Policy News Roundup: December 7, 2023

Key reads

Supreme Court hears Purdue settlement case

The Supreme Court heard arguments this week surrounding the contested bankruptcy settlement for Purdue that would funnel billions of dollars into addressing the opioid crisis in exchange for shielding members of the Sackler family from related civil lawsuits. The U.S. Trustee had challenged the deal, saying it violated federal law by guaranteeing such wide-ranging immunity for the Sacklers, who themselves had not declared bankruptcy. The justices seemed divided, debating the practical effects of unraveling the agreement for victims who have urgently sought settlement funds and broader concerns over whether releasing the Sacklers from liability would free them from further scrutiny over their role in the opioid crisis. A decision in the case could also have consequences for other agreements resolved through the bankruptcy system. Justices’ questions did not appear to line up along ideological lines, signaling the decision could be a close one. A decision could come as late as June, near the end of the court’s term.

Source: Supreme Court Appears Split Over Opioid Settlement for Purdue Pharma (The New York Times)

Regulations need to address the marijuana industry's use of Big Tobacco tactics

Thomas Farley, MD, MPH, former health commissioner for New York City and for Philadelphia, writes that marijuana industry tactics are increasingly resembling those of Big Tobacco. Retailers sell products in brightly colored packages that are attractive to kids. Marijuana companies are making health claims, as Big Tobacco claimed that smoking was good for you. Tobacco companies advertised in the media channels of the day and used what we would today call influencers. Marijuana companies are advertising on radio, billboards and digital channels and have major influencers. While Philip Morris secretly manipulated freebase nicotine levels, marijuana manufacturers are publicly raising THC levels. State governments tend to use the regulatory model for alcohol, but the tobacco model would be better. Such an approach would limit potency and prohibit new delivery forms until they were evaluated for safety. It would regulate packaging, including requiring child-proof containers, limiting total THC in a package, requiring generic text, prohibiting graphics and including traffic light-style THC content labeling. It would limit the number, density and location of retailers and prohibit home delivery. It would prohibit advertising, promotion and sponsorship, and ban unproven health claims. It would tax products heavily enough to discourage use, base taxes on THC content to counterbalance the drive to higher potency and use revenue to fund not just treatment but also anti-marijuana education campaigns.

Source: Big Weed today is a whole lot like Big Tobacco in the 1950s (STAT)

Senate health committee will consider SUPPORT Act reauthorization next week

The Senate Health, Education, Labor and Pensions Committee will hold a markup of SUPPORT Act reauthorization legislation on December 12. The committee will also vote on the Modernizing Opioid Treatment Access Act. Chairman Sanders (I-VT) said he is pleased to reach an agreement to reauthorize and expand the SUPPORT Act but stressed that it is a modest piece of legislation and that much more needs to be done to address the crisis. Even if the bill passes the committee and full Senate, its fate remains unclear. Earlier this year, two House committees passed a similar reauthorization bill, but the full chamber has not approved the legislation, and it is unclear where the addiction crisis ranks on the priority list of new House Speaker Johnson.

Source: MEDIA ADVISORY: HELP Committee to Hold Markup on the SUPPORT Act and ESRA (U.S. Senate Committee on Health, Education, Labor & Pensions); Sweeping bill to fight opioid addiction will be considered by Senate health committee (STAT)

Congress passes TRANQ Research Act

The Testing, Rapid Analysis, and Narcotic Quality (TRANQ) Research Act passed the House and will now head to the president’s desk for his signature. The bill had previously received unanimous support in the House and in June passed the Senate with minor changes. The bill directs the National Institute of Standards and Technology to focus their research on existing and emerging illicit substances containing xylazine and other emerging substances.

Source: Congresswoman Caraveo’s Bipartisan TRANQ Research Act Passes House, Goes to President’s Desk (Representative Yadira Caraveo)

FDA argues in court for cigarette graphic warning labels

The Biden administration urged a federal appeals court to let a regulation requiring graphic health warnings on cigarette packages and ads take effect, a year after it was blocked by a lower court in response to a challenge by tobacco companies. The lawyer representing the Food and Drug Administration (FDA) told a three-judge panel of the 5th U.S. Circuit Court of Appeals that images on the proposed labels were necessary because text-only warnings failed to deter teens from starting to smoke. The tobacco companies that challenged the regulation have argued the labels violate their right to free speech under the First Amendment by compelling them to make emotionally charged, controversial statements, not mere facts like existing written labels stating that smoking can cause cancer. The FDA said the images were factual, even if they provoked strong reactions in viewers. The judges asked relatively few questions and did not clearly indicate how they would rule.

Source: Biden admin urges court to allow graphic warning labels for cigarettes (Reuters)

Proposed menthol ban delayed until at least March

The Biden administration will further delay a long-awaited ban on menthol cigarettes after fierce lobbying from critics. The administration is expected to announce today that it plans to finalize the rules in March. Officials acknowledged that the process could be delayed still further because of pressure during an election year. The tobacco industry has a long history of aggressively marketing to Black communities, and among smokers who are Black, 81% choose menthols. The proposed ban has revealed deep fissures in the Black community, with proponents saying that removing menthol cigarettes will save hundreds of thousands of lives, and opponents saying a ban would foster an underground market that could lead police to disproportionately target smokers who are Black. The ban on flavored cigars and new limits on nicotine in cigarettes are also set to be delayed until at least March.

Source: Biden ban on menthol cigarettes to be delayed amid political concerns, officials say (The Washington Post)

Schools increasingly offer online therapy

Schools around the country are offering telehealth therapy in response to soaring mental health struggles among youth. At least 16 of the 20 largest public school districts are offering online therapy to millions of students. Some experts raise concerns about the quality of care offered by fast-growing tech companies funded by venture capitalists. As schools cope with shortages of in-person practitioners, however, educators say teletherapy works for many and is meeting a massive need. For rural schools and lower-income students in particular, it has made therapy easier to access. Many schools are using pandemic relief money to fund the services. Experts welcome the extra support but caution about potential pitfalls, including that it is getting harder to hire school counselors and psychologists, and competition with telehealth providers is not helping. The rapid growth of the companies raises questions about the qualification of the therapists, their experience with children and privacy controls.

Source: Lacking counselors, US schools turn to the booming business of online therapy (Associated Press)

Safehouse argues it has a religious right to open a safe consumption site

Safehouse argued in federal court that it has a religious right to open a safe consumption site. Safehouse, whose board members include faith leaders from Philadelphia, argues the federal government is infringing upon members’ religious beliefs by barring them from opening a supervised consumption site. The U.S. Attorney’s Office said Safehouse is not specifically religious and therefore cannot assert a religious right to prevent overdoses. They said the group can provide other services to people who use substances without violating federal law. Even if Safehouse prevails in court, the concept faces political opposition from city and state leaders. Safehouse initially did not pursue the religious freedom claim in its court appearances, instead saying the “crackhouse statute” does not prohibit medically supervised drug consumption. A federal judge ruled in Safehouse’s favor, but an appeals court struck down the ruling, and Safehouse then returned to court on the religious freedom claim.

Source: Safehouse attorneys in court say the Philly nonprofit has a religious right to open a supervised drug consumption site (The Philadelphia Inquirer)

Washington governor will ask for $50 million to address the opioid crisis

Washington Governor Inslee said he will ask for an additional $50 million in the state budget to fight the opioid crisis. The funding would be directed to expanding a range of efforts, including education about the risks of fentanyl and treating opioid use disorder. The funds would bolster state public health outreach programs to boost awareness of the danger of fentanyl in schools and in tribal communities, expand community health hubs, support distribution of naloxone to first responders, set up 15 machines stocked with naloxone and other health supplies in communities where overdoses are disproportionately high, expand funding for opioid treatment programs, pay for medications for substance use disorder treatment in jails, open six more recovery homes and provide money to police departments to disrupt drug rings. The Inslee administration is also looking into state regulations around allowing paramedics to provide an initial dose of certain medications approved for long-term treatment of opioid use disorder to people who have overdosed.

Source: Gov. Inslee to seek $50M more toward opioid education, treatment (The Seattle Times)

New York provides funding for school-based mental health clinics and pediatric behavioral health teams

New York Governor Hochul announced $5.1 million to support 137 school-based mental health clinic satellites, including startup funding for clinics at 55 schools and funding for clinics at 82 schools in high-needs districts. Once these are established, there will be roughly 1,200 school-based clinics throughout the state. The clinics will be staffed regularly throughout the academic week by mental health practitioners, who will help identify childhood mental health needs earlier and engage families that might not have otherwise sought assistance. Hochul also announced that more than $17.7 million was awarded to expand HealthySteps, an evidence-based program that pairs behavioral health professionals with pediatric teams to provide early childhood mental and physical health care in a pediatric setting. Funding will establish 46 new sites and expand 51 existing sites, with the goal of growing the program to serve roughly 354,000 children at 224 sites by 2027. Counties with the highest percentage of children in poverty were prioritized for awards.

Source: Governor Hochul Announces $5.1 Million to Establish School-Based Mental Health Clinics; Governor Hochul Announces $17.7 Million to Expand HealthySteps Program Statewide (Governor Kathy Hochul)

Poll shows health care is an important issue in 2024

A KFF poll found that voters identify inflation as the most important topic for 2024 candidates to discuss. The affordability of health care came in a close second, with 8 in 10 saying it is “very important” for candidates to discuss, followed by the future of Medicare and Medicaid (75%) and access to mental health care (70%). About half said it is very important for candidates to discuss the opioid crisis (53%) and future of the Affordable Care Act (49%). When asked to pick their top issue, 8% said affordability of health care, 6% the future of Medicare and Medicaid, 3% access to mental health care and 1% the opioid crisis. Democratic voters are more than twice as likely as Republican voters to say the future of the ACA is a very important issue. Six in 10 voters say they trust Democrats more on handling the ACA. Democrats have a similar edge on access to mental health care, affordability of health care and the future of Medicare and Medicaid. Voters are split on which party they trust to do a better job handling the opioid crisis, with 50% saying they trust Democrats more and 48% saying Republicans.

Source: KFF Health Tracking Poll: Health Care Issues Emerge as Important Topics on 2024 Campaign Trail, Plus Concerns Loom Large Around Medicaid Unwinding (KFF)