Policy News Roundup: January 12, 2023

Key reads

SAMHSA releases 2021 National Survey on Drug Use and Health

The Substance Abuse and Mental Health Services Administration released the 2021 National Survey on Drug Use and Health today. Estimates cannot be compared to prior years’ because COVID necessitated methodological changes. Among people 12+ in 2021, 61.2 million people (21.9% of the population) used illicit substances in the past year. The most commonly used was marijuana (52.5 million). Nearly two in five young adults 18-25 used illicit substances in the past year, and one in three used marijuana. The survey found 9.2 million people 12+ misused opioids in the past year, while 46.3 million people (16.5%) had substance use disorder (SUD), including 29.5 million with alcohol use disorder and 24 million people with substance use disorder. The percentage of people with past-year SUD was highest among young adults. In 2021, 94% of people with SUD did not receive any treatment. 7 in 10 adults who ever had a substance use problem considered themselves to be recovering or in recovery (20.9 million).

Source: SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021 (Substance Abuse and Mental Health Services Administration)

988 capacity and use is quickly expanding

The mental health helpline 988 has quickly expanded its reach in the six months since it launched, with more than 2 million calls, texts and chat messages pouring in. The number of centers answering calls in Spanish grew from three to seven. A pilot line dedicated to LGBTQ youth started taking calls in September. Plans are underway to add Spanish language chat and text options later this year and to expand those services to a 24/7 operation for the LGBTQ line. The 988 helpline registered 154,585 more calls, texts and messages during Nov. 2022 compared to the lifeline in Nov. 2021. Texting increased 1,227%. The Veterans Crisis Line accessed through 988 experienced a 10% increase in calls, texts and messages. Washington launched a line dedicated to American Indian/Alaska Native people. States are expected to receive more money from the omnibus bill to fund 988, but long-term funding is in jeopardy in some states, which have yet to figure out a permanent funding plan.

Source: Cries for help pour into 988 mental health, suicide line (Associated Press)

HHS awards funds to support youth mental health

The Department of Health and Human Services awarded nearly $245 million in Bipartisan Safer Communities Act funding, including $185.7 million from the Substance Abuse and Mental Health Services Administration (SAMHSA) and nearly $60 million from the Health Resources and Services Administration (HRSA), to support youth mental health, help the health care workforce address mental health needs and fund other critical mental health supports. SAMHSA’s awards include funding for Project AWARE, Mental Health Awareness Training grants, School Based Trauma-Informed Support Services and Mental Health Care for Children and Youth, the National Child Traumatic Stress Initiative and Resiliency in Communities after Stress and Trauma grants. HRSA’s awards will support the integration of mental health training into the training of primary care clinicians, with a special focus on children and adolescents.

Source: HHS Awards Nearly $245 Million to Support Youth Mental Health and Help the Health Care Workforce Meet Families’ Mental Health Needs (Department of Health and Human Services)

ONDCP releases report on medications for addiction treatment in correctional settings

To help facilitate universal access to medications for addiction treatment and reduce overdose deaths, the Office of National Drug Control Policy released Performance Measures for Medication-assisted Treatment in Correctional Settings. The report provides professionals at correctional settings with a performance management framework to monitor medication treatment for opioid use disorder in correctional settings. It recommends 12 performance measures to track key activities associated with corrections-based medication treatment programs and their impact, including rates of opioid use disorder, referrals to medications for addiction treatment and rearrests and fatal overdoses.

Source: ONDCP Releases Report on Substance Use Treatment in Correctional Settings to Save Lives, Reduce Costs (Office of National Drug Control Policy)

CMS issues guidance to expand access to specialty care in Medicaid

The Centers for Medicare and Medicaid Services issued guidance that creates an easier path to specialty care for Medicaid and CHIP beneficiaries. For the first time, state Medicaid/CHIP programs will be able to pay specialists directly when a beneficiary’s primary care provider asks for advice. For example, if a pediatrician consults with a specialty behavioral health provider about a patient’s needs, both providers may be reimbursed for their care, even if the patient is not present. The policy eliminates the need for consulting providers to coordinate payment via separate agreements with the treating practitioner, allowing Medicaid/CHIP to develop payment methods to reimburse consulting practitioners directly. This will expand and expedite access to specialty care. The policy aligns Medicaid/CHIP with standards of practice across health care, including Medicare, which has had a similar policy since 2019.

Source: HHS Expands Access to Essential Specialty Care for Millions of Medicaid and CHIP Beneficiaries (Centers for Medicare and Medicaid Services)

Leaders discuss strategies to address fentanyl and drug trafficking at North American Leaders' Summit

At the North American Leaders’ Summit, the U.S., Mexico and Canada committed to coordinate actions and strategies to combat arms and drug trafficking, as well as trafficking in persons, that present a shared threat to the three countries. These include continuing collaboration within the North American Drug Dialogue (NADD) under an updated strategic framework to address illegal drug threats and strengthen public health approaches to substance use. This includes increased information sharing on chemicals used in the illicit manufacture of fentanyl and other synthetic substances, meetings of NADD principals and a trilateral Public Health Summit. During their meeting, President Biden and President López Obrador discussed increased cooperation to prosecute drug traffickers and dismantle criminal networks, disrupt the supply of illicit precursor chemicals used to make fentanyl, shut down drug labs and prevent trafficking of drugs, arms and people across the shared border.

Source: FACT SHEET: Key Deliverables for the 2023 North American Leaders’ Summit; Readout of President Joe Biden’s Meeting with President López Obrador of Mexico (White House)

Philadelphia announces plan for opioid settlement funds

Philadelphia officials announced Philadelphia’s Opioid Settlement Fund spending plan, with the city slated to receive up to $200 million over the next 18 years. The city will use the funds to support substance use education, treatment, harm reduction, prevention and targeted engagement. The city outlined a spending plan for the first two payments, including for community-driven supports in Kensington (to respond to community trauma, promote youth development and public safety, make improvements to impacted schools); mobile support (mobile wound care and methadone services); outreach and engagement (Opioid Response Unit will pilot targeted outreach and engagement for communities at high risk of substance misuse and overdose to connect residents with harm reduction services, expand outreach for juvenile justice-involved young people, faith-based communities, Black maternal/family engagement and pregnant/parenting persons); housing opportunities (increase housing availability and supportive services through Housing First and Supportive Housing programs); and Community Fund (grants for community-based organizations working with communities impacted by the overdose crisis).

Source: The City announces plan for investing funds from Pennsylvania’s opioid settlement (City of Philadelphia)

Maine's program providing medications for addiction treatment in prisons could be a national model

In Maine, 40% of inmates across the prison system are administered medications for opioid use disorder (MOUD). Fatal overdoses among people leaving prison have dropped 60% since the program started in 2019. Drug smuggling, violence and suicide attempts inside state prisons have plummeted. More jails and prisons across the country are offering MOUD, but the programs only cover a fraction of the country’s incarcerated population. Even the programs that do exist are limited (e.g., only one medication offered, only before release, limited availability, etc.). The Biden administration, which wants to increase the number of jails and prisons offering MOUD by 50% in the next two years, says Maine’s program is a model for the rest of the country. Maine’s program offers voluntary medication and counseling to anyone in a state prison diagnosed with opioid use disorder, regardless of their release date, and ensures everyone leaving the prison has naloxone and fentanyl test strips.

Source: Maine’s prisons taught Washington a crucial lesson in fighting opioids (Politico)

Xylazine is increasingly spreading across the country and causing harm

In Philadelphia, and increasingly across the country, xylazine is being used to bulk up illicit fentanyl. Xylazine can cause severe wounds and induce a blackout stupor for hours that can render people vulnerable to rape and robbery. It does not respond to naloxone. The federal government issued a xylazine alert to clinicians and is tracking xylazine’s spread. Xylazine’s prevalence is unknown, as hospitals and some state medical examiners do not test for it. It was approved 50 years ago as a veterinarian-prescribed analgesic and is not listed as a controlled substance for animals or humans, and therefore is not subject to strict monitoring. Some epidemiologists theorize that during the pandemic, xylazine purchased online with a veterinary prescription or diverted from veterinary supply chains became popular as a cheap, easy opioid filler. There is no medical protocol yet for managing xylazine withdrawal. Doctors are perplexed by how xylazine causes extreme wounds, sometimes not even at injection sites.

Source: Tranq Dope: Animal Sedative Mixed With Fentanyl Brings Fresh Horror to U.S. Drug Zones (The New York Times)

KFF releases findings from survey on strategies to address behavioral health workforce shortages

A survey of state Medicaid officials found that strategies for addressing behavioral health workforce shortages fell into four key areas – increasing rates, reducing burden, extending workforce and incentivizing participation. Nearly all states indicated using strategies to increase the workforce, with almost half endorsing at least one in all areas. To attract or retain professionals, nearly two-thirds of responding states implemented rate increases. In some states, rate increases were targeted to specific provider types. Nearly all states reported that they had at least one strategy to expand the workforce, such as extending the types of providers that could bill for services, using interprofessional consultation codes or engaging in outreach efforts to recruit providers. About three-quarters reported strategies to reduce provider administrative burden (such as seeking provider feedback on administrative processes and implementing centralized/standardized credentialing). Most reported prompt payment policies, but fewer reported financial incentives for integrated behavioral health. Some reported strategies to grow the workforce or create new training opportunities (such as student loan repayment, outreach and clinical supervision).

Source: A Look at Strategies to Address Behavioral Health Workforce Shortages: Findings from a Survey of State Medicaid Programs (Kaiser Family Foundation)

KFF releases findings from survey on telehealth delivery of behavioral health services in Medicaid

A survey of state Medicaid officials about policies and trends related to telehealth delivery of behavioral health services found that nearly all responding states took at least one specified Medicaid policy action to expand access to behavioral health care via telehealth (such as added audio-only coverage of services, expanded services allowed to be delivered via telehealth, and expanded provider types that may be reimbursed for telehealth services). As of July 2022, states were more likely to allow audio-only coverage of behavioral health services compared to other services. Many states reported permanently adopting some or all of these telehealth policy expansions. Nearly all states monitored utilization of behavioral health services delivered via telehealth. Many states reported high utilization for behavioral health care across all or most Medicaid populations, though some states noted geographic, demographic and temporal trends. Key issues to watch include data and quality, as well as federal guidance and legislation.

Source: Telehealth Delivery of Behavioral Health Care in Medicaid: Findings from a Survey of State Medicaid Programs (Kaiser Family Foundation)