Residential addiction treatment for teens is limited and expensive
In a recent study, researchers called 160 residential addiction treatment facilities that treated adolescents with opioid use disorder, role-playing as the aunt or uncle of a 16-year-old child with a recent nonfatal overdose, to inquire about policies and costs. The study found 87 facilities (54.4%) had a bed immediately available. Among sites with a waitlist, the mean wait time for a bed was 28.4 days. Of facilities providing cost information, the mean cost of treatment per day was $878. Daily costs among for-profit facilities were triple those of nonprofit facilities. Half of facilities required up-front payment by self-pay patients. The mean up-front cost was $28,731. Researchers were unable to identify any facilities for adolescents in 10 states or D.C. Just over half of the facilities accepted Medicaid, including one in five for-profits and four in five nonprofits. Only seven states had a facility that accepted Medicaid, had a bed open the same day and offered buprenorphine. Access to adolescent residential treatment centers is limited and costly.
Source: Adolescent Residential Addiction Treatment In The US: Uneven Access, Waitlists, And High Costs (Health Affairs); Residential addiction treatment for adolescents is scarce and expensive (National Institute on Drug Abuse)
Study finds non-medication treatments do not reduce opioid overdose risks
A study using Connecticut data on opioid overdose deaths in 2017 and exposures to treatment in the prior six months aimed to determine the relative risk of death following exposure to treatments for opioid use disorder compared to no treatment. It found that exposure to methadone or buprenorphine reduced the relative risk by 38% or 34%, respectively. The relative risk of non-medication treatments was equal or worse than no exposure to treatment. Exposure to non-medication treatments provided no protection against fatal opioid poisoning, whereas the relative risk was reduced following exposure to medications for opioid use disorder, even if treatment was not continued. Population-level efforts to reduce opioid overdose deaths need to be focused on expanding access to medication treatments and are unlikely to succeed if access to non-medication treatment is made more available.
Source: Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016–17 (Drug and Alcohol Dependence)
Sen. Hassan highlights importance of reauthorizing the SUPPORT Act
In an opinion piece, Sen. Hassan (D-NH) stresses the need to reauthorize and expand the SUPPORT Act. The SUPPORT Act established vital infrastructure for communities to prevent, treat and support recovery from addiction. One critical provision required every state to provide Medicaid coverage for medications for opioid use disorder (MOUD). Now that the SUPPORT Act has expired, this requirement ends in 2025, jeopardizing access to MOUD, as many states could choose not to cover it under Medicaid anymore. There are also new threats to address since SUPPORT was passed in 2018, including xylazine. The reauthorized and expanded SUPPORT Act would expand access to test strips. Action is needed beyond SUPPORT Act reauthorization, as well. Health care providers should be trained to recognize the signs of substance use disorder and understand the benefits of MOUD. Stigma and restrictive regulations block access to methadone. The Modernizing Opioid Treatment Act would allow physicians to prescribe methadone to their patients so that they do not need to go to methadone clinics, which could help save lives and promote recovery.
New ARPA-H program seeks to increase investment in preventive care
The Advanced Research Projects Agency for Health (ARPA-H) is seeking to increase investment in preventive care, especially in areas of the country where health outcomes are worse than the national average. The goal of the Health Care Rewards to Achieve Improved Outcomes (HEROES) program is to kickstart a virtuous cycle, where health organizations and their partners invest money in addressing preventable health problems and are compensated if successful. ARPA-H is seeking proposals from “health accelerators,” such as community health centers, health provider systems, nonprofits, payers or combinations of groups, which will target a geographic region and choose one of four health issues to work on – maternal health complications; opioid overdoses; heart attack and stroke risk; or alcohol-related harms. Once awarded a contract, they will work on a “pay for success” basis. While ARPA-H will commit up to $15 million, they are giving preference to parts of the country that secure matching funds from entities such as large employers, payers or philanthropies. The program aims to create the right incentives and accountability for prevention.
Source: Pay grows for health care performance (Politico)
White House facing increased pressure on menthol ban
White House officials are wrestling with whether to ban menthol cigarettes, and the decision to again delay a final rule in December has supercharged lobbying efforts. Senior White House officials including domestic policy chief Neera Tanden and “cancer moonshot” coordinator Danielle Carnival have argued that the ban is essential, citing projections that it could save hundreds of thousands of Black lives in coming decades. But some including former Rep. Butterfield, now a lobbyist for Altria, have echoed tobacco company talking points in meetings with the White House, asserting that the ban could cause unintended consequences, such as creating an illegal market for menthol products. Democratic pollster Cornell Belcher has circulated polling, paid for by Altria, suggesting the ban could alienate Biden supporters in battleground states. Advocates are amping up the pressure. Worried a potential new administration could reverse a ban, some officials want to publish regulations by January 20 to lock in industry requirements that require a year to take effect. Further delays could also subject the ban to the Congressional Review Act, which would allow Congress to overturn the rule if it is announced too close to the end of the year.
Source: White House weighs menthol ban amid dueling health, political pressures (The Washington Post)
State and local news
Supreme Court declines to hear challenge to California's flavored tobacco ban
The U.S. Supreme Court declined to hear R.J. Reynolds Tobacco Company’s challenge to a voter-approved measure in California that banned flavored tobacco products. The justices rejected an appeal by R.J. Reynolds and other plaintiffs (Neighborhood Market Association and a vape shop) of a lower court’s ruling holding that California’s law did not conflict with a federal statute regulating tobacco products. The plaintiffs had argued that the federal Tobacco Control Act preempts state and local laws that bar flavored tobacco product sales. A federal judge ruled those arguments were foreclosed by an earlier decision upholding a similar ban in Los Angeles County. The Supreme Court declined to hear an appeal of the Los Angeles ruling last year. In 2022, it also rejected R.J. Reynolds’ request to prevent the California law from taking effect while it pursued its appeals.
Source: US Supreme Court rejects challenge to California flavored tobacco ban (Reuters)
Much of Kansas opioid settlement money is going to law enforcement
Kansas expects to receive more than $340 million in opioid settlement funds over the next 18 years. This year, the Kansas Fights Addiction Board, through the attorney general’s office, allocated $10 million. Hundreds of thousands of dollars went to state and local law enforcement agencies. The Kansas Bureau of Investigation received $110,000 to expand its joint fentanyl impact team, which targets people in the illicit drug market. The Kansas Highway Patrol received about $186,000 to buy fingerprint readers and TruNarc Devices, which law enforcement says help identify substances during investigations. The devices cost almost $25,000 apiece. About $4 million went to dozens of community organizations for prevention efforts, including expanding access to naloxone. In addition, $195,000 of settlement funds for prevention went to the Overland Park Police Department for a van and equipment to distribute naloxone, fentanyl test strips and other items. Safe Streets, a coalition focused on preventing substance-related harms that distributes naloxone, fentanyl test strips and other resources to community members for free, was denied funds.
New York Medicaid demonstration approved
New York received federal approval for a $7.5 billion, three-year Medicaid 1115 waiver demonstration. It allows New York to make large investments across a series of Medicaid initiatives, including establishing Social Care Networks to integrate health, behavioral and social care services that connect high-need members to critical nutritional and housing support services; enhancing access to coordinated and comprehensive treatment for substance use disorder; investing in primary care; and making long-term, sustainable investments in the health care workforce. The demonstration will address workforce shortages in safety net settings through innovative career pathways training programs for front-line health and social care professionals that will increase access to culturally appropriate services. The workforce initiatives also include a loan repayment program for certain health care professionals who commit to working in community-based practices in underserved areas, including dentists, psychiatrists and clinical nurse specialists.
Source: Governor Hochul Announces Groundbreaking Medicaid 1115 Waiver Amendment to Enhance New York State’s Health Care System (Governor Kathy Hochul)
New York State of the State includes proposals to address mental health and addiction
New York Governor Kathy Hochul delivered her 2024 State of the State address this week, which included many proposals to address mental health, addiction and other health care. New York will disburse over $200 million more in opioid settlement funds to bolster the addiction treatment workforce, grow street outreach efforts and distribute more naloxone and xylazine/fentanyl test strips. Hochul will also continue her commitment to triple the number of Certified Community Behavioral Health Clinics statewide by 2024; propose legislation to update the controlled substances schedule to include fentanyl analogs and xylazine, as well as permit health care providers in emergency rooms to dispense up to a three-day supply of buprenorphine; and direct the health department to synthesize data across information systems to strengthen surveillance and propose legislation to increase the retention period for which patient data is stored in prescription drug monitoring programs. Proposals also include efforts to crack down on unlicensed marijuana businesses, including expanding the powers of the Office of Cannabis Management and local governments to streamline padlocking of illicit shops. Proposals also address youth mental health and other youth services, serious mental illness and health care.
Source: Governor Hochul’s 2024 State of the State: Our New York, Our Future; Governor Hochul Announces Initiatives to Transform and Strengthen Health Care Throughout New York State; Governor Hochul Proposes Legislation to Combat Illicit Cannabis Sales through Improved Enforcement (Governor Kathy Hochul)
Other news in addiction policy
Buprenorphine diversion is a misguided reason not to prescribe the medication
Even with the buprenorphine waiver requirement eliminated, the number of providers prescribing buprenorphine has not grown significantly. Critics express concern that more flexible policies could lead to diversion, but diversion of buprenorphine could actually reduce use of much more deadly opioids. Increasing the amount of non-prescribed buprenorphine within communities decreased the number of overdoses by 3-6%. Sharing buprenorphine or selling part of a prescription is common. Diversion is a form of harm reduction. People are unlikely to seek buprenorphine to get “high.” Lessening restrictions does not obviate the need for patient education on safe storage to reduce the risk of accidental exposure for children, and patients need to be aware that the risk of overdose rises significantly if using other substances including alcohol, stimulants and benzodiazepines. We should continue to make access to buprenorphine low- to no-barrier, and health care providers should set aside concerns about diversion and consider prescribing the medication.
YouTube launching short first-aid tutorials, including on overdose and psychosis
YouTube is launching a new feature directing users to short, step-by-step first-aid tutorials on how to deliver potentially lifesaving care, such as directions on performing CPR, recognizing a heart attack or administering naloxone, before first responders arrive. It is the company’s latest move to combat health misinformation by providing high-quality, vetted information. It also comes as policymakers are pushing for expanded access to emergency measures like Narcan and defibrillators that the general public can use but are not familiar with. Content will be pinned on the website to appear first when searched. Previously, YouTube would have prioritized information from authoritative health sources when viewers searched for these sorts of videos, but they were not necessarily the most helpful in an emergency. Other videos in the new initiative will help viewers recognize and respond to seizures, psychosis, choking, stroke, bleeding, snake bites and poisoning.