Policy News Roundup: August 24, 2023

    Key reads

    Marijuana and hallucinogen use increase among adults

    A Monitoring the Future report on adults aged 19-60 found that past-year use of marijuana and hallucinogens by adults 35-50 continued a long-term upward trajectory to reach all-time highs in 2022. Among younger adults 19-30, reports of past-year marijuana and hallucinogen use, as well as marijuana and nicotine vaping, significantly increased in the past 5 years, with marijuana use and vaping at their highest historic levels for this age group in 2022. While binge drinking has generally declined for the past 10 years among younger adults, adults 35-50 in 2022 reported the highest prevalence of binge drinking ever recorded for this age group, which also represents a significant past-year, 5-year and 10-year increase. Past-year use of cigarettes, sedatives and non-medical use of opioid medications showed a 10-year decline for both groups, while past-year amphetamine use continued a 10-year decrease among those 19-30 and 10-year increase among those 35-50.

    Source: Marijuana and hallucinogen use, binge drinking reached historic highs among adults 35 to 50 (National Institute on Drug Abuse)

    Americans rank opioids as top public health threat

    An Axios/Ipsos American Health Index poll found that people think the top threat to American public health right now is opioids and fentanyl, with 26% of respondents listing that as the top concern, above obesity (23%), access to guns/firearms (20%), cancer (11%), unsafe roads/driving (3%), smoking/tobacco products (3%), COVID (2%) and alcohol misuse (2%). The poll found 44% are familiar with the fact that U.S. overdose deaths reached a record high last year, with those who live in rural areas more familiar (51%). According to the poll, 82% report caring about record-high overdose deaths, with 51% caring a lot; 89% back health insurers covering mental health care at the same levels as physical health care; 79% agreed the government should be doing more to reduce overdose deaths; 20% said that they or anyone in their immediate circle has used marijuana in the past three months; and 2% reported the same for hallucinogenic drugs, 26% for prescribed pain medications, 3% for non-prescribed prescription pain medications and 2% for other illegal substances.

    Source: Amid recent uptick in cases, Americans now less convinced the Covid pandemic is over (Ipsos); Americans’ biggest fears: Opioids surge past guns in Axios-Ipsos poll (Axios)

    Federal news

    Overdose death rate continues to flatten, but with over 110,000 yearly deaths

    The Centers for Disease Control and Prevention’s latest release of provisional overdose death data continues to show a flattening of overdose deaths in the U.S. over the past 13 months. The Office of National Drug Control Policy Director Rahul Gupta said he is encouraged to see progress in flattening the trend but that flattening the growth is just the beginning, and that now is the time to double down on efforts to address the overdose crisis. The provisional data show that in the 12-month period ending March 2023, there were a predicted 110,469 overdose deaths, a 0.1% increase over the year before. This includes 83,766 predicted overdose deaths due to opioids (including 76,472 related to synthetic opioids), 35,756 related to psychostimulants with abuse potential and 28,770 related to cocaine.

    Source: White House ONDCP Director Statement on Flattening Overdose Death Rate Over the Past Year (Office of National Drug Control Policy); Provisional Drug Overdose Death Counts (Centers for Disease Control and Prevention)

    NIDA projects aim to implement substance use prevention in primary care

    National Institute on Drug Abuse Director Nora Volkow announced winners of the Primary Care Challenge to generate ideas for how primary care practices can more effectively identify people at risk for substance use/intentional misuse and prevent substance use initiation and escalation of misuse to use disorder. Three winning teams will each receive $25,000 to support implementation of prevention solutions targeting underserved/high-risk populations. The University of Arizona will provide screening and prevention services for adults who have been recently incarcerated or on probation. Services will be delivered at primary care clinics, and health workers will reach out to persons who do not yet have primary care providers to help with insurance enrollment and visit scheduling. Yale and Fair Haven Community Health Care pediatricians will aim to make personalized substance use prevention interventions in their pediatric clinic as “Easy as Vaccination!” The project will harness the power of electronic health records, machine learning, team-based care and the existing workflow to screen and connect patients to universal and selective prevention, including resources from Partnership to End Addiction. University of Vermont and HealthCentric Advisors pediatricians will use follow-up visits for depression, anxiety and ADHD to screen for substance use and deliver brief prevention interventions. The team’s prevention approach uses brief video modules made by local peers.

    Source: Innovative projects answer NIDA’s challenge to implement substance use prevention in primary care (National Institute on Drug Abuse)

    State and local news

    South Carolina will make naloxone available at schools

    The South Carolina Dept. of Health and Environmental Control (DHEC) and Dept. of Education (SCDE) are joining forces to make naloxone available to schools across the state. A new law enacted earlier this year authorized DHEC, in consultation with SCDE, to create and update a list of lifesaving medications school nurses and trained staff are authorized to use in schools and provide guidelines for each medication. DHEC is authorizing naloxone nasal spray for the 2023-24 school year. DHEC partnered with SCDE to issue naloxone to schools that want it during a distribution event last week. Two boxes of naloxone (each containing two doses) have been made available for pickup to every K-12 school in South Carolina that wants it, at no cost to the schools. The new law allows life-saving medication to be administered to not only students, but also to staff, parents and campus visitors.

    Source: DHEC, Department of Education Partner to Make Naloxone Available in South Carolina Schools (South Carolina Department of Health and Environmental Control)

    NY governor and representative announce plan to improve opioid treatment in Harlem

    New York Governor Kathy Hochul and Representative Adriano Espaillat announced actions to improve the way opioid treatment is provided in Harlem to support the community and address community concerns about services in their neighborhood, while continuing efforts to fight the overdose crisis. The Office of Addiction Services and Supports (OASAS) will work with opioid treatment program providers to address high foot traffic and idling at certain sites while better serving existing patients by requiring fewer visits to receive take-home medications, when appropriate. This will eliminate barriers to treatment and reduce the number of in-person visits needed for each patient. Additionally, OASAS will expand the mobile medication unit program to additional regions later this year, including Wards Island, helping to alleviate traffic issues along the 125th Street corridor.

    Source: Governor Hochul and Representative Espaillat Update New Yorkers on Joint Commitment to Improve Opioid Treatment in Harlem (Governor Kathy Hochul)

    Hopeful Futures Campaign releases school mental health legislative guide

    The Hopeful Futures Campaign released a school mental health state legislative guide to provide legislators with practical policy recommendations that support student mental health, with examples of recently passed legislation, in three categories – school mental health services, financing, and prevention and early intervention. Policy recommendations to increase the availability of mental health services for students include improving the ratios of school counselors, school social workers and school psychologists; expanding the school mental health workforce pipeline; implementing school telemental health programs; and facilitating school-linked mental health services. To provide more diversified and sustainable funding for school-based mental health services, states are encouraged to extend Medicaid to cover school-based mental health services. To support mental health prevention and early intervention, states are encouraged to promote skills for life success, increase suicide prevention awareness and training, require mental health education, permit excused absences for mental health, provide annual mental health screenings and provide access to mental health services without a formal diagnosis.

    Source: 2023 School Mental Health Legislative Guide (Hopeful Futures Campaign)

    Other news in addiction policy

    A record-high percentage of Americans view moderate drinking as unhealthy

    A Gallup poll found that a record-high 39% of Americans say that consuming one to two drinks a day is bad for health, marking an 11-percentage-point increase since 2018. Half of adults believe that drinking in moderation makes no difference, while 10% say it is good for health (down five and six points, respectively). The increased belief that moderate alcohol consumption is detrimental is owed largely to young adults 18-34, among whom it has risen 18 points since 2018, compared to a 13-point increase among middle-aged adults and virtually no change among those 55+. Women are more likely than men to view drinking in moderation as harmful, as are Americans living in the Western and Midwestern regions compared to those in the East or South, and those who do not identify with a religion compared to those identifying as Christian. Adults perceive alcohol as less harmful than a variety of tobacco and nicotine products. The poll found 76% say cigarettes are “very harmful” to health, along with 58% for pipes and 54% for e-cigarettes, compared to 39% for chewing tobacco, 39% for cigars, 30% for alcohol and 23% for marijuana.

    Source: More Americans View Moderate Drinking as Unhealthy (Gallup)

    U.S. smoking rate near historic low

    A Gallup poll found that 12% of U.S. adults say they smoked cigarettes in the past week, similar to last year but significantly lower than any other year since 1944, when 41% said they smoked. From a high of 45% a decade later, rates have gradually descended, falling permanently below 30% in 1989 and 20% in 2015. The poll found 76% think cigarettes are “very harmful,” significantly more than for other tobacco products, marijuana and alcohol. Typically, young adults had higher smoking rates than other age groups, but fewer young adults today are smoking. According to the poll, 35% of young adults said they smoked cigarettes 2001-2003, compared to 10% in 2019-2023. Since 2021, an average of 21% of smokers said they consume a pack of cigarettes per day, and 6% smoke more, compared to nearly 40% and 20% in the 1940s/1950s. The poll found 8% say they used e-cigarettes in the past week. Young adults are the most likely to vape. Vaping is more common than smoking among young adults, but marijuana usage surpasses both; 54% see vaping as “very harmful,” while just 23% say the same about marijuana, though another 35% say it is “somewhat harmful”; and 55% favor making laws/regulations on vaping stricter.

    Source: U.S. Cigarette Smoking Rate Steady Near Historical Low (Gallup)

    Alcohol use among young adults declining

    A Gallup poll found that U.S. young adults have become progressively less likely to use alcohol, while older Americans have become more likely. The rate of those who “ever have occasion to use alcoholic beverages” has declined 10 percentage points over the past two decades among young adults 18-34 and increased 10 percentage points among older adults 55+. Those 35-54 maintain a stable, higher rate. The percentage of young adults who drink who reported having a drink in the past week has decreased, while the percentages of older Americans increased and of middle-aged adults held steady. Middle-aged adults were most likely to have had a drink in the past week, a change from two decades ago, when younger adults were most likely. The percentage of young adults reporting overdrinking has decreased. The main reason for the decline in young adults’ drinking may be the greater racial/ethnic diversification in their population than among middle-aged and older adults. Non-White Americans have persistently been less likely than White Americans to use alcohol. Growing concern about alcohol’s health risks and young adults’ increased use of marijuana could also contribute. The increase among older adults is likely due to generational change, as more of this group becomes Baby Boomers, who have consistently been more likely to drink than the Silent Generation.

    Source: Young Adults in U.S. Drinking Less Than in Prior Decades (Gallup)

    Indivior settles Suboxone lawsuit with health plans

    Indivior has agreed to pay $30 million to settle a class action lawsuit filed by health plans accusing it of illegally suppressing generic competition for Suboxone. The settlement must still be approved by a judge. Indivior is still facing claims by drug wholesalers that bought Suboxone from the company directly, with a trial scheduled in October. Suboxone was approved for U.S. sale in 2002. Indivior had the exclusive right to sell the treatment in tablet form until 2009. The health plans and wholesalers claimed in their lawsuits that Indivior switched to an oral film version from the tablet version to extend its monopoly, just as generic manufacturers were poised to sell their own lower-cost tablets. Indivior agreed in June to pay $102.5 million to settle related claims by 41 states and D.C., and in 2020 agreed to pay $600 million to resolve U.S. government allegations that it fraudulently promoted Suboxone, including by marketing the film version as safer and less likely to be intentionally misused than similar drugs.

    Source: Indivior to pay $30 million to settle health plans’ Suboxone claims (Reuters)