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    Policy News Roundup: April 13, 2023

    Key reads

    ONDCP declares fentanyl combined with xylazine an emerging threat

    The White House declared that fentanyl combined with xylazine is an emerging threat facing the U.S. It is the first time that any administration has declared a substance to be an emerging threat, an authority created in 2018. The administration now has 90 days to coordinate a national response. The Office of National Drug Control Policy published criteria for determining when a substance should be designated an emerging threat earlier this year. The criteria focus on geographic presence of an emerging threat and impact measured by metrics such as overdoses in a year. Forensic lab identifications of xylazine rose in all four U.S. census regions 2020-2021, notably in the South (193%) and West (112%). Xylazine-positive overdose deaths increased by 1,127% in the South, 750% in the West, more than 500% in the Midwest and more than 100% in the Northeast. These levels of geographic distribution and rapid increase in negative health outcomes meet the criteria. The response plan will include work on xylazine testing, treatment and supportive care protocols, comprehensive data systems, strategies to reduce the illicit supply of xylazine and rapid research.

    Source: Biden administration declares fentanyl laced with xylazine ‘an emerging threat’ in the US (CNN); Biden-⁠Harris Administration Designates Fentanyl Combined with Xylazine as an Emerging Threat to the United States (White House)

    Prevention needs dedicated infrastructure and funding

    National Institute on Drug Abuse Director Nora Volkow explains the need for a greatly expanded focus on prevention. Prevention interventions are underutilized, despite evidence on their effectiveness, due to lack of will, fiscal shortsightedness, lack of dedicated infrastructure and workforce and lack of dedicated funding. Prevention researchers should develop and test interventions in settings where they are intended to be delivered and that meet criteria that qualify them for funding under the Affordable Care Act, child welfare or Substance Abuse and Mental Health Services Administration prevention dollars. Greater collaboration between researchers and those in a position to fund prevention could facilitate interventions that have greater promise of being paid for and sustained and that are more responsive to community needs. It could spur the development of interventions in less traditional settings like justice systems and new strategies that take advantage of virtual tools. We must do more to foster mental health and resilience in young people and screen patients at all ages for potential or emerging substance use issues before experimentation escalates or addiction begins.

    Source: Creating Sustainable Homes for Prevention Services (National Institute on Drug Abuse)

    Federal news

    ONDCP launches fentanyl and naloxone education campaign

    The Office of National Drug Control Policy, in partnership with the Ad Council, launched the first phase of its campaign to educate young people on the dangers of fentanyl and the lifesaving effects of naloxone. The campaign meets young people where they are on social media platforms and enlists the help of influencers such as college athletes and lifestyle content creators to talk about the pervasiveness of fentanyl in the drug supply and inform viewers about how they can keep themselves and their loved ones safe by carrying naloxone. Information about naloxone will be featured on digital billboards in places young people frequent, including college campuses, gas stations, bars and restaurants. The campaign builds on the existing Real Deal on Fentanyl platform.

    Source: Biden-⁠Harris Administration Launches Campaign to Raise Awareness About the Dangers of Fentanyl and the Life-Saving Effects of Naloxone in Partnership with the Ad Council (White House)

    Biden administration strengthening approach to addressing illicit fentanyl supply

    The Biden-Harris administration announced a strengthened whole-of-government approach to save lives by disrupting the trafficking of illicit fentanyl and its precursors. The administration is leading a coordinated global effort with international partners to disrupt the illicit synthetic drug trade; strengthening coordination and information-sharing among U.S. intelligence and domestic law enforcement agencies; accelerating work with the private sector globally (to strengthen cooperation with international and domestic consignment carriers to interdict more illicit substances and production materials, educate companies on safeguarding against the sale/distribution of dual-use chemicals and equipment that could be used to produce illicit fentanyl, intensify global engagement with private chemical industries); further protecting the U.S. financial system from use and abuse by drug traffickers; and continuing to call on Congress to close legal loopholes for illicit synthetic substances (permanently schedule all illicitly produced fentanyl-related substances into Schedule I and take other complementary actions consistent with the Administration’s proposal from 2021).

    Source: FACT SHEET: Biden-⁠Harris Administration Announces Strengthened Approach to Crack Down on Illicit Fentanyl Supply Chains (White House)

    Reagan-Udall Foundation and FDA release report on naloxone payors and nonprescription status

    The Reagan-Udall Foundation and Food and Drug Administration issued a report on distribution of naloxone in the U.S. and potential economic impacts of a change in naloxone’s prescription-only status. The transition of prescription products to nonprescription is assumed to yield an economic benefit to both the consumer and health care system, as well as increase overall sales. However, a typical health insurance prescription drug benefit may not include coverage of nonprescription products, thus increasing out-of-pocket cost to the consumer if the nonprescription price is greater than the benefit copay. The distribution and payor mix for naloxone differs from traditional prescription-only products, due to standing orders and provision through community-based organizations. While there is often no out-of-pocket cost for naloxone (i.e., zero copay through insurance or free through community organizations), the posture of providers may change with a switch to nonprescription. The report describes the current distribution and funding mix for naloxone, the policy of payors related to coverage of nonprescription products and potential impacts of policy changes to expand coverage for nonprescription products.

    Source: Summary Report: Naloxone Economic View (Reagan-Udall Foundation)

    FDA, SAMHSA and Reagan-Udall Foundation to host meeting on buprenorphine initiation and care

    The Reagan-Udall Foundation, in collaboration with the Food and Drug Administration and the Substance Abuse and Mental Health Services Administration, is holding a two-day virtual public meeting 5/10-5/11 on real-world experiences and scientific evidence for buprenorphine initiation strategies, as well as medication dosing and management during continued treatment across different care settings. Presentations and discussions will include people who use substances, their families and community, harm reduction programs, health professionals from inpatient and outpatient settings, academic researchers and federal partners.

    Source: Considerations for Buprenorphine Initiation and Care (Reagan-Udall Foundation)

    GOP increasingly pushing for use of military force in Mexico to combat fentanyl

    Republicans are increasingly rallying around the idea that to solve the fentanyl crisis, American needs to bomb it away. In recent weeks, Trump has discussed sending “special forces” and using “cyber warfare” to target cartel leaders if he is re-elected and asked for “battle plans” to strike Mexico. Reps. Crenshaw (R-TX) and Waltz (R-FL) introduced a bill seeking authorization for the use of military force against cartels. Sen. Cotton (R-AR) said he is open to sending U.S. troops into Mexico without Mexico’s permission. Lawmakers have filed legislation to label some cartels as foreign terrorist organizations, a move supported by GOP presidential aspirants. The eagerness to embrace the plan illustrates the ways in which frustration with immigration, overdose deaths and antipathy toward China are defining the GOP’s larger foreign policy. Democrats oppose the proposals. If a Republican wins in 2024, those ideas could become policy, especially if Trump wins. As president, Trump considered placing cartels on the State Department’s terrorist blacklist and asked about using missiles to take out drug labs and cartels in Mexico.

    Source: GOP embraces a new foreign policy: Bomb Mexico to stop fentanyl (Politico)

    State and local news

    Juul reaches settlements with group of seven states and West Virginia

    New York, California, Colorado, the District of Columbia, Illinois, Massachusetts and New Mexico announced a $462 million settlement with Juul, resolving lawsuits claiming the company aggressively marketed its e-cigarettes to young people and fueled the nation’s vaping crisis. The agreement brings much of the company’s legal woes to a conclusion, with settlements reached with most states and 5,000 individuals and local governments. Juul is in the middle of a trial in Minnesota. Juul’s efforts to broker deals over the lawsuits have cost it nearly $3 billion so far. Like other settlements, the latest requires Juul to refrain from marketing to youth, to stop offering free or nominally priced products to consumers, and to refrain from using the marketing technique of “product placement” in virtual reality systems. Separately, Juul reached a $7.9 million settlement with West Virginia. The lawsuit accused Juul of engaging in unfair or deceptive practices in the design, manufacturing, marketing and sale of e-cigarettes in violation of the state’s Consumer Credit and Protection Act.

    Source: Juul Reaches $462 Million Settlement With New York, California and Other States (The New York Times); Vaping company Juul settles West Virginia lawsuit for $7.9M (Associated Press)

    Texas Gov. Abbott launches $10 million fentanyl awareness campaign and naloxone distribution plan

    Texas Governor Greg Abbott announced a $10 million fentanyl awareness campaign and plan to distribute doses of Narcan to every county in the state. The “One Pill Kills” multimedia campaign is designed to warn residents about the unlawful use of fentanyl, and the Texas Division of Emergency Management will be delivering a total of 20,000 naloxone doses to all 254 counties in the state. The naloxone will be distributed to sheriff offices in each county. The “One Pill Kills” campaign, led by the Texas Health and Human Services Commission, will include public service announcements on television and radio stations and online. The awareness campaign will be paid for with the help of the federal Substance Use Prevention, Treatment and Recovery Block Grant, while the naloxone will be funded though opioid settlement funds.

    Source: Gov. Greg Abbott launches $10 million effort to combat fentanyl crisis, sends overdose-reversing meds to all 254 counties (Texas Tribune)

    Other news in addiction policy

    Doctors worry rise in youth mental health concerns following COVID is just beginning

    Doctors worry that the number of children who need treatment for mental health won’t slow down, even as the pandemic recedes, as kids who experience traumatic events often do not show symptoms for years. Doctors are forecasting not only more diagnoses but also more severe ones. Many children did not get treatment because of the pandemic or an overloaded mental health system, likely causing conditions to worsen over time. That could intensify as children lose Medicaid coverage after the continuous enrollment requirement from the pandemic ends. Sen. Casey (D-PA) plans to introduce bills that would create grants for children’s mental health services and make them more available, help gather better national data on mental health and children and focus on the mental health of kids in foster care. A bill introduced by Sens. Bennet (D-CO) and Wyden (D-OR) would strengthen parity. Sen. Sanders (D-VT) said he plans to hold Senate Health, Education, Labor and Pensions Committee hearings to discuss mental health workforce shortages.

    Source: Covid hurt kids’ mental health. The worst may be yet to come. (Politico)