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    Policy News Roundup: August 3, 2023

    Key reads

    FDA approves second OTC naloxone

    The Food and Drug Administration approved nonprofit Harm Reduction Therapeutics’ RiVive naloxone nasal spray for over-the-counter use. It is the second over-the-counter naloxone product approved and the first from a nonprofit company. The move could bring cheap and even free doses to Americans who need it most. The company said it anticipates RiVive will be available in early 2024, primarily to harm reduction organizations and state governments, at a lower price than other opioid reversal nasal sprays. It said it is focused on supplying RiVive to communities that need it most and will make at least 200,000 doses, 10% of projected initial annual production, available for free. The company said it will make RiVive available for free or at low break-even cost, which is about $18 per dose, lower than other prescription and over-the-counter options.

    Source: More options for opioid overdose reversal (The Hill)

    Medicaid redeterminations threaten progress on opioid crisis

    As COVID-era protections unwind, Medicaid redetermination could create a setback in the progress against the opioid crisis. Changes in coverage for millions of Americans could derail treatment for the most vulnerable patients being treated for opioid use disorder. People with opioid use disorder are disproportionately covered by Medicaid, so the changes could have an outsized impact on the overdose crisis. Patients may relapse if unable to afford or access previously covered, effective care if they become uninsured. Even if the loss of coverage is temporary for some, people with substance use disorder are susceptible to relapse during that gap in coverage and care. Some state health officials are identifying grants that can pay for treatment when people inevitably lose coverage, but many are likely to fall through the cracks. The National Institute on Drug Abuse is also concerned and prioritizing research on the implications of the Medicaid redetermination process on the opioid crisis.

    Source: Medicaid cuts may put addiction treatment out of reach (Politico)

    Federal news

    DOJ asks Supreme Court to pause Purdue settlement

    The Department of Justice asked the U.S. Supreme Court to stop Purdue from proceeding with a bankruptcy settlement that protects the Sackler family members from future lawsuits. An appeals court rejected a proposed delay last week, ruling that Purdue may proceed with a bankruptcy plan approved in May. The Department’s Office of the U.S. Trustee argued that Purdue should not be allowed to move forward with its restructuring before the Supreme Court had a chance to weigh in on legal protections for non-bankrupt entities, an issue that has divided bankruptcy courts across the U.S. The U.S. Trustee argued that the settlement is an abuse of bankruptcy protections meant for debtors in “financial distress,” not people like the Sacklers, who withdrew $11 billion from Purdue before agreeing to contribute $6 billion to the settlement.

    Source: US asks Supreme Court to delay Purdue Pharma bankruptcy settlement (Reuters)

    Provider shortage complicates parity efforts

    The Biden administration’s new effort to improve insurance coverage for mental health and addiction services will be challenged with the shortage of behavioral health professionals. More than 160 million Americans live in mental health professional shortage areas. Skimpy insurance coverage for behavioral health services is only one factor contributing to this shortage, but advocates say parity is a prerequisite to getting more providers in the system. Close to half of mental health providers do not accept insurance. Mental health providers face lower reimbursement rates than physical health providers, which makes it more lucrative to avoid insurer networks and bill patients directly. Poor pay can deter professionals from entering or staying in the field. There is also a cap on the number of federally funded residency positions for psychiatrists, limiting the number of new psychiatrists entering the field. The new parity rules could help make the field a more viable career path by addressing reimbursement rates, provider networks and other practices that limit behavioral health care access.

    Source: A major provider shortage bedevils Biden’s plan to boost mental health coverage (Axios)

    At House hearing, Gupta emphasizes the connection between mental health and addiction crises

    At a House Oversight Committee hearing last week on the work of the Office of National Drug Control Policy, Director Rahul Gupta emphasized the need to address both mental illness and addiction simultaneously to reduce fentanyl deaths. In his opening statement, Rep. Raskin (D-MD) called on Congress to address untreated mental illness that can lead people to self-medicate and that is fueling the addiction crisis. Gupta testified that “mental illness and drug addiction go hand in glove,” and that it is important to address mental health, social isolation and addiction. He noted that young people take pills they think are Xanax or Adderall but are laced with fentanyl. Republicans largely focused on securing the border and the threat from Mexican cartels and China, while Democrats largely focused on public health. Areas of bipartisan interest included addiction treatment in the criminal justice system and xylazine.

    Source: Mental illness, drug addiction go hand in glove, Biden’s drug czar tells lawmakers (STAT)

    State and local news

    Mendocino County uses opioid settlement funds to address budget shortfall

    States vowed that opioid settlement money would be used to address addiction, determined to avoid a repeat of the tobacco settlement funds, which went toward budget gaps instead of anti-smoking programs. Local leaders are already struggling with this promise. Mendocino County, California, for example, is using more than $63,000 (6.5%) of settlement funds to help fill a budget shortfall, covering employee health insurance premiums, wage increases and cost-of-living adjustments. The board of supervisors noted that insurance deficits were caused, in part, by overprescribing and addiction treatment for county employees. The Find more of our must-reads in policy news, including the FDA’s approval of a second over-the-counter naloxone spray.settlements require at least 85% of funds be spent on opioid remediation, with suggested strategies. In California, 70% of funds funnel into an abatement account from which the state allocates funds to localities. All money from that account must be spent on future opioid remediation efforts, with at least half for creating treatment infrastructure, diversion, youth prevention or other activities the state identified as high-impact. The Department of Health Care Services has issued guidance and offered assistance to localities to ensure proper use of funds, but it only has authority over money from the abatement fund and an additional 15% the state receives directly. The final 15% goes straight to local governments and can be used for anything they define as opioid-related.

    Source: Repeating History: California County Plugs Budget Gap With Opioid Settlement Cash (KFF Health News)

    Seattle announces funding and legislation to address opioid crisis

    Seattle Mayor Bruce Harrell announced a plan to invest $27 million in facilities, treatments and services to address the opioid crisis. This includes $7 million toward capital investments in facilities to provide services such as post-overdose care, opioid medication delivery, health hub services, long-term care management and drop-in support. It also includes $20 million toward a long-term strategy to increase treatment and overdose response services, including Seattle Fire Department’s new post-overdose response team, access to mobile opioid medication delivery and harm reduction services. Harrell also proposed legislation to codify state law making public consumption of illegal substances a gross misdemeanor, designate diversion and treatment as the preferred approach to addressing substance use issues and define a new threat of harm standard to differentiate between substance use that threatens others versus the individual alone. Next week, Harrell will issue an executive order providing guidance to police on how the law should be applied, further detailing threat of harm standards and defining tools to collect and analyze data to measure success.

    Source: Mayor Harrell Announces Efforts to Improve Addiction Treatment, Proposes Legislation to Reduce Public Consumption of Fentanyl and Other Illegal Drugs (Seattle Office of the Mayor)

    New York announces $22 million for addiction services

    New York Governor Kathy Hochul announced more than $22 million from the state’s Opioid Settlement Fund for addiction prevention, treatment, harm reduction and recovery services. More than $12 million is going to Recovery Community and Outreach Centers, which offer a community-based, non-clinical setting that promotes long-term recovery through skill-building, recreation, employment readiness and the opportunity to connect with peers, as well as health, wellness and other critical supports. A total of $6.6 million through the “Connections to Care” initiative will support connections for underserved and high-need populations to care that will support long-term recovery and overall health, including harm reduction, physical and behavioral health services and connections to transportation, supportive housing programs and legal services. More than $3.9 million will support the development of community prevention coalitions geared toward addressing fentanyl, opioids and prescription substance misuse through evidence-based strategies and raising awareness of harm reduction services.

    Source: As Part of Ongoing Efforts to Treat Addiction and Support Recovery, Governor Hochul Announces Award of More Than $22 Million in Funds from New York State’s Opioid Settlement Fund to Support Range of Addiction Services Across New York State (Governor Kathy Hochul)

    Other news in addiction policy

    History shows the current shift toward tougher penalties will not solve the opioid crisis

    Maia Szalavitz outlines the ineffective history of toughening drug penalties. With the rise in overdose deaths, it is easy to think that imposing longer, tougher sentences might save lives by deterring sales. However, the history of mandatory sentencing shows this is not the case. Some 30 states and the federal government allow for the prosecution of street fentanyl suppliers as murderers. At least five require a mandatory life sentence. During the 2023 legislative session, fentanyl-related crime bills were introduced in 46 states. The history of tough drug laws shows that they never significantly reduced the supply or lowered addiction rates or overdose deaths. Drug busts may actually increase overdose risk while saddling people with criminal records that inhibit recovery. Increases in mandatory minimums were repeatedly tried, from the 1951 Boggs Act to New York’s Rockefeller drug laws in 1973 to federal laws regarding cocaine in the 1980s. The laws did not reduce substance use or crime, and prison populations skyrocketed, with Black and Latino individuals disproportionately represented. The laws have since been repealed or amended, as they did not work. Law enforcement cannot stop addiction, and states with more drug arrests and incarceration do not have less substance use.

    Source: I Thought We Learned Mandatory Minimums Don’t Solve Drug Epidemics (The New York Times)

    Marijuana addiction is often met with skepticism

    Most people can use marijuana without significant negative consequences, but some can develop addiction. Their struggles to quit are complicated by the perception that marijuana is natural and therapeutic, not a substance that can be addicting. For decades, marijuana’s deleterious health effects were exaggerated, leading to excessive criminalization. As legal recreational sales have expanded, the suggestion that marijuana is addictive has often been met with derision. Other substances stir deeper fears and greater attention. Medical experts and even many proponents of legalized marijuana, however, acknowledge it can be addictive. The THC content in marijuana products is much higher than it was a few decades ago, which may increase the risk for addiction. At least 16.3 million Americans had cannabis use disorder in 2021. Most cases were mild, an estimated 26% were moderate and 16% severe. People with more serious addictions face challenges in seeking care, including a lack of affordable treatment and few beds in rehabilitation centers, as well as little treatment targeted at marijuana and dismissal in other treatment/recovery settings. No medication exists to treat marijuana addiction. Treatment revolves around behavioral therapy, including contingency management.

    Source: Marijuana addiction is real. Those struggling often face skepticism. (The Washington Post)