Policy News Roundup: February 29, 2024

Key reads

More than 40% of Americans know someone who has died of an overdose

A study found that more than 40% of Americans know someone who has died of an overdose, suggesting that 125 million Americans have experienced such a loss. About one-third of those individuals say their lives were disrupted by the death. The lifetime exposure to an overdose death is more common among women than men, married than unmarried participants, U.S.-born participants than immigrants and those who live in urban settings than in rural settings. Rates of exposure were significantly higher in New England and in the East South Central region than in other parts of the country. The findings emphasize the need for research into the prevalence and impact of overdose loss, as little research has explored the experiences of those left behind by overdose deaths.

Source: More Than 40 Percent of Americans Know Someone Who Died of Drug Overdose; 13 Percent Say Deaths Have Disrupted Their Lives (RAND)

Opioids continue to be seen as the top public health threat

The latest Axios/Ipsos American Health Index found that opioids and fentanyl continue to be seen as the top threat to American public health, with 24% of respondents citing it as the top threat. This is followed by obesity (19%), mental health issues (17%) and access to guns or firearms (15%). For younger Americans, mental health rises further toward the top, with around one in five Americans 18-29 and 30-49 citing it as the top threat, compared to only 10% of those 65+. One in eight Americans report receiving mental health assistance in the last three months. Nine in ten support parity in coverage between mental and physical health, with 64% strongly supporting it. Support is particularly strong among women, Black Americans and Democrats. The poll found 74% support continuing Affordable Care Act exchange subsidies, with support strongest among women, Black Americans, Democrats and those 65+. Republicans were twice as likely as Democrats to identify opioids and fentanyl as the top threat (32% vs. 16%).

Source: Few Americans familiar with CDC plan to change COVID isolation guidelines (Ipsos); Mental health seen as a top health threat in Axios-Ipsos poll (Axios)

HHS announces funding and guidance to expand behavioral health services

The Department of Health and Human Services announced $36.9 million for behavioral health grants and issued guidance expanding Medicaid funding for behavioral health providers. The funding includes $8.1 million to improve delivery and implementation of substance use prevention; $10 million to implement Screening, Brief Intervention and Referral to Treatment in primary care, community health settings and schools; $5 million to provide trauma-informed interventions to youth/young adults at high risk for psychosis; $6.2 million for first responder naloxone training and distribution; $5.4 million for substance use education in health professions programs; and $1.1 million each to enhance the capacity of statewide mental health consumer-run and family-controlled organizations. The guidance expands the pool of behavioral health providers eligible for enhanced Medicaid dollars to include Masters of Social Work and other master’s-level behavioral health providers, such as marriage and family therapists and mental health counselors. It also allows funds to support Nurse Advice Lines for Medicaid beneficiaries, which can help states expand workforce capacity and provide an initial source of non-emergency care, including for behavioral health.

Source: Biden-Harris Administration Announces New Funding to Increase Capacity for Behavioral Health Services (Department of Health and Human Services)

New York proposes rules to establish network adequacy standards for behavioral health services

The New York Department of Financial Services announced a proposed regulation to establish network adequacy standards for behavioral health services. The proposed regulation establishes appointment wait time standards for insurers for behavioral health services; requires insurers to assist consumers in accessing in-network providers and to allow access to out-of-network providers at no additional cost when in-network providers are not available; sets specific information to be included in provider directories, including affiliations with facilities and restrictions on scope of services, such as age of patients or mental health conditions treated; and requires insurers to submit an annual certification regarding their access plan that must include collection of data and monitoring of its behavioral health network. The regulation will be open for comment for 60 days. The Department of Health has proposed an identical regulation for health maintenance organizations, including Medicaid managed care plans, child health plus and the essential plan.

Source: DFS Superintendent Adrienne A. Harris Announces Proposed Regulation Requiring Insurers To Provide Increased Access For Mental Health And Substance Use Disorder Services (New York State Department of Financial Services)

States increasingly using naloxone vending machines to help prevent fatal overdoses

Naloxone vending machines, which provide the medication for free, can help people access doses quickly and reduce risk of fatal opioid overdose. The vending machines also offer fentanyl test strips. Across the country, harm reduction vending machines have been placed in areas with high numbers of overdoses. An analysis found that at least 33 states and D.C. have naloxone vending machines. In some states, city or county health departments or local nonprofits might operate the machines without state involvement. Other states do not currently have vending machines but plan to launch programs this year. A study conducted in Cincinnati found that a single vending machine was directly associated with reversing overdoses for at least 78 people in its first year. Another study in Clark County, Nevada, found that in the first year of vending machines, 41 opioid overdose deaths were averted. In addition to providing the products at no cost, the vending machines also offer anonymity.

Source: How vending machines help states battle the opioid crisis: ‘You don’t know when you’re going to need these products’ (CNN)

Oregon proposal would provide $10 million for MOUD in jails

As Oregon lawmakers consider rolling back Measure 110 (decriminalization), members are pushing for more funding for medications for substance use disorder treatment in jails. The proposal would allow jails seeking to create or expand medication treatment programs to apply for grants from a $10 million fund. It has bipartisan support and backing from public health advocates and some in law enforcement. More states and local counties have taken steps to expand access to treatment in jails/prisons recently. In Washington, lawmakers want to dedicate $7.4 million to the issue, on top of the $7.5 million already approved in the budget last year. Part of the boost would come from opioid settlement funds. It would double the number of jails providing medication. Other states, including New York, Vermont, Maryland and Utah, have passed laws requiring jails to provide medications for opioid use disorder to people who already had prescriptions when they were incarcerated.

Source: Amid fentanyl crisis, Oregon lawmakers propose more funding for opioid addiction medication in jails (Associated Press)

Group brings simulation platform to Alabama to make opioid settlement spending decisions

Helios Alliance, a group of consultants, statisticians and artificial intelligence experts, is bringing a simulation platform to help make decisions on how to spend opioid settlement funds to Alabama. The platform takes in local data about addiction services and the drug supply. It simulates the impact different policies or spending decisions can have on overdose deaths and substance use disorder rates. A local Native American tribe and a state agency have contributed $750,000 to build the platform in Alabama. Helios says it needs $750,000 more to complete it. Helios is telling local officials they can use 5% of opioid settlement funds to build the tool, which will then tell them how to best spend the rest. Ten Alabama cities are considering investing. There is a struggle to balance urgent needs and long-term goals, as while Helios may help spending in the future, people need treatment, housing and other services today.

Source: Can a simulation platform better decide how to spend opioid settlement money? (NPR)

San Francisco is joining more conservative California counties in use of drug-induced homicide charges

Local prosecutors in California are increasingly charging drug dealers with murder as a strategy to stem increasing deaths. District attorneys in Placer, Riverside, Sacramento, Fresno, San Joaquin, San Bernardino and San Diego Counties are charging people who supply doses of fentanyl that result in overdose deaths with murder and sentencing them to prison for terms of 15 years to life. Many of the counties adopting the strategy are in more conservative areas, where law enforcement has long embraced a tough-on-crime philosophy. Now, however, San Francisco is preparing to follow suit. It is in the final stages of forming a law enforcement task force charged with investigating opioid deaths and illicit drug dealing in the city as potential homicide cases. The effort is set to launch this spring. The tactic has not gained traction in Los Angeles County, where the district attorney has focused resources on prevention efforts and prosecuting high-level manufacturers and traffickers.

Source: Some California D.A.s are fighting fentanyl with murder charges. Why San Francisco will join them (Los Angeles Times)

Few primary care pediatricians diagnose or treat adolescents' OUD

A 2021-2022 American Academy of Pediatrics survey assessed pediatricians’ preparedness to provide adolescent opioid use disorder care (OUD), approaches to substance use management and perceived barriers to prescribing medications for OUD (MOUD). Over 90% of primary care pediatricians who care for adolescents agreed or strongly agreed that it is their responsibility to identify substance use disorder (SUD) and refer patients to treatment. Fewer agreed or strongly agreed that it is their responsibility to treat SUD (20.3%) or prescribe medications for addiction treatment (12.4%). Fewer felt prepared to counsel adolescents on opioid use than on alcohol, cannabis and e-cigarette use. Pediatricians were less likely to provide counseling and more likely to refer patients off-site for care for opioid use than for alcohol, cannabis or e-cigarette use. Nearly one-quarter reported ever diagnosing an adolescent with OUD, and 5.5% had ever prescribed MOUD. The most cited barrier was lack of personnel. Training focused on treating OUD in primary care, including prescribing medications and addressing misperceptions, is needed.

Source: Treating Adolescent Opioid Use Disorder in Primary Care (JAMA)

Portugal's opioid crisis response was effective but proves difficult in the U.S.

In the late 1990s, Portugal faced a wave of overdose deaths and infectious diseases from heroin use. Portugal responded with a focus on health care, treatment, job training and housing. The system is integrated into the country’s national health care system and is free and easy to navigate. Portugal decriminalized personal substance use and reinvented the role of police. When they encounter people using substances, police schedule meetings with counselors rather than arrest them. The sessions are not compulsory, but police are trained in strategies designed to encourage attendance, and roughly 90% of people referred do turn up. Portugal drastically cut substance use-related deaths and disease cases. A debate is underway over whether Portugal’s system could work in the U.S. Some cities/states have de-emphasized drug war policies, but implementation has been rocky. Critics say substances were decriminalized before social programs were in place and widely available. Efforts have been crippled by a lack of funding, strict laws that make some harm reduction measures illegal and the U.S.’s complicated, costly and poorly regulated treatment system. There is a different political environment in the U.S., including a different health care system and role of police.

Source: How Portugal eased its opioid epidemic, while U.S. drug deaths skyrocketed (NPR)