Justice Department releases guidance on ADA protections for people using MOUD
The Department of Justice released guidelines saying that employers, health care providers, law enforcement agencies that operate jails and others are violating the Americans with Disabilities Act (ADA) if they discriminate against people taking medications for opioid use disorder. The guidelines clarify that addiction is considered an impairment under the ADA. They are not a policy change but clarify existing requirements.
Source: US: Discrimination Based on Opioid Treatment Violates Law (Associated Press)
GAO report finds access challenges to mental health care services
The Government Accountability Office (GAO) released a report describing the challenges consumers with coverage for mental health care services experience with accessing those services and federal efforts to address those challenges. GAO found that consumers experience challenges finding in-network providers, which could cause consumers to face higher costs, delays in care or difficulties finding a provider close to home. Low reimbursement rates and inaccurate or out-of-date information on provider networks contribute to this. GAO found that consumers experience challenges with restrictive health plan approval processes and plan coverage limitations (such as prior authorization and limits on certain treatments or providers), often more restrictive than those for medical services. Government agencies are working to ensure access to in-network providers by enforcing requirements for plans to update and maintain provider directories, to increase the mental health workforce, to address structural issues that contribute to lack of capacity and to enhance parity compliance.
Source: Mental Health Care: Access Challenges for Covered Consumers and Relevant Federal Efforts (Government Accountability Office)
CDC reports show youth behavioral health threats during COVID
Centers for Disease Control and Prevention (CDC) analyses found that in 2021, 37% of high school students reported poor mental health during the pandemic, and 44% reported persistently feeling sad or hopeless. The CDC found 55% reported experiencing emotional abuse by an adult in the home and 11% experienced physical abuse, while 29% reported an adult in their home lost a job. Youth who felt connected at school were significantly less likely to report persistent feelings of sadness or hopelessness, or that they seriously considered attempting suicide or attempted suicide. However, only 47% reported feeling close to people at school. Between January and June 2021, 31.6% reported current use of tobacco, alcohol or marijuana or misuse of prescription opioids. Current alcohol, vape and marijuana use were more prevalent than prescription opioid misuse, cigarette smoking, cigar smoking and smokeless tobacco use. Approximately one in three who ever used substances reported using them more during the pandemic. Students only attending school virtually had a lower prevalence of using most substances.
Source: New CDC data illuminate youth mental health threats during the COVID-19 pandemic; Use of Tobacco Products, Alcohol, and Other Substances Among High School Students During the COVID-19 Pandemic — Adolescent Behaviors and Experiences Survey, United States, January–June 2021 (Centers for Disease Control and Prevention)
Congress launches 988 & Crisis Services Task Force
Reps. Napolitano, Katko, Cárdenas and Stewart announced a new Bipartisan House 988 & Crisis Services Task Force, housed under the Congressional Mental Health Caucus, to ensure effective implementation of 988 and corresponding infrastructure to provide crisis care services.
Source: Napolitano, Katko, Cárdenas & Stewart Launch Bipartisan 988 & Crisis Services Task Force (Congresswoman Grace F. Napolitano)
House passes marijuana bills
The House of Representatives passed the Marijuana Opportunity Reinvestment and Expungement (MORE) Act, largely along party lines. This is the second time in less than two years that the House passed the legislation. It would decriminalize cannabis, expunge some marijuana-related convictions and allow states to make their own decisions about legalization. However, the bill has little chance of getting the Republican support needed to pass the Senate. The House also passed the Medical Marijuana Research Act, which would streamline the process for scientists to conduct medical marijuana research and direct the Department of Health and Human Services to ensure that there is a supply of marijuana available for researchers’ use. The Senate passed similar legislation last month.
Source: House passes marijuana legalization bill (again), but with no clear path forward (Politico); House passes bill to facilitate medical marijuana research (The Hill)
State and local news
State lawmakers working to address fentanyl crisis
State lawmakers have been considering and adopting laws on two fronts to address the fentanyl crisis – harm reduction and increasing the penalties for dealing fentanyl or mixing it with other substances. Republican state attorneys general are calling for more federal action, and some GOP governors are deploying National Guard units to stop the flow of fentanyl from Mexico. Since last year, at least a half-dozen states have enacted laws to increase access to fentanyl test strips and naloxone, and at least a dozen others have considered them. 12 states have fentanyl-specific drug trafficking or possession laws as of last year, and 19 have introduced or considered similar measures since the start of 2021. That does not include measures to add more synthetic opioids to controlled substances lists to mirror federal laws, which have also been adopted in many states.
Source: States look for solutions as US fentanyl deaths keep rising (Associated Press)
Georgia mental health and parity bill signed into law
Georgia enacted a new law to strengthen the mental health system. Parity provisions would require insurers to follow independent standards and block them from deciding for themselves what they would pay for. The law keeps the current standard for a police officer to involuntarily commit someone into treatment, saying the person must show an “imminent” risk of harm to themselves or others. The measure allows an officer to take someone to an emergency facility to be evaluated after getting permission from a physician. It requires extensive data collection and reports aimed at enforcing parity and would forgive loans for people studying to become mental health professionals. The House also passed a bill that would require the state’s local mental health agencies to provide co-responders to any local law enforcement agency that wants them.
Source: Insurance deal spurs Georgia mental health bill to passage (Associated Press)
All correctional facilities in Massachusetts to provide MOUD
The U.S. Attorney’s Office for Massachusetts announced that it completed a review to ensure that state and county correctional facilities will maintain all medications for opioid use disorder (MOUD) for people already in treatment for opioid use disorder prior to entering a carceral facility’s custody, as required by the Americans with Disabilities Act. Three facilities have implemented plans to provide all three medications before the end of 2022 and in the meantime will transfer inmates to facilities that can provide the needed medications or will otherwise facilitate maintaining the medications. All remaining correctional facilities in Massachusetts now provide access to all three forms of MOUD.
Source: U.S. Attorney Rollins Announces Correctional Facilities Statewide to Maintain All Medications for Opioid Use Disorder (United States Attorney’s Office District of Massachusetts)
Florida and West Virginia reach opioid settlements, and trial begins in West Virginia
Florida reached a more than $870 million settlement with CVS, Teva and Allergan to resolve opioid litigation. Teva will provide $84 million worth of its naloxone nasal spray. West Virginia also reached a $26 million settlement with Endo, removing the company from a trial that began this week against Janssen, Teva and Allergan. The lawsuit alleges violations of the state Consumer Credit and Protection Act and accuses the companies of causing a public nuisance. During opening statements, the state attorney general urged the judge to hold the companies liable for causing a “tsunami” of opioid addiction. He argued that the crisis has affected the state’s police forces, hospitals, foster care systems and jails, with effects that will linger for more than a generation. The companies denied the allegations, saying their medications were a small percentage of opioids in the state and the prescriptions were medically necessary.
Source: Attorney General Moody Secures More Than $870 Million From CVS, Teva, Allergan and Endo (Office of Attorney General Ashley Moody); West Virginia reaches $26M settlement with opioid maker Endo (Associated Press); West Virginia lawsuit against opioid makers set to start (Associated Press); West Virginia says J&J, drugmakers created ‘tsunami’ of opioid addiction (Reuters)
Other news in addiction policy
Barriers remain on contingency management
Methamphetamine deaths are growing, but contingency management (CM) remains underutilized despite its proven effectiveness. Several states, including California, Montana and Washington, are starting pilot programs, and a growing number of telehealth companies are offering remote options for those who can pay out-of-pocket. The Centers for Medicare and Medicaid Services should create a billing code for CM, and the Biden administration should clear up regulatory confusion that has discouraged states and clinics from offering it. The Substance Abuse and Mental Health Services Administration should lift its $75-per-year restrictions on CM rewards and require programs to adhere to evidence-based protocols and continually assess outcomes as a condition of funding.
Source: Opinion: She was paid to stay off drugs. Here’s why this approach could help others. (Washington Post)
Advocate for Change
Ask your members of Congress to support the Into the Light for Maternal Mental Health and Substance Use Disorders Act, which would expand access to screening, treatment, and support for pregnant and postpartum individuals and their families affected by maternal mental health and substance use disorders.