Policy News Roundup: August 22, 2024

Key reads

Modernizing methadone regulations could help address fentanyl crisis

To avoid precipitated withdrawal, clinicians must wait longer to give buprenorphine to patients who use fentanyl, which can lead to difficulties. Microdosing is one strategy aiming to improve induction. But in practice, microdosing is complicated by the need for patients to continue using fentanyl during the microdosing period. Unlike buprenorphine, methadone does not require patients to be in withdrawal prior to initiation and avoids legal and clinical pitfalls of buprenorphine microdosing. But methadone is highly regulated and available only at limited, stigmatized opioid treatment programs (OTPs) that require daily trips. New OTP regulations this year expanded take-home doses, authorized telehealth treatment and eliminated the one-year history of substance use disorder requirement. Congress is considering the Modernizing Opioid Treatment Access Act to allow addiction medicine physicians and psychiatrists to prescribe methadone outside of OTPs and dispense it through pharmacies. OTPs must comply with mandatory components of the new regulations by October 2, but the federal government has few practical mechanisms for enforcing the new standards, and take-home medication is not a requirement under the new regulations but rather at the discretion of individual medical directors.

Source: To Battle The Fentanyl Overdose Epidemic, Modernize Methadone Treatment (Health Affairs)

States take various approaches to parity enforcement

State regulators use tools for parity oversight including consumer and provider complaints, rate and form reviews and market conduct exams. States can and do require that insurers provide comparative analyses mandated by a 2021 law, but states differ in approaches to reviewing the analyses. Most or all comparative analyses that states have received thus far are insufficient to assess parity compliance. States use outcomes data to identify treatment disparities. They collect data such as measures of provider network access, factors that discourage providers from joining networks and measures of utilization management. Many states have implemented consumer protections that advance parity’s goals and support enforcement, such as medical necessity standards, definitions of mental health and substance use disorders, limits on prior authorization, cost-sharing requirements and network adequacy requirements. States agreed that the federal parity law is a strong foundation for improving access to behavioral health services and an important tool to use with other measures that more directly affect access to services.

Source: Enforcing Mental Health Parity: State Options to Improve Access to Care (Commonwealth Fund)

NIH launches program to support substance use research in Native American communities

The National Institutes of Health launched a program that will support Native American communities to lead public health research to address overdose, substance use and pain, including related factors such as mental health and wellness. The Native Collective Research Effort to Enhance Wellness (N CREW) Program will total approximately $268 million over seven years and will support research projects led directly by Tribes and organizations that serve Native American communities. The N CREW Program focuses on supporting research prioritized by Native communities, including research elevating and integrating Indigenous knowledge and culture; enhancing capacity for research led by Tribes and Native American Serving Organizations by developing and providing novel, accessible and culturally grounded technical assistance and training, resources and tools; and improving access to, and quality of data on substance use, pain and related factors to maximize the potential for use of these data in local decision-making.

Source: NIH launches program to advance research led by Native American communities on substance use and pain (National Institute on Drug Abuse)

New Jersey expands harm reduction programs

New Jersey boosted its annual funding for harm reduction programs from $4.5 million to $16.5 million this year. It gave approvals increasing the number of harm reduction centers allowed from seven to 45. Gov. Murphy signed legislation last January to remove pipes, needles and other supplies distributed by harm reduction programs from the list of illegal drug paraphernalia. Recipients of the supplies are given registration cards from the harm reduction programs telling police that the items came from harm reduction efforts and that the person holding them should not be charged with possession of paraphernalia. Murphy signed legislation in 2022 that changed the process for approval of harm reduction programs, shifting the authority to state government rather than requiring local municipal officials to enact an ordinance allowing the programs in their towns. New Jersey is using $24 million from opioid settlement funds for the $12 million-per-year harm reduction funding increase for this fiscal year and next, but it is not clear where the state will get the money to continue the current level of harm reduction spending in 2027.

Source: NJ expands harm reduction efforts by distributing clean needles, drug test kits (Paterson Press)

Baltimore reaches settlement with Cardinal Health

Baltimore reached a $152.5 million opioid settlement with Cardinal Health. Cardinal will pay the entire amount this year. The deal is the third settlement Baltimore has announced, following $45 million settlements with both Allergan and CVS this summer. The city has now received a total of $242.5 million in settlements. Its case proceeds to trial next month against five remaining defendant groups. Had Baltimore joined the national settlement with distributors, it would have received less than $70 million spread over two decades from Cardinal Health, McKesson, AmerisourceBergen and Johnson & Johnson. Instead, with just one of those four defendants, the city has received more than double the amount it would have received from all global settlements. Baltimore has committed to using its funds from Cardinal for providing recovery funds to various substance use treatment centers and community organizations.

Source: City of Baltimore Reaches $152.5 Million Deal with Cardinal Health to Resolve Ongoing Opioid Litigation (Mayor Brandon M. Scott)

New York announces grants for workforce development

New York Gov. Hochul announced three Workforce Investment Organizations will receive awards totaling up to $646 million over the next three years to implement the Career Pathways Training (CPT) Program, which will recruit and train thousands of new health, mental health and social care workers across the state. It will also provide new career advancement opportunities to current health care workers. Funding will be used to conduct outreach and recruit new and current health, mental health and social care workers for participation in the CPT Program; support CPT Program participants with tutoring and other academic support (such as apprenticeship and mentorship programs); support participants’ tuition program fees, textbooks and supplies; aid in job readiness and placement; hold educational programs, including application and enrollment assistance; form partnerships with education institutions and other stakeholders to increase career opportunities; and perform data collection and reporting.

Source: Governor Hochul Announces $646 Million to Recruit and Train Thousands More Health Care Workers Across New York (Governor Kathy Hochul)

Montana announces funds for new Wellness Kiosks

Montana Gov. Gianforte announced an investment of up to $400,000 to provide low-cost, lifesaving resources across the state to respond to the opioid crisis. As recommended by the Behavioral Health System for Future Generations Commission, the investment represents the next allocation of $300 million in funding secured by the governor last year to reform Montana’s behavioral health and developmental disabilities services. The one-time funding will be used to install 24 Wellness Kiosks, which will dispense fentanyl test strips and naloxone. The kiosks will be placed at community-based programs such as Projects for Assistance in Transition from Homelessness and Drop-in Centers, both low-barrier access points to behavioral health treatment that offer individualized supports.

Source: Governor Gianforte Announces $400,000 Investment in Response to Fentanyl, Opioid Crisis (Montana Department of Public Health and Human Services)

More Americans view alcohol as unhealthy, fewer are smoking

A Gallup poll found a new high of 45% of Americans say drinking one or two alcoholic beverages per day is bad for one’s health. Another poll found that cigarette smoking is at an 80-year low, with 11% of U.S. adults saying they have smoked cigarettes in the past week. The smoking rate is about half of what it was a decade ago and one-third as large as in the late 1980s. Almost 9 in 10 say alcohol use is very (33%) or somewhat (53%) harmful. The poll found 79% say cigarettes are very harmful, and 57% say the same of e-cigarettes. Young adults were more likely to say alcohol presents health risks, and their alcohol consumption has dropped significantly in recent years. Smoking has plummeted among young adults, who typically had been the most likely group to smoke. However, young adults are the most likely to smoke e-cigarettes.

Source: Cigarette Smoking Rate in U.S. Ties 80-Year Low; Alcohol Consumption Increasingly Viewed as Unhealthy in U.S. (Gallup)

Buprenorphine more restricted in racially and economically segregated communities

A study found that among 858 pharmacies surveyed in 473 counties, pharmacies in the most ethnically segregated and economically deprived counties had 2.66 times the odds of restricting buprenorphine dispensing (inability to fill a buprenorphine prescription requested by a “secret shopper”), compared to pharmacies in the most privileged counties. Pharmacies in counties with high racialized economic segregation also had higher odds of restricting buprenorphine dispensing. Similar associations were observed for economic segregation, but not ethnic or racial segregation alone. Restricted buprenorphine dispensing was most pronounced in socially and economically disadvantaged communities, potentially exacerbating gaps in substance use disorder treatment access. Policy interventions should target both prescribing and dispensing capacity.

Source: Association of economic and racial segregation with restricted buprenorphine dispensing in U.S. community pharmacies (Drug and Alcohol Dependence Reports)