Policy News Roundup: December 14, 2023

Key reads

2023 Monitoring the Future shows adolescent substance use holding steady

The 2023 Monitoring the Future survey found that the percentage of adolescents reporting they used any illicit substances in 2023 continued to hold steady below pre-pandemic levels reported in 2020, with 10.9% of 8th graders, 19.8% of 10th graders and 31.2% of 12th graders reporting any illicit substance use in the past year. Reported use for almost all substances decreased dramatically between 2020 and 2021, after the onset of COVID. In 2022, most substance use held steady at these lowered levels, and the latest data show this trend continued into 2023. However, other research has reported a dramatic rise in overdose deaths among teens, suggesting that while substance use is not becoming more common among young people, it is becoming more dangerous. The survey found that adolescents most commonly reported use of alcohol, nicotine vaping and cannabis in the past year.

Source: Reported drug use among adolescents continued to hold below pre-pandemic levels in 2023 (National Institute on Drug Abuse)

Milliman report demonstrates need to increase accessibility of behavioral health care

A Milliman report found that access to behavioral health care services is highly variable across the U.S., and even among health care coverage types within each state. Over 24% of individuals across commercial, Medicare fee-for-service and Medicaid coverage had diagnoses for at least one behavioral health condition in 2021, but only 33% of them received treatment from a behavioral health specialist. Approximately 8% of emergency department visits included a principal diagnosis of a behavioral health condition in 2021. Among those receiving outpatient behavioral health therapy, the average number of therapy visits was 10.8 per year in 2021. In 2023, over half of the population lives in counties entirely designated as Mental Health Professional Shortage Areas. Those living in areas of low provider supply use less behavioral health services than those in areas with the highest supply. Psychiatrists are less likely to accept coverage of all types compared to other specialties. The average self-pay cost for someone without insurance coverage for a 60-minute psychotherapy visit was $174 per visit in 2021. The findings underscore the urgent need for strategies to increase the availability and affordability of behavioral health services.

Source: Access across America State-by-state insights into the accessibility of care for mental health and substance use disorders (Milliman)

Senate Health Committee and House move SUPPORT Act reauthorization

The House voted to reauthorize the SUPPORT Act. The bill would reinstate a requirement for states to cover medications for opioid use disorder through Medicaid, extend grants for opioid recovery centers and permit states to use federal money for test strips. New provisions would allow states to permanently use Medicaid to pay for short-term addiction treatment in institutions for mental diseases, allow pregnant people in pretrial detention to keep Medicaid coverage and prohibit states from disenrolling people from Medicaid when incarcerated. It would make xylazine a Schedule III substance for three years. The Senate Health, Education, Labor and Pensions Committee also approved its version of SUPPORT Act reauthorization, setting up consideration by the Senate and likely enactment of a law soon. New provisions in this version would require the Food and Drug Administration to review clinical methodology used to approve opioids and allow it to consider whether a new opioid is safer or more effective than existing ones. The bill would require a study on how states can screen people who want to provide peer support. The committee also voted for the Modernizing Opioid Treatment Access Act, which would allow addiction physicians to prescribe methadone to patients and pharmacists to dispense it.

Source: Congress moves to reup landmark opioid law (Politico)

Addiction doctors and methadone clinics at odds over expanding methadone access

The Modernizing Opioid Treatment Access Act, which would allow certified addiction doctors to prescribe methadone to patients outside of methadone clinics, received a Senate committee markup this week. Methadone clinics and law enforcement groups have strongly opposed the bill, and it faces significant obstacles in Congress. However, support from major addiction groups and lawmakers from both parties highlights a shift in attitude toward methadone. The trade group representing methadone clinics, AATOD, and several for-profit clinic chains launched a public relations campaign, “Program, Not a Pill,” arguing that expanding access to methadone without requiring in-person attendance at clinics and counseling would do more harm than good. Lobbyists and congressional aides said that the American Society of Addiction Medicine and AATOD’s lobbying against one another, and the broad coalition supporting the bill, may be a sign that AATOD’s influence is waning. Last year, AATOD retained a lobbying firm for the first time and suffered a legislative defeat after lobbying against elimination of the buprenorphine waiver.

Source: Methadone clinics spar with addiction doctors on bill that would widen access (STAT)

Biden administration calls for expanding naloxone access in housing programs

The Office of National Drug Control Policy, Department of Health and Human Services, and Department of Housing and Urban Development issued a joint letter to public health departments and health care systems to partner with housing providers, community development organizations and other housing agencies to help expand access to naloxone and other life-saving overdose reversal medications in the communities they serve. Overdose reversal medications should be readily available in and around public housing settings, multifamily housing programs, housing counseling offices and programs for people experiencing homelessness.

Source: Biden-Harris Administration Calls on Housing Community to Help Expand Access to Life-Saving Opioid Overdose Reversal Medications Like Naloxone (Department of Health and Human Services)

Some states are slow to roll out settlement funds

Many places have begun deciding where settlement money will go and making payments to schools, public health departments and local governments. Montana, West Virginia and Hawaii are among states moving slower. Montana began receiving settlement payments in January, but as of early December, the Montana Opioid Abatement Trust, a private nonprofit created to oversee 70% of the state’s share, had met once to agree to its rules of operations, with money still locked behind an inactive grant portal. The remainder, divided among the state and local governments, either had not been spent or was not publicly recorded. Nationwide, there is a conflict between those handling settlement dollars, who say governments should take their time planning how to use the funding to create a lasting framework, and others who argue for urgency in spending the money as the crisis becomes increasingly deadly.

Source: Millions in opioid settlement funds sit untouched as overdose deaths rise (CBS)

LAPPA releases guide for states on addressing the addiction crisis

The Legislative Analysis and Public Policy Association released the 2023 State of the States: Legislative Roadmap for Reducing Overdose Deaths and Increasing Access to Treatment, which guides state leaders on the most effective approaches to addressing the opioid and other drug epidemic by identifying 10 evidence-based policy approaches to reduce overdoses. Each of the strategies outlined points to a specific type of policy that states can implement to reduce overdose deaths and increase access to treatment for substance use disorder. The strategies include supporting syringe service programs, fentanyl test strips, drug checking equipment, medication for addiction treatment in correctional settings, withdrawal management in correctional settings, school response to substance-related incidents, naloxone in public high schools, addiction treatment in the emergency department, substance use during pregnancy and family care plans and overdose fatality review teams.

Source: 2023 State of the States (Legislative Analysis and Public Policy Association)

New York Attorney General finds inadequate mental health provider networks

A New York Attorney General report found that health insurance companies are failing to offer adequate access to mental health care. The office surveyed nearly 400 mental health providers listed across 13 health plans’ networks and found that the overwhelming majority were “ghosts,” meaning they were unreachable, not in-network or not accepting new patients. Callers attempted to schedule an appointment for an adult or child with a provider listed as accepting new patients. Only 14% of providers called offered appointments. The report recommends that state regulators monitor insurance networks to ensure directories are up to date, require plans to ensure members can get timely appointments with in-network providers and require plans to report information about whether network providers are providing care. State regulators should take enforcement actions against plans that violate the law and seek penalties, corrective actions and restitution to consumers. Plans should be required to meet cultural competence and language access standards and should recruit and provide more incentives for providers to join and stay in their networks.

Source: Attorney General James Uncovers Major Problems Accessing Mental Health Care through Insurance Companies (New York State Attorney General)

We know how to address the addiction crisis

A New York Times Opinion piece states there are very effective addiction treatments, but few receive them because they are hard to access. Most medical and law enforcement professionals do not receive adequate addiction training, and treatment centers face workforce shortages and inadequate funding. Stigma and punitive polices prevent many from seeking help, and those who do are often made to jump through hoops. Clinics should accept walk-ins, medication should be cheap or free, patients should be met with acceptance instead of judgement and relapse should not be cause for punishment. Treatment should be voluntary, not coercive, but providers should not necessarily wait for patients to come knocking on clinic doors. The solutions to the crisis are not new. We do not need to wait for new treatments; we just need to use existing insights and tools. We need to stop dehumanizing people who use substances; make use of evidence about which treatments and approaches work and which do not; address the workforce shortage, in part by changing the way treatment for substance use disorder is funded; lower barriers to long-proven therapies like methadone; and ensure those therapies are accessible to the most vulnerable populations, including incarcerated individuals.

Source: 48 Million Americans Live With Addiction. Here’s How to Get Them Help That Works. (The New York Times)

Nitazenes from China become an increasing concern

The increasing presence of nitazenes, which can be many times more powerful than fentanyl, is raising concerns. A recently unsealed federal indictment in South Florida opens a rare window into the source of nitazenes – manufacturers in China that officials say sell them online and ship them to dealers in the U.S. According to one of the indictments, the Chinese company selling nitazenes used websites, social media accounts and messaging apps to sell chemicals such as protonitazene and metonitazene to customers in the U.S., Europe, Asia and South America. As part of the investigation, a U.S. Postal Inspection Service agent posing as a buyer ordered nitazenes from the company. It was among the first criminal prosecutions to target an overseas source of nitazenes. Although Beijing announced last month that it would curb the sale of precursor chemicals used to manufacture fentanyl, experts worry that an unintended consequence could be the proliferation of other synthetic drugs such as nitazenes.

Source: On the streets, opioids sometimes more potent than fentanyl: nitazenes (The Washington Post)