Policy News Roundup: August 5, 2021

Key reads

Journal of Adolescent Health: Restricting youth access to marijuana is essential as legalization efforts grow

In a commentary published in the Journal of Adolescent Health, Partnership to End Addiction’s Linda Richter, Vice President of Prevention Research and Analysis, and Lindsey Vuolo, Vice President of Health Law and Policy, explain the importance of restricting youth access to marijuana, as demonstrated by tobacco control and COVID-19 restrictions. Youth use of e-cigarettes and alcohol seems to have declined during the pandemic, partly due to reduced physical access. The tide in youth smoking turned with policies to restrict access to tobacco — such as higher minimum age laws, clean air acts, advertising restrictions — before unrestricted promotion made e-cigarettes readily available and appealing to youth. Restricting youth exposure, they argue, must be a deliberate element of any marijuana legalization law. They also recommend that advertising, promotion and sale of marijuana should have at least the same restrictions as those for cigarettes, including being prohibited near locations frequented by youth and in outlets that can be seen by youth; that marketing that targets youth and child-oriented packaging and flavors should be banned; that labels should be required to indicate marijuana contents; that packages should provide warnings on their danger to children and be child-resistant; that home delivery should be prohibited; and that THC doses should be limited.

Source: The Importance of Restricting Youth Access to Marijuana in the Age of Legalization: Lessons Learned From Tobacco Control Efforts and COVID-19 Restrictions (Journal of Adolescent Health)

Punitive approaches to drug use increase stigma and its negative effects

In a commentary for STAT, Nora Volkow, director of the National Institute on Drug Abuse (NIDA), writes about the negative impacts of stigma and how the continuing criminalization of substance use contributes to these effects. Stigma impedes access to and reduces quality of care, she writes, and may lead individuals to avoid or delay care or to conceal substance use. In some states, pregnant people with substance use disorder (SUD) risk being charged with child abuse or losing parental rights, and fear of such consequences may cause individuals to avoid care. Stigma surrounding treatment manifests in providers’ attitudes, confidentiality protections that limit data sharing and restrictive insurance limits. Many people with SUD intersect with the criminal justice system, but few receive treatment. In addition to increased risk of overdose, Volkrow writes, imprisonment increases the likelihood of dying prematurely and negatively impacts mental health and social adjustment due to the stigma of incarceration. Interacting with members of a stigmatized group has a destigmatizing effect, but while a growing number of people in recovery are speaking openly, people who actively use drugs cannot do so without fear of legal consequences. According to Volkrow, an effective public health response must consider the policy landscape of criminalizing substance use, a socially sanctioned form of stigma. Research on outcomes associated with alternative policy models that prioritize treatment over punishment is needed, she argues.

Source: Punishing drug use heightens the stigma of addiction (STAT)

SAMHSA awards $250 million to CCBHCs

SAMHSA awarded 100 grants totaling $250 million, including $77 million from the American Rescue Plan, to Certified Community Behavioral Health Clinics (CCBHCs). The CCBHC expansion grant program increases access to and improves the quality of community mental health and substance use disorder services. The $77 million will help expand the CCBHC program in both breadth and depth – the program will be able to establish services in new facilities and make services more robust at existing facilities. The 100 grants comprise $115 million in COVID-19 relief funds, $77 million in American Rescue Plan funds and $59 million in annual appropriations.

Source: SAMHSA Awards $250 Million to 100 Certified Community Behavioral Health Centers to Improve Community Substance Use Disorder and Mental Health Treatment Services (Substance Abuse and Mental Health Services Administration)

HHS releases guide for providing culturally and linguistically appropriate services in behavioral health

HHS Office of Minority Health released a guide underscoring the ways in which the National CLAS Standards (National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care) can improve access to behavioral health care, promote quality behavioral health programs/practice, and reduce disparities in mental health and substance use disorder treatment for underserved, minority populations and communities. The guide provides concrete, feasible strategies for the health and behavioral health care community to improve the provision of services to all, regardless of race, ethnicity, language, socioeconomic status and other factors. Sections on the overarching themes of the standards each include the purpose of the National CLAS Standard, a hypothetical behavioral health scenario relevant to the Standard, implementation strategies pertaining to the scenario and implementation examples.

Source: Behavioral Health Implementation Guide For The National Standards For Culturally And Linguistically Appropriate Services In Health And Health Care (Department of Health and Human Services)

Members of Congress urge the Biden administration to maintain COVID-19 MOUD flexibilities

Senators Markey and Warren and Representative Kuster led a group of colleagues (Senators Baldwin, Booker and Whitehouse; Representatives Trone, Trahan and Blunt Rochester) in a letter to the Biden administration calling for the continuation of pandemic regulatory flexibilities for opioid treatment providers that were instituted in March 2020 at the onset of COVID-19. The letter calls on SAMHSA and DEA to maintain telehealth flexibilities on medications for opioid use disorder (MOUD) and to continue allowing expanded use of take-home methadone. It also calls on the administration to explore further regulatory reductions on MOUD to help improve access.

Source: With Compounding Coronavirus And Opioid Crises, Senators Markey, Warren, And Rep. Kuster Urge Biden Administration To Maintain Flexibilities That Break Down Barriers To Opioid Treatment (Senator Ed Markey)

States to determine how to spend opioid settlement funds

While settlements will create guideposts, it will be up to states to decide how to spend the money they receive from opioid settlements. It could easily become subject to competing interests, with legislatures squabbling with governors over priorities and counties demanding autonomy. Some raise concerns about the quality of programs to which states could allocate funding. The attorneys spearheading the suits say they are building safeguards into the agreements to guarantee that most funding goes to addiction prevention and treatment, but state officials often look for any available revenue to bolster constrained budgets and are likely to work around such rules to use funding for broader purposes. Some states are creating “lock boxes” and commissions to allocate funds. The $26 billion deal with the distributors and Johnson & Johnson lists acceptable abatement strategies such distributing naloxone, providing MAT to people without insurance and to incarcerated people, and expanding syringe exchange programs. Still, political and law enforcement officials sometimes oppose the most effective treatments. There is a tension between wanting states to be able to tailor the funds to their populations’ needs but also recognizing that states do not always make decisions according to the evidence.

Source: States could get billions from opioid lawsuits. They have to decide how to spend it (STAT)

CDC provides recommendations to address the HIV outbreak in West Virginia

The West Virginia Department of Health and Human Resources, Kanawha-Charleston Health Department, and CDC presented final recommendations based on a CDC investigation the area’s HIV outbreak. Recommendations included expanding and improving access to sterile syringes, testing, and treatment by reducing barriers to harm reduction and using mobile and street outreach; making HIV and hepatitis C testing routine in settings where people who inject drugs engage in care; and co-locating services to facilitate transitions to care for HIV, hepatitis C, substance use and mental health. Other recommendations included involving the community in efforts to address the outbreak — such as increased engagement and dissemination of information, community discussion with key stakeholders, engaging people who inject drugs in the design of services — and conducting data analysis to understand the extent of injection drug use in the county and to prioritize outreach to other counties at highest risk for outbreaks.

Source: Final CDC Recommendations on Kanawha County HIV Outbreak Presented (West Virginia Department of Health and Human Resources)

Philadelphia decriminalizes fentanyl test strips

Philadelphia Mayor Kenney signed an executive order establishing that the city will no longer arrest people for possessing or distributing fentanyl test strips, even though state law makes them illegal because they are considered drug paraphernalia. The decision is in line with a position the District Attorney’s Office took earlier this year, when it formally adopted a policy of not prosecuting people found to be in possession of or distributing the strips. DA Krasner and Mayor Kenney suggested the test strips are a tool to prevent overdoses and save lives, not a crime. The attitude has also been adopted at the state level, with Attorney General Shapiro issuing a statement saying his office will also not prosecute people who are arrested for possessing test strips.

Source: Kenney: No more arrests for possession of fentanyl test strips (WHYY)

Overdose data is limiting in prevention efforts

Models to predict who is at highest risk of developing opioid use disorder or overdosing could help health officials target strained prevention resources, but scattered and siloed data inhibits such efforts. Turning data on opioid prescribing, substance use disorder (SUD) diagnoses, and overdoses into useful models is challenging. Federal regulations require certain SUD treatment records to be kept separate from a patient’s other health care records. Opioid prescriptions can provide some data, but illicit substance use is harder to track. Medical records on overdoses sometimes do not specify the drug involved, and collecting data on a single patient across systems is difficult due to use of different record systems. Details collected when an ambulance crew responds to an overdose are often scattershot and often do not include information on a patient’s medical history or the drug involved. Syncing datasets across health and social agencies would require policy change and a cultural shift in how health data is shared.

Source: Overdose data, often scattered and siloed, pose challenges for researchers racing to predict risk (STAT)

Advocates strive to expand crisis response system

Advocates are citing the pandemic and the implementation of the crisis hotline 988 as reasons to attach suicide prevention resources to an infrastructure or appropriations bill. Advocates want to build crisis care infrastructure and add resources before 988 takes effect in a year, including specialized services for high-risk populations. Advocates are re-conceptualizing the suicide hotline to be a broader behavioral health crisis line. Crisis hotline resources are primarily funded at the local level, but advocates say the shift to 988 requires more federal funding and want appropriations for crisis infrastructure, including hotline staff, training, and technology and operations upgrades to field the projected increase in calls. The House-passed Labor-HHS-Education appropriations bill would provide $113.6 million for the lifeline for fiscal year 2022, a $89.6 million bump and create a 10% set-aside in the Mental Health Block Grant for crisis care, up from 5%. Organizations asked Congress in May for $10 billion to cover technology and training at call centers; to expand behavioral health workforce training; to broaden eligibility for federal loan repayment to include call center staff, mobile crisis teams and health clinics; and to expand grants for stabilization. The American Rescue Plan offered an enhanced federal match and $15 million in grants for states for crisis services.

Source: Mental health advocates seek crisis hotline expansion resources (Roll Call)