Policy News Roundup: November 7, 2024

2023 MH/SUD facility survey insights

The Substance Abuse and Mental Health Services Administration released data from the 2023 National Substance Use and Mental Health Services Survey of active mental health and substance use disorder facilities in the U.S.

What it measures: It presents findings on the key operational characteristics and service offerings of treatment facilities for mental health (MH), substance use disorder (SUD) and mental health and substance use disorder (MH/SUD).

The findings:

• Private non-profit and for-profit organizations operated 91% of SUD facilities, 83% of MH facilities and 86% of MH/SUD facilities.
• Programs tailored for adolescents were provided by 25% of SUD facilities, 38% of MH facilities and 51% of MH/SUD facilities.
• Other tailored programs included those for LGBTQ clients, clients with HIV/AIDS, veterans and active-duty military clients.
• Private insurance and Medicaid were accepted at 77% of SUD facilities, and 83% and 87% of MH facilities accepted private health insurance and Medicaid, respectively.
• Pharmacotherapies were offered by 74% of SUD facilities, with 59% reporting using medications for opioid use disorder and 46% reporting using medications for alcohol use disorder.
• Services in language other than English were provided by 55% of SUD facilities, 71% of MH facilities and 74% of MH/SUD facilities.

Why it’s important: While many facilities are offering needed services and associated coverage, there is still a long way to go in making evidence-based, effective treatment accessible and affordable for all who need it.

Source: National Substance Use and Mental Health Services Survey (N-SUMHSS) 2023: Data on Substance Use Disorder Treatment and Mental Health Treatment Facilities (Substance Abuse and Mental Health Services Administration)

The main point: California law requires health insurance plans to provide enrollees with all medically necessary mental health and substance use disorder treatment, but there is a big gap between what that law requires and what plans provide.

The details:

• Most people who receive treatment authorization denials do not appeal to their health plans.
• And the fraction that do are often denied again by reviewers who are not trained in using the decision making criteria required under state law (American Society of Addiction Medicine (ASAM) criteria).
• A few doctors, working on behalf of the plans, appear to deny almost every appeal for behavioral health treatment they review.
• Regulators do not have data to track these reviewers’ decisions. Neither the state’s Department of Managed Health Care nor Department of Insurance is authorized by state law to routinely require health plans to submit information about how often they deny treatment, nor do they have access to the records of individual doctors making the denials.
• But: When state regulators do get involved, they overwhelmingly side with patients, demonstrating that these denials should not be happening.

What’s coming:

• Ryan Matlock died of a fentanyl overdose after being released from a residential treatment facility after just three days due to insurance rejecting more coverage. His mother has sued U.S. Behavioral Health Plan of California (OptumHealth Behavioral Solutions of California), alleging the plan disregarded her son’s safety.
• In recent years, a variety of potential fixes that could require more accountability from plans have come before state lawmakers, but most have not passed.

Why it’s important: Individuals seeking treatment should not face arbitrary denials that prevent them from accessing needed care.

• Plans are disregarding laws and requirements meant to protect patients.
• Increased enforcement of parity and other insurance laws is needed.

For more: See Partnership’s new Insurance Resource Center for more on these issues!

Source: He wanted to live. After his insurance rejected coverage, he died of a fentanyl overdose (Cal Matters)

The main point: Zyn nicotine pouches are becoming increasingly popular among men.

The details: The product sits in a cultural nexus of frat life, hard partying and dubious wellness space populated by popular figures who make misleading statements about the product’s supposed health benefits.

Why it’s important:

• The packets, which do not contain tobacco, are frequently discussed as a potential smoking cessation tool, but some who use the product never regularly smoked or vaped. Some say they have gotten hooked on the nicotine buzz Zyn delivers.
• From the Marlboro Man to the “vape guy,” tying tobacco or nicotine products with masculinity has been a popular tactic used by the tobacco industry.
• But: The role that social media has played in Zyn’s rise is new. Some teens say they first learned of the product on TikTok, where aspiring influencers have gone viral with videos featuring Zyn. This is free marketing for the industry, targeting young people.

What’s coming:

• Zyn represents a new strategy for the tobacco industry, which is looking to survive amid the tobacco use decline.
• But Senator Schumer asked the Food and Drug Administration (FDA) in January to take a closer look at Zyn’s practices, warning the pouches posed a danger to teens, and the FDA has issued warning letters to some companies selling the products. Further scrutiny of the products could mean they face an uncertain fate.

Source: What’s That in Your Mouth, Bro? (New York Times)

A study examined how the opioid industry used scientific studies to promote and shape claims about opioid safety and effectiveness.

The findings: The study found that 15 scientific articles were collectively mentioned in over 3,500 documents supporting five common, inaccurate claims:

1. Opioids are effective for treatment of chronic, non-cancer pain
2. Opioids are “rarely” addictive
3. “Pseudo-addiction” is due to inadequate pain management
4. No opioid dose is too high
5. Screening tools can identify those at risk of developing addiction

Why it’s important:

• Shaping scientific knowledge and information available to consumers and prescribers helped drive the opioid crisis.
• The opioid industry’s strategies to use and misuse science followed a playbook pioneered by the tobacco industry and used across industries selling products that impact health (e.g., food/drink, alcohol, fossil fuels, pharmaceutical products/medical devices, gambling).
• The articles contributed to the eventual normalization of these claims by symbolically associating them with scientific evidence, building credibility, expanding and diversifying audiences and the parties asserting the claims, and obfuscating conflicts of interest.

Going forward: Understanding the opioid industry’s use of scientific evidence can sharpen clinicians’ ability to discern reliable information and can help inform policymakers as they seek to prevent similar industry-driven public health crises.

• These corporate strategies require policy and structural responses that limit commercial influence and stretch beyond simple conflict-of-interest policies.

Source: The opioid industry’s use of scientific evidence to advance claims about prescription opioid safety and effectiveness (Health Affairs Scholar)

The Food and Drug Administration approved a modification to the Opioid Analgesic Risk Evaluation and Mitigation Strategy (OA REMS) to advance drug disposal options.

The details:

• Companies participating in the OA REMS Program will be required to begin providing pre-paid drug mail-back envelopes upon request to outpatient pharmacies and other dispensers of opioid analgesics by March 31, 2025. Patients and caregivers will be provided a free, pre-paid drug mail-back envelope when dispensed opioids.
• An updated Patient Guide includes information about the risk of unused opioid analgesics and the importance of safe disposal.
• A new Patient Education Sheet to be included with each mail-back envelope explains the risk of unused opioids and the importance of safe disposal.

Why it’s important: Disposing of unused opioids can help avoid misuse by preventing accidental exposure, use by others to whom the opioids were not prescribed, or other use beyond what is recommended by a doctor.

Source: FDA approves REMS modification, advancing new drug disposal option (Food and Drug Administration)