Policy News Roundup: November 16, 2023

Key reads

SAMHSA releases 2022 National Survey on Drug Use and Health

The Substance Abuse and Mental Health Services Administration released the 2022 National Survey on Drug Use and Health. It provides nationally representative data on the self-reported use of tobacco, alcohol and illicit substances; substance use disorder; mental health conditions; suicidal thoughts and behaviors; and mental health and substance use disorder treatment among the civilian, noninstitutionalized population aged 12 and older in the U.S. In 2022, 59.8% people used tobacco products, vaped nicotine, used alcohol or used an illicit substance in the past month, including 48.7% who drank alcohol, 18.1% who used tobacco products, 8.3% who vaped nicotine and 16.5% who used an illicit substance. The survey found 24.9% (70.3 million) used illicit substance in the past year, including 22% who used marijuana. The survey also found 48.7 million (17.3%) had substance use disorder in the past year, including 29.5 million who had alcohol use disorder, 27.2 million who had a substance use disorder and 8 million who had both. One in four adults 18+ had any mental illness in the past year, and one in five adolescents had a past-year major depressive episode.

Source: HHS, SAMHSA Release 2022 National Survey on Drug Use and Health Data (Substance Abuse and Mental Health Services Administration)

Majority of Americans say the U.S. is losing ground in addressing illegal substances

A poll found that Americans are more negative about U.S. progress in dealing with the problem of illegal substances than at any prior point since polling started in 1972. For the first time, a majority of adults (52%) say the U.S. has lost ground in coping with the problem. A record-low 24% say it has made progress, while 23% believe it has stood still. The results are a sharp reversal from 2019, when more Americans thought that progress was being made (41%) than that the U.S. was losing ground (30%). The public was most optimistic about the problem in 1999 and 2000, when an average of 47% believed the U.S. was making progress. Republicans are extremely negative about progress, with 12% believing the U.S. is making progress and 75% losing ground. 22% of Independents believe progress is being made, and 52% think the situation is getting worse. More Democrats think the situation is improving (40%) than worsening (27%). The poll found 74% of adults described the substance use problem in the nation as extremely or very serious, while 35% say the problem in their local area is extremely or very serious. Majorities of all party groups say the problem is serious.

Source: Majority Now Say U.S. Losing Ground on Illegal Drug Problem (Gallup)

White House announces resources to support recovery-ready workplaces

The Biden administration is unveiling resources to equip businesses and state leaders with tools to expand employment opportunities for Americans with substance use disorder or in recovery. The administration is releasing a Recovery-Ready Workplace Toolkit with guidance and resources to help businesses and employers prevent and respond more effectively to substance use disorder among employees, build their workforces through hiring people in recovery and develop a recovery-supportive workplace culture. Model legislation for state governments supports the creation and development of recovery-ready workplaces. It would establish a program by which employers can become recovery-ready workplace participants or certified as recovery-ready workplaces, and encourage employers to institute workplace policies that establish a culture that values a healthy work environment and offers opportunities for recovery and retention; help reduce occupational injuries and work-related stressors that might lead to intentional substance misuse; encourage hiring of qualified people in recovery; and eliminate barriers for employees seeking treatment. It would also assist employees in maintaining recovery, wellness, safety and productivity; establish a tax credit and stipend for certified employers; and establish funding mechanisms to further recovery-ready workplaces.

Source: Biden-⁠Harris Administration Announces New Actions to Support Recovery-Ready Workplaces and Strengthen Our Economy (White House)

Sanders wants to address opioid crisis and improve the SUPPORT Act

In an interview, Senator Bernie Sanders (I-VT), chair of the Health, Education, Labor and Pensions Committee, said one of the issues he wants to address before the end of the year is the opioid crisis. He said he has been working with a number of colleagues to think of the best way forward to make the SUPPORT Act as strong as it can be, and that it is something he wants to do in the very near future. When asked why the committee has yet to take up SUPPORT Act reauthorization despite ranking member Bill Cassidy (R-LA) introducing a reauthorization bill, Sanders said that he and Cassidy have fundamental disagreements about the way forward. Sanders thinks we have to not simply reauthorize the modest fixes there, as the serious opioid crisis calls for serious responses and legislation that actually address the crisis. He wants to not just reauthorize the existing bill but substantially improve it, which he is working on now.

Source: Bernie says holding up Bertagnolli’s nomination sent ‘a message’ (The Washington Post)

New York fines insurance companies for inadequate behavioral health coverage

New York Governor Kathy Hochul announced more than $2.6 million in penalties against five Medicaid managed care health plans following a comprehensive examination of their reimbursement of behavioral health service claims. New York State levied the fines after the carriers repeatedly and inappropriately denied claims or failed to pay for specialty behavioral health services at the rates required by law. The fines resulted from the Health Plan Focused Survey Results for Behavioral Health Claims Denials, a report compiled by the Office of Mental Health. Denials were most frequently for care provided by assertive community treatment, personalized recovery-oriented services, comprehensive psychiatric emergency program, partial hospitalization and adult behavioral health home and community-based services.

Source: Governor Hochul Announces $2.6 Million in Fines Against Insurance Companies for Failing to Adequately Cover Behavioral Health Services (Governor Kathy Hochul)

Marijuana legalization faces tough odds in remaining hold-out states

The success of the legalization ballot measure in red-leaning Ohio illustrates the rapidly changing politics of marijuana. Once the law takes effect next month, more than half of Americans will live in a state where marijuana is legal for recreational use. Advocates hope the 14 percentage point margin of victory will ramp up pressure on the mostly GOP-run holdout states and, eventually, Congress. Fifteen states have legalized marijuana since 2019, including deep-red Missouri and Montana. Florida could be the next major battleground if a measure slated for the 2024 ballot survives a legal challenge. Legalization bills have recently stalled in GOP-run statehouses including in Wisconsin and Texas. Voters in Arkansas, Oklahoma, South Dakota and North Dakota rejected legalization measures in the past year. Republican lawmakers are largely still opposed, forcing advocates to rely on ballot measures in red states. However, citizen initiatives are not allowed in 17 of the states where marijuana remains illegal.

Source: Marijuana legalization faces tough odds in red states despite Ohio win (The Washington Post)

Treatment fraud in Arizona creates emergency among tribes

A few years ago, white vans began popping up around tribal reservations in the Southwest, approaching anyone who looked homeless or intoxicated to offer shelter and sobriety, and bringing people who accepted to one of hundreds of sober living homes that have proliferated around Phoenix in recent years, with little oversight or control. Prosecutors and tribal leaders are calling it one of the largest, most exploitative frauds in Arizona history. Hundreds of rehab centers provided shoddy or nonexistent addiction treatment to thousands of vulnerable Native Americans that cost the state as much as $1 billion. Scores of people ended up unhoused, still struggling with untreated addiction. Some died of overdoses. The treatment centers took advantage of gaps in a program that funds health care for low-income tribal members. State officials said the fund amounted to a virtually unguarded pool of money that was poorly regulated and easily exploited, and they have since tightened rules. Arizona has suspended more than 300 treatment businesses and charged more than 40 people with defrauding taxpayers. The Navajo Nation declared a public health emergency over the fraud.

Source: They Wanted to Get Sober. They Got a Nightmare Instead. (The New York Times)

DC declares public health emergency in response to opioid crisis and youth violence

Washington, D.C. Mayor Bowser issued a public health emergency that will allow the D.C. government to respond more efficiently and urgently to the opioid epidemic and youth violence. The order allows D.C. to immediately modify the current data sharing agreement between the Department of Behavioral Health, D.C. Health and the Fire and Emergency Medical Services Department to require agencies to input suspected nonfatal overdoses into a common data tracking system. This can help deployment of outreach teams to overdose hotspots, as well as the provision of harm reduction services and supports. The order will also allow D.C. to take emergency measures regarding capacity across the continuum of placements for youth in the Department of Youth Rehabilitation Services’ custody. The order authorizes expedited procurement, the disbursement of funds and the activation, implementation and coordination of mutual aid agreements between D.C. and federal, state or local jurisdictions.

Source: Mayor Bowser Issues Public Emergency to Give District New Tools for Responding to Opioid Crisis and Increase in Youth Violence (Government of the District of Columbia)

Addiction crisis complicated by polysubstance use

The U.S. is in a new stage in the illicit drug crisis, which includes not only opioids, but rapidly growing polysubstance use. Over the last three years, studies of people with opioid use disorder (OUD) have consistently shown that 70 to 80% also take other illicit substances. This shift is stymieing treatment efforts and confounding policies. The non-opioid substances include xylazine, anti-anxiety medications like Valium and Klonopin and stimulants like cocaine and meth. The incursion of meth has been particularly problematic. There is no approved medical treatment for meth addiction, and meth can undercut the effectiveness of OUD therapies. Narcan has no effect on stimulants. OUD treatment plans often collapse if a patient is also using meth. Treatment options for meth addiction in pregnant women are almost nonexistent. Harm reduction efforts are also complicated by the prevalence of so many substances. While billions of dollars are being poured into opioid interventions, there has been comparatively little discussion about stimulants.

Source: ‘A Monster’: Super Meth and Other Drugs Push Crisis Beyond Opioids (The New York Times)

Vape designs target young people

The understated look of Juul has been edged out by the rounded, vivid designs of Elf Bars and other brands of vapes, whose color schemes often correspond with their flavors. Public health experts are concerned that the playful appearance of these devices, which is in line with the maximalist aesthetic preferences of Gen Z, may offer appealing new cover for nicotine products. Along with candy- and fruit-inspired flavors, alluring vape packaging could steer young people toward e-cigarettes. The products have not been authorized for sale by the Food and Drug Administration but are readily available. While the earliest e-cigarettes were clunky modular systems or mimicked the appearance of real cigarettes, the new colorful, disposable e-cigarettes are seen as trendy, cool fashion accessories. The new bolder look may correspond with a shift in some young people’s openness about vaping. Linda Richter, Partnership to End Addiction’s Senior Vice President, Prevention Research and Analysis, explains that the tobacco industry’s lobbying has resulted in a regulatory environment that fails to reign in the flow of vaping products now available in colors and flavors, with high doses of nicotine and marketed to kids. Schools and communities should not have to shoulder the responsibility of prevention on their own.

Source: Vapes Get a Gen Z Makeover (The New York Times)