol Pressroom)

Juul settles thousands of vaping lawsuits

Juul announced that it had agreed to settle about 5,000 lawsuits in a Northern California court case for an undisclosed sum. The proposed agreement on the multidistrict litigation would wrap up personal injury, consumer class action, government and Native American tribe cases in a deal that Juul said it had secured an investment to fund. The settlement does not offer funds immediately but will open up a claims process and will put compensation in the hands of victims and their families, get funds to schools for abatement programs and help government and tribal entities prevent youth e-cigarette use. Juul said the agreement involved about 10,000 plaintiffs, many of whom claimed they had not been aware that the product could be more addictive than cigarettes. The plaintiffs, which included school districts, also argued that the e-cigarettes were unreasonably dangerous because of their attractiveness to young people. They made a wide range of claims, from racketeering to fraud and unjust enrichment.

Source: Juul Agrees to Settle Thousands of Vaping Lawsuits (New York Times)

Report outlines steps for ensuring insurance coverage of behavioral health emergency services

The Kennedy Forum released a report on ensuring commercial insurance coverage for behavioral health emergency services. It outlines the crisis response continuum of care and current statutory landscape of emergency services. Broadly speaking, commercial insurers do not currently cover mobile crisis response services. Instead, publicly funded agencies are left paying for and administering these services. Mobile crisis teams are currently funded by federal, state and local discretionary funds and by Medicaid. The limited funding impairs the ability to build a robust behavioral health emergency response system. Coverage of mobile crisis response services should be characterized by the following – insurance payment is required for any situation in which a prudent layperson would have believed an emergency existed; prior authorization is prohibited; provider network status does not matter/all cost-sharing is at in-network levels; and balance billing by providers is prohibited. The report also includes a case study of Washington state, as well as actions for federal and state policymakers.

Source: Ensuring Coverage of Behavioral Health Emergency Services (The Kennedy Forum)