Policy News Roundup: April 6, 2023

    Key reads

    Federal judge strikes down ACA preventive services mandate

    A federal judge struck down the provision of the Affordable Care Act (ACA) that requires free coverage of a wide range of preventive care services. District Court Judge Reed O’Connor, the author of several previous rulings against the ACA, sided with a group of conservative employers in Texas, ruling that the U.S. Preventive Services Taskforce, which made the requirements, has been acting unconstitutionally and blocking enforcement of the rules nationwide. O’Connor also ruled that the requirement to cover PrEP violated the religious rights of the employers and could not be enforced against them. O’Connor said the individuals had standing to sue because “compulsory coverage for those services violates their religious beliefs by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman.” O’Connor had already sided with the challengers on these points in September but had not said whether his ruling would apply only to people suing, to everyone in Texas or nationwide, and requested a further briefing. O’Connor ultimately granted the pleas for a universal ruling, upending the national insurance market. The Biden administration is appealing.

    Source: Texas judge strikes down free HIV drugs, cancer screenings under Obamacare (Politico); US Justice Dept appeals Obamacare ruling blocking coverage mandate- White House (Reuters)

    Study finds telehealth services for OUD treatment associated with lower risk of fatal overdose

    A study by researchers at the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services and National Institute on Drug Abuse found that expanded availability of opioid use disorder (OUD)-related telehealth services and medications during COVID was associated with a lowered likelihood of a fatal overdose among Medicare beneficiaries. Medicare beneficiaries who began a new episode of OUD-related care during the pandemic and received OUD-related telehealth services were found to have a 33% lower risk of a fatal overdose. Beneficiaries who received medications for OUD from opioid treatment programs and those who received buprenorphine in office-based settings had reduced odds of a fatal overdose of 59% and 38%, respectively. Only 1 in 5 beneficiaries in the pandemic cohort received OUD-related telehealth services, and only 1 in 8 received medications, underscoring the need for continued expansion of these interventions.

    Source: Increased Use of Telehealth Services and Medications for Opioid Use Disorder During the COVID-19 Pandemic Associated with Reduced Risk for Fatal Overdose (National Institute on Drug Abuse)

    Federal news

    Schumer announces plan to address xylazine

    Senate Majority Leader Chuck Schumer revealed a three-pronged plan to combat the rise in xylazine, calling for a major boost in federal support to combat drug trafficking and the public health crisis. Schumer called for the Food and Drug Administration to accelerate its operations to track down illicit sources of xylazine to cut off supply; for nearly $537 million in new funds through the federal COPS Hiring Program to help stop drug trafficking; and for an all-of-the-above approach to treat the overdose crisis and for new boosts to the Substance Abuse and Mental Health Services Administration appropriations, including grants that can be used to fund testing infrastructure for xylazine.

    Source: Schumer: Xylazine, A Deadly Skin-Rotting Zombie Drug, Often Mixed W Fentanyl, Is On The Doorstep Of Schenectady & The Capital Region, Already Fueling A Horrific Wave Of Overdoses & Deaths Across Upstate Ny; Senator Will Launch Three-Pronged Plan To Cut Off Supply, Aid Local Law Enforcement, & Bolster Addiction Services To Combat Overdose Epidemic (Charles E. Schumer)

    Bill introduced to restore Medicaid access 30 days prior to release from incarceration

    Reps. Turner (R-OH), Paul D. Tonko (D-NY), John Rutherford (R-FL) and David Trone (D-MD) introduced the Reentry Act, which would empower states to restore access to health care, including mental health and substance use disorder treatment, through Medicaid for incarcerated individuals up to 30 days before their release. Sens. Braun (R-IN) and Baldwin (D-WI) are introducing companion legislation in the Senate.

    Source: Turner, Tonko, Rutherford, and Trone Introduce Reentry Act (Mike Turner)

    FDA issues Consumer Update on naloxone

    The Food and Drug Administration issued a Consumer Update on naloxone. It outlines how to recognize an opioid overdose and use naloxone, urges consumers to discuss naloxone when getting a prescription for opioids and explains that naloxone will not harm someone who does not have opioids in their system.

    Source: Access to Naloxone Can Save a Life During an Opioid Overdose (Food and Drug Administration)

    FDA requires opioid manufacturers to make mail-back envelopes available in outpatient settings

    The Food and Drug Administration (FDA) announced it is requiring manufacturers of opioid analgesics dispensed in outpatient settings to make prepaid mail-back envelopes available to outpatient pharmacies and other dispensers as an additional opioid analgesic disposal option for patients. The FDA issued a notice to all manufacturers of opioid analgesics used in outpatient settings that they are required to submit the proposed modification to the Opioid Analgesic Risk Evaluation and Mitigation Strategies (REMS) within 180 days. When implemented, outpatient pharmacies and other dispensers will have the option to order prepaid mail-back envelopes from opioid analgesic manufacturers, which they may then provide to patients prescribed opioid analgesics. The REMS modification also requires manufacturers to develop educational materials for patients on safe disposal of opioid analgesics, which outpatient pharmacies and other dispensers may also provide to patients. The FDA is also exploring whether to require manufacturers to also make in-home disposal products available to patients.

    Source: FDA Moves Forward with Mail-back Envelopes for Opioid Analgesics Dispensed in Outpatient Settings (Food and Drug Administration)

    NIH study finds ED-initiated buprenorphine is safe and effective for those who use fentanyl

    A multisite clinical trial supported by the National Institutes of Health found that less than 1% of people with opioid use disorder whose drug use includes fentanyl experienced withdrawal when starting buprenorphine in the emergency department. The study’s findings are strong evidence that buprenorphine can be safely started in the emergency department without triggering withdrawal, even for people who use stronger opioids. Clinical concern over this type of withdrawal can be a barrier to using this treatment. Although instances of buprenorphine-precipitated withdrawal have only been reported in relatively small case studies and anecdotal evidence, some clinicians and patients worry that the risk of experiencing precipitated withdrawal from buprenorphine might be increased among people who use fentanyl, which has led some clinicians to prescribe buprenorphine at lower doses for people using fentanyl. Lower doses can be less effective, making individuals more likely to resume use of illicit opioids. The study should help assuage concerns about precipitated withdrawal following buprenorphine treatment in the emergency department.

    Source: Buprenorphine initiation in the ER found safe and effective for individuals with OUD who use fentanyl (National Institute on Drug Abuse)

    DHS secretary calls fentanyl 'single greatest challenge' faced by U.S.

    In a Senate Appropriations subcommittee hearing, Department of Homeland Security (DHS) Secretary Mayorkas said that the record number of Americans dying of fentanyl overdoses is the “single greatest challenge we face as a country.” Sen. Murphy (D-CT), chairman of the panel, opened the budget review hearing, telling Mayorkas he wanted fentanyl to be a top priority for the department in 2024. Republican lawmakers have blamed the administration’s immigration policies for the increase in fentanyl smuggling and overdose deaths, saying U.S. agents and officers are too distracted by a record level of illegal migration. Mayorkas told senators that fentanyl was a years-long scourge that has been building and that the administration is working with Mexico to “bring the fight to the cartels.” DHS’s 2024 budget proposal includes $305 million for new scanning equipment at border crossings and more than 300 additional agents. Sen. Tester urged the administration to consider designating Mexican traffickers as foreign terrorist organizations. Mayorkas said the line between criminality and terrorism was a complicated question that he would discuss with the senator.

    Source: Fentanyl is ‘single greatest challenge’ U.S. faces, DHS secretary says (The Washington Post)

    State and local news

    Reporting requirements for opioid settlement fund spending are lacking

    How opioid settlement money will be spent remains shrouded in mystery, with reporting requirements scant. Most settlements stipulate that states must spend at least 85% on addiction treatment and prevention, but defining those concepts depends on stakeholders’ views. Many states are not being transparent about where funds are going. Only 12 states have committed to detailed public reporting of all their spending. Per most settlements, governments are required to report only on the 15% of money that can be used for things unrelated to the crisis, and only three states and counties have filed such reports. State and local governments can enact more rigorous reporting protocols, but few have. With scant oversight, many fear dollars may flow to efforts research has proven useless (e.g., arresting people who use drugs, expanding jails, abstinence-only recovery). There are also concerns the money will go toward unrelated uses. The agreements require the money to be used on opioid-related expenses and include a list of suggested interventions, but enforcement of the 85% standard is left to the companies that paid out the money, which are unlikely to be vigilant.

    Source: $50 Billion in Opioid Settlement Cash Is on the Way. We’re Tracking How It’s Spent. (Kaiser Health News)

    Five states started Medicaid unwinding

    Beginning April 1, states began to sever Medicaid beneficiaries from the rolls following the end of a policy preventing states from removing people from Medicaid during the COVID pandemic. An estimated 15 million people are expected to lose coverage. Five states (Arizona, Arkansas, Idaho, New Hampshire and South Dakota) started April 1 to cut beneficiaries who no longer qualify for Medicaid or have not provided proof they still deserve the coverage. Nearly all other states will begin to remove people between May and July. Almost half of the states have set in motion the preliminary work of checking eligibility.

    Source: Millions poised to lose Medicaid as pandemic coverage protections end (Washington Post)

    Recovery high schools help kids with addiction recover and receive an education

    There are 43 recovery high schools nationwide. They are designed for students who are recovering from substance use disorder and might also be dealing with related mental health disorders. The first recovery high school opened in Silver Spring, Maryland, in 1979, and similar programs now operate in 21 states. According to one study, compared with their peers at regular schools who have gone through treatment, recovery high school students have better attendance, are more likely to stay sober and have higher graduation rates. Most recovery schools are publicly funded charter or alternative schools that carry a higher cost of educating students than traditional schools do, due to smaller enrollment, the need for mental health and recovery personnel, higher faculty-to-student ratios and other factors.

    Source: Recovery high schools help kids heal from an addiction and build a future (NPR)

    States figuring out how to cover 988 crisis line costs

    An infusion of federal money to the national nonprofit that administers 988 and to local call centers has largely covered the expense of launching 988 and the recent increase in volume. In the future, however, state and local governments will be responsible for funding the local centers where calls are first routed, leaving many budget writers grappling with how to cover the costs. Congress allowed states to enact new telecommunications fees to fund 988 operations, but only five states have done so (California, Colorado, Nevada, Virginia and Washington). Six other states have pending legislation that would impose a fee (Minnesota, New Jersey, Oregon, Rhode Island, Texas and Vermont). About 20 other states this year have either passed or are considering other 988-related legislation, ranging from money for the 988 program or mobile crisis services to creating a task force or launching a study of potential funding sources.

    Source: As 988 Crisis Line Sees More Use, States Debate How to Pay for It (Pew Stateline)

    Other news in addiction policy

    DEA’s proposed rules on buprenorphine teleprescribing may limit access to treatment

    Former Rep. Patrick Kennedy argues that the Drug Enforcement Administration’s (DEA) proposed buprenorphine telemedicine rules will fail to accomplish their stated objective and will effectively end access to treatment for many with opioid use disorder. Research shows that access to medications for opioid use disorder (MOUD) via telemedicine during COVID reduced opioid-related emergency room visits and overdoses. Restricting access to buprenorphine to a 30-day prescription via telemedicine, as proposed, would increase risks to a vulnerable population. Reducing access to buprenorphine increases overdoses, emergency room visits and deaths. DEA’s proposed rule suggests that DEA feels telemedicine-only OUD care should be illegal, even though it has been shown to be safe and effective. The requirement of in-person provider visits to continue care has no rational purpose for patient care or safety.

    Source: Proposed DEA restrictions on telehealth will accelerate America’s opioid crisis (Roll Call)