CDC releases new opioid prescribing guidelines
The Centers for Disease Control and Prevention (CDC) published a draft updated Clinical Practice Guideline for Prescribing Opioids. The new guidelines remove the previous recommended ceiling on doses for chronic pain patients and instead encourage doctors to use their best judgment. The recommendations encourage doctors to first turn to nonopioid therapies for both chronic and acute pain. They are the first revisions of the CDC opioid prescribing guidelines since 2016. They walk a fine line between embracing the need for opioids in some cases and guarding against exposing patients to the risks. Though the ceilings in the 2016 guidelines were merely a recommendation, dozens of states codified them, and many doctors misapplied them as rigid standards due to fear of criminal and civil penalties. The new recommendations build in flexibility for individualized care. They also suggest that when patients test positive for illicit substances, doctors offer counseling, treatment and, when necessary, careful tapering.
Source: C.D.C. Proposes New Guidelines for Treating Pain, Including Opioid Use (New York Times)
Congressional action on behavioral health fuels lobbying on parity
Congress is again trying to address parity, as the insurance industry and its allies have continually staved off enforcement. The companies are now talking with committee chairs and sending letters to key lawmakers to stop a pair of bills that include tougher enforcement that are likely to be included in the mental health and addiction legislative package lawmakers plan to draft this summer. Insurance companies are lobbying against enforcement and fines. They argue that they have tried to comply and are being unfairly singled out. Mental health care providers are also ramping up their lobbying to counter the insurance industry’s claims. The scale of the mental health and addiction crises and the need for legislative wins are fueling the congressional push on behavioral health. Few issues stand a chance of winning 60 votes in the Senate, but previous parity bills have won bipartisan support, and Republicans have signaled an openness to stricter enforcement.
Source: Mental health push in Congress sparks lobbying frenzy (Politico)
Controversy over harm reduction stirs among Congress and the administration
After reports circulated that crack pipes would be included in safe smoking kits being distributed as part of a federal harm reduction grant program, the Department of Health and Human Services put out a statement clarifying that no federal funding will be used to put pipes in safe smoking kits. The grant solicitation did not specifically mention the inclusion of pipes for smoking, though such materials can sometimes be part of safe smoking kits. Reports circulated on Fox News and other conservative outlets that the grant program was being used to fund “crack pipes,” and the narrative quickly spread among conservative lawmakers. Members of Congress have continued to push the issue, largely in a stigmatizing way. Lawmakers introduced the CRACK Act, PIPES Act, and HUNTER Act to prevent federal funds from being used to purchase or distribute drug paraphernalia. Several Republican lawmakers have denounced harm reduction efforts including distribution of harm reduction supplies, syringe service programs and safe injection sites.
Source: White House disputes reports of federal funds for crack pipes (The Hill)
Opioid prescribing case heads to the Supreme Court
The Supreme Court will hear a case next month concerning two physicians convicted of unlawfully dispensing opioids. The case is raising alarms among advocates for pain patients and some health policy experts. They fear a ruling could enable aggressive prosecution of prescribers and warn that such a decision could discourage doctors from providing opioids even when they are warranted. Oral arguments are set for March 1. In a 1975 decision, the court found that doctors could be convicted under the Controlled Substances Act when “their activities fall outside the usual course of professional practice.” However, courts have since landed on different interpretations of what that means. Some have found that the government needs to prove that the prescriber intentionally or knowingly violated best practices, while others have found doctors guilty for prescribing in ways deemed to be outside accepted standards, without considering intent.
Senate confirms Robert Califf to lead FDA
The Senate voted 50-46 to confirm Robert Califf as the commissioner of the Food and Drug Administration (FDA). Five Democrats voted against (Sens. Manchin, Markey, Blumenthal, Hassan, Sanders), and six Republicans voted for (Sens. Burr, Murkowski, Collins, Romney, Blunt, Toomey). The FDA has been without a permanent leader for nearly 400 days. Issues Califf will face as commissioner include tobacco regulation and opioids. The FDA has yet to make decisions on e-cigarette marketing applications from major market players, including Juul and NJOY. The FDA is slated to take action to ban menthol cigarettes by April. Several Democrats voted against Califf’s nomination after concluding that he would not change the agency’s approach to opioids. Many want to see the FDA address labeling guidance for opioids and an accounting of past decisions to approve opioids despite a saturated market or independent advisers’ opposition.
State and local news
NYC launches buprenorphine treatment pathway for at-risk residents
The NYC Test & Trace Corps announced the launch of a Buprenorphine Treatment Pathway to connect New Yorkers with opioid use disorder to buprenorphine treatment through NYC Health + Hospitals’ Virtual Buprenorphine Clinic (VBC). The initiative will expand treatment options offered by the Street Health Outreach + Wellness (SHOW) program, a mobile urgent care initiative, to provide comprehensive care. SHOW provides a range of medical treatments and social services focused on residents experiencing homelessness, including COVID testing, vaccinations, physical and mental health screenings, and harm reduction services. SHOW teams can now make referrals to VBC, which provides virtual/telephone appointments for assessment with a buprenorphine-waivered provider, works with local pharmacies to facilitate multi-week buprenorphine prescriptions and provides referrals to ongoing treatment.
Source: NYC Test & Trace Corps Launches Buprenorphine Treatment Pathway to Help New Yorkers With Opioid Use Disorder (NYC Health + Hospitals)
Maryland legislation and funding to address behavioral health
Maryland Lieutenant Governor Boyd K. Rutherford urged the General Assembly to pass a bill that would expand access to telehealth services. The bill would allow licensed, out-of-state behavioral health practitioners to provide services to patients virtually in Maryland. Rutherford also urged passage of a bill that would increase availability of naloxone to individuals at high risk for overdose. The Opioid Operational Command Center announced $8 million for a new grant program supported by the Opioid Restitution Fund (money from opioid litigation) to help local jurisdictions expand access to screening, treatment and other services for individuals involved in the criminal justice system with opioid use disorder. The state health department is launching the Overdose Notification Pilot Project, which will use emergency medical services and emergency department data to send secure, near real-time notifications to participating local health departments when there is an overdose in their jurisdiction.
Source: Lt. Governor Rutherford Highlights Legislation to Expand Access to Mental and Behavioral Health Resources, New Initiatives to Combat Opioid Epidemic in Maryland (The Office of Lt. Governor Boyd K. Rutherford)
New Mexico passes legislation to legalize fentanyl test strips
New Mexico’s legislature passed a bill to legalize fentanyl test strips. It now goes to Governor Lujan Grisham, who supports the initiative. It will also give state health officials new authority to intervene and prevent the spread of diseases like HIV and hepatitis through intravenous drug use.
Source: New Mexico bill allows testing to prevent fentanyl deaths (Associated Press)
Other news in addiction policy
Hopeful Futures Campaign releases school mental health report cards
The Hopeful Futures Campaign, of which Partnership to End Addiction is a partner organization, released a report on school mental health. It is a national report card grading every state in the country on policies that support school mental health. The report includes recommendations for states to take further action to help their children. It also includes an action center so that students, parents and others can learn about the state of school mental health where they live and take action to improve their state’s response to the youth mental health crisis. The report cards look at policies surrounding school mental health professionals, school-family-community partnerships, teacher and staff training, funding supports, well-being checks, healthy school climate, skills for life success and mental health education.
Source: America’s School Mental Health Report Card (Hopeful Futures Campaign)
Providers must combat mistrust of people who use drugs toward the health care system
In an op-ed, an internal medicine physician and addiction fellow writes about a patient who said, “I trust my drug dealer more than I trust this vaccine.” The patient explained that her dealer listens to her concerns without judgment and accepts her for who she is. Her dealer is attentive, will not sell her drugs if they know she is in a bad place, is highly accessible, delivers an immediate response to her needs, has time for her and treats her like any other human. In contrast, the health care system stigmatizes people who use drugs and often provides them with inferior care. Providers and public health experts must combat the mistrust that people who use drugs have toward the health care system. They can do this by being attentive and available, creating systems of care that are accessible, offering long-lasting provider relationships, listening to patients’ concerns without judgment, meeting patients where they are, delivering actionable/tangible responses to needs and treating people who use drugs like anyone else.
Source: ‘I trust my drug dealer more than I trust this vaccine’ (STAT)