Policy News Roundup: August 10, 2023

Key reads

Fewer than 1 in 5 people with opioid addiction receive medication treatment

A study from the Centers for Disease Control and Prevention and the National Institute on Drug Abuse found that only one in five people with opioid use disorder (OUD) receive medications to treat opioid use disorder (MOUD), the gold-standard of treatment. Among adults with past-year OUD, 35.6% received any past-year substance use treatment, and 22.3% received MOUD. Experts say stigma about addiction and lack of training among health care providers often limits use of MOUD. The study found that MOUD is vastly underused, particularly among women, Black individuals, unemployed individuals and people living in cities. People with OUD who receive medical support via telehealth were roughly 38 times more likely to receive MOUD, adding to the growing evidence that telehealth services are an important strategy to help bridge the gap in treatment. Researchers say the medical community must address inequalities in treatment in order to reduce overdose deaths.

Source: Only 1 in 5 people with opioid addiction get the medications to treat it, study finds (NPR)

DEA open to creating special registration process for prescribing via telemedicine

The Drug Enforcement Administration (DEA) issued a notice last week saying it is open to creating a special registration process that would allow providers to prescribe certain controlled substances via telemedicine without requiring the patient to have an in-person evaluation. The DEA will hold listening sessions next month to allow the public to weigh in on the issue. Stakeholder groups and lawmakers have been pressing the DEA to change its policy and applaud the move. During the COVID public health emergency, the DEA relaxed its restrictions on controlled substances prescribing, allowing virtual prescribing without in-person visits to prevent lapses in care. In February, the DEA proposed new rules rolling back those flexibilities, but paused them and extended pandemic flexibilities after pushback from groups expressing concern that the new rules would limit access to care. Congress told the DEA to facilitate virtual prescribing through a special registration process in the 2008 Ryan Haight Act, but the agency still has not done so.

Source: Advocates applaud DEA for being open to relaxing virtual prescribing rules (The Hill)

Uninsured rate reached record low

The Department of Health and Human Services released a report showing that the national uninsured rate reached an all-time low of 7.7% in early 2023. Approximately 6.3 million people have gained coverage since 2020. During the Affordable Care Act (ACA) Open Enrollment period that ended this past January, a record-breaking 16 million Americans enrolled in coverage. The success is due to the American Rescue Plan’s enhanced ACA subsidies and the Inflation Reduction Act’s extension of those subsidies, as well as the continuous enrollment condition in Medicaid, several recent state Medicaid expansions and substantial enrollment outreach by the administration between 2021 and 2023. The administration has also been working to help Americans keep their coverage, including as Medicaid coverage renewals begin for the first time in three years. The results are likely to mark the low point in the uninsured rate in 2023 as Medicaid continuous coverage condition ended in April 2023.

Source: New HHS Report Shows National Uninsured Rate Reached All-Time Low in 2023 After Record-Breaking ACA Enrollment Period (Department of Health and Human Services)

HHS enters agreement with Pennsylvania to protect rights of people in recovery

The Department of Health and Human Services’ Office for Civil Rights (OCR) entered an agreement with the Pennsylvania Department of Human Services (PA DHS), protecting the rights of persons with disabilities, including persons in recovery from substance use disorder (SUD). The agreement resolves a complaint against a county-operated child welfare agency overseen by PA DHS that denied an individual the opportunity to apply to be a foster parent because she receives medication for the treatment of SUD, a violation of her rights under federal disability laws. During its investigation, OCR identified systemic concerns regarding PA DHS’s oversight of county child welfare agencies’ policies, practices and procedures to prevent discrimination against individuals with disabilities. Under the agreement, PA DHS will refrain from discrimination against individuals with disabilities; designate a coordinator on federal disability laws; develop a non-discrimination policy that emphasizes that individuals with SUD are entitled to protections; develop a procedure for individuals to file complaints; track and review requests by individuals for reasonable accommodations; develop annual mandatory training on compliance with federal civil rights laws and working with participants with disabilities; and resolve the complainant’s allegations.

Source: HHS Office for Civil Rights Secures Agreement with Commonwealth of Pennsylvania to Advance the Rights of People in Recovery and Involved in Child Welfare Services (Department of Health and Human Services)

Purdue asks Supreme Court to reject DOJ's request for delay of opioid settlement

Purdue asked the U.S. Supreme Court on Friday to reject the Department of Justice’s (DOJ) request to delay its bankruptcy settlement resolving thousands of lawsuits against it over the opioid crisis. The DOJ asked the Supreme Court last week to pause the settlement, which would shield the Sacklers from opioid lawsuits in exchange for a $6 billion contribution to a broader settlement with states, local governments and victims of addiction. Purdue argued a delay would be destructive, imperiling a settlement that has the support of all major stakeholders, including state attorneys general and people affected by the opioid crisis. Purdue argued that the DOJ’s position would “take billions of dollars out of opioid abatement programs that are sorely needed” and potentially “deprive victims of any meaningful recovery” if the deal falls apart. The DOJ has argued the settlement abuses legal protections meant for debtors in “financial distress,” not for wealthy corporate owners like the Sacklers, who did not file for bankruptcy themselves.

Source: Purdue asks Supreme Court not to block opioid settlement during US appeal (Reuters)

U.S. Attorney threatens enforcement action against NYC overdose prevention centers

Manhattan’s top federal prosecutor, U.S. Attorney for the Southern District of New York Damian Williams, is warning that OnPoint NYC’s supervised consumption sites are illegal and is suggesting that his office could crack down and end the effort. OnPoint said its two overdose prevention centers have reversed 1,000 overdoses since they opened more than a year and a half ago. The centers were authorized by City Hall in 2021 and are the only such sites operating openly in the U.S. This week, Williams issued an apparent warning that came in stark contrast to the more tolerant approach the Biden administration has been signaling toward the centers. Williams said that he is an enforcer, not a policymaker, and that until New York policymakers take action to authorize the sites, they are operating in violation of federal, state and local law. He said his office is prepared to exercise all options, including enforcement, if the situation does not change.

Source: Federal Officials May Shut Down Overdose Prevention Centers in Manhattan (The New York Times)

Charleston, West Virginia, rejects proposal for syringe services program

City councilors in Charleston, West Virginia, voted against a proposal from the state’s long-time abortion provider to start a syringe services program (SSP). The Women’s Health Center of West Virginia made the proposal as part of an effort to expand services for marginalized communities now that the state has a near-total abortion ban. The 17-9 vote came two years after the council and state legislature passed regulations restricting SSPs. The opposition said they feared the program would bring increased substance use and crime to Charleston’s west side, a low-income area that has suffered from redlining and historic disinvestment. Supporters said substance use is already prevalent and that an SSP would help more people get into recovery in the community, which has also historically seen the city’s highest percentage of emergency overdose calls. West Virginia has the highest rate of opioid overdoses. In 2021, the Centers for Disease Control and Prevention declared Charleston the scene of the country’s “most concerning HIV outbreak” due to intravenous drug use.

Source: West Virginia’s capital officials reject abortion provider’s proposal to start syringe service (Associated Press)

California leads in providing addiction treatment in prison

The majority of incarcerated Americans have substance use disorder, and related deaths in state prisons have risen in recent years, but treatment is only sporadically available in prisons and jails. In 2019, California approved a far-reaching plan for treatment in prisons. The state is one of only a few with a comprehensive treatment program across the prison system, which has led to a significant reduction in overdose deaths. In January, California became the first state to secure permission to use Medicaid for some health care in correctional facilities, allowing use of federal funds to cover addiction treatment. Going without treatment can leave individuals vulnerable to recidivism after release, and people in jails/prisons are especially vulnerable to fatal overdoses shortly after release. When inmates leave state prisons in California, they are offered naloxone, and those being treated for opioid addiction receive a 30-day supply of buprenorphine. However, many encounter problems securing a prescription after that, with questions about insurance coverage and challenges navigating the systems and the many responsibilities after release (such as working, moving into housing, securing benefits and attending medical appointments).

Source: California Battles Fentanyl With a New Tactic: Treating Addiction in Prison (The New York Times)

Child nicotine poisonings reach record high amid growth in vape sales

Cases of vaping-related nicotine exposure reported to poison centers hit an all-time high in 2022, despite the 2016 Child Nicotine Poisoning Prevention Act, which requires child-resistant packaging on bottles of vaping liquid. The law does not require protective packaging on devices themselves. Refillable vapes are designed to hold liquid nicotine in a central reservoir, making them dangerous to kids. Even vapes that appear more child-resistant because their nicotine is sealed inside a removable cartridge present a risk, as the cartridges can be pried open. Some disposable e-cigarettes, now the top-selling type, contain as much nicotine as multiple packs of cigarettes. Many e-cigarettes and liquids are designed to appeal to kids, with appealing packages, names and flavors. Vapes are more tempting and hazardous for kids than traditional cigarettes, which have lower doses of nicotine and a bitter taste that often prompts children to quickly spit them out. Senator Blumenthal (D-CT) said he would push to expand the childproof packaging requirement to disposable and pod-cased e-cigarettes.

Source: Doctors Sound Alarm About Child Nicotine Poisoning as Vapes Flood the US Market (KFF Health News)

Opioid victims struggle to qualify for piece of Purdue settlement

As part of Purdue’s proposed bankruptcy settlement, qualified individual victims or families can receive payments ranging from $3,500 to $48,000, based on factors like length of opioid use, addiction, overdose and death caused by opioids. However, victims must show proof of being prescribed OxyContin, and many say the stringent documentation requirements effectively lock them out of making claims. Some states require pharmacy records to be destroyed after a certain period of time; relatives face more barriers in obtaining records of someone who died; those who acquired opioids illegally would not generate pharmacy paperwork; and physicians are only required to hold medical records for a certain number of years, varying by state. Individuals who cannot obtain medical records can submit two affidavits, one written by themselves and one by individuals who have “first-hand knowledge” of the claimant’s use of qualified opioids, but the claims administrator could disregard affidavits if they do not sufficiently prove Purdue product use. Even if claims are accepted, individuals could receive little money, as lawyers would charge around 40% of final reimbursement.

Source: Opioid Victims Struggle With Purdue Pharma Settlement’s High Bar (Bloomberg Law)