Methadone access, harm reduction and telehealth policies could change in 2024
Going into 2024, methadone access, harm reduction and telehealth are areas for potential change. A Senate committee approved the Modernizing Opioid Treatment Access Act, which would allow board-certified addiction doctors to prescribe methadone to patients, but it is not likely to become law. The Biden administration could potentially act on its own to make methadone more accessible. More methadone clinics could take advantage of COVID-era regulations and become more liberal with take-home doses. While the U.S. has generally warmed to harm reduction, some are moving to ban harm reduction tools, and the U.S. is seeing a resurgence of advocacy for hardline, police-first tactics. It is hard to tell which direction drug policy will turn in 2024. When the COVID emergency ended, the Drug Enforcement Administration moved to roll back measures that allowed prescribing via telehealth, including for buprenorphine. Amid blowback, the DEA delayed its decision until December 2024, but the DEA and Congress will soon need to decide the future of telehealth addiction medicine.
Regulations should limit availability and appeal of addictive substances to kids
Partnership to End Addiction’s Linda Richter and psychologist Aaron Weiner explain the need for regulation to curb youth exposure and access to addictive substances. Scary commercials about smoking-related lung problems did less to shift the trajectory of youth smoking than smoke-free laws and tax hikes. Lectures to kids about risks of vaping did less to stabilize the spike in vaping than did bans on flavored vapes and reduced access to popular brands. The marijuana industry systematically advertises to youth, and the more available marijuana is and the more exposure youth have to ads, the more they tend to use THC or view it as normal. The same holds true for nicotine, and vaping companies are using Big Tobacco marketing strategies. Ubiquitous ads have made marijuana use and online betting routine for teens. A regulatory agenda dictated by industries that stand to profit from loose regulations harms young people, as promoting new addictive substances normalizes use, reduces perception of harm and increases access. There must be stronger guardrails to ensure products are not available to youth, and enforceable regulations should prevent their marketing, sale and appeal to minors.
Biden pardons more marijuana-related offenses and commutes several non-violent drug offense sentences
President Biden issued a proclamation pardoning additional individuals experiencing unnecessary collateral consequences of a conviction for simple marijuana possession, attempted simple possession of marijuana or use of marijuana. A proclamation in October 2022 pardoned individuals who committed or were convicted of simple possession of marijuana. The new proclamation grants a full, complete and unconditional pardon to all current U.S. citizens and lawful permanent residents who committed or were convicted of simple possession of marijuana, attempted simple possession of marijuana or use of marijuana in violation of federal or D.C. laws, including retroactively. The pardon does not apply to other offenses such as possession with intent to distribute or driving offenses committed while under the influence of marijuana. Biden also commuted the sentences of 11 Americans serving unduly long sentences for non-violent drug offenses, all of whom would have been eligible to receive significantly lower sentences if they were charged with the same offense today.
Source: A Proclamation on Granting Pardon for the Offense of Simple Possession of Marijuana, Attempted Simple Possession of Marijuana, or Use of Marijuana; Clemency Recipient List; Statement from President Joe Biden on Clemency Actions (White House)
Updated guidelines for safety stations in federal buildings recommend adding naloxone
The Department of Health and Human Services and the U.S. General Services Administration announced the first updated guidelines for safety stations in federal facilities in the past 15 years. This expands existing recommendation beyond automated external defibrillators (AED) to also include opioid reversal agents such as naloxone and hemorrhagic control such as Stop the Bleed. Overdose reversal medications can be found in many schools, libraries and other community institutions and should be readily available in and around federal buildings. The updated guidelines expand the concept of an AED program by introducing the “safety station,” which would enable anyone located within a federal facility to access the necessary tools quickly and easily to respond to an emergency situation. Under the new recommendation, anywhere that an AED was previously located can and should be converted to a safety station. The safety station program is voluntary and not mandatory for federal facilities.
Source: HHS and GSA Update Guidelines for Federal Safety Stations to Improve Health and Safety, Facilitate Overdose Prevention (Department of Health and Human Services)
FDA approves DNA test to assess OUD risk
The Food and Drug Administration approved the first test that uses DNA in assessing whether certain individuals may have an elevated risk of developing opioid use disorder. As part of a clinical evaluation, the test is intended to be used prior to first exposure to oral opioid pain medications in patients being considered for a 4- to 30-day prescription for acute pain treatment. The test is a prescription-only genetic lab test for adults, to be used only with patients who consent and have no prior use of oral opioid analgesics. Health care providers administer it by swabbing the patient’s cheek to collect a DNA sample used to determine if a patient has a combination of genetic variants that may be associated with elevated risk of developing opioid use disorder. This information should be used as part of a complete clinical evaluation and risk assessment. It may help patients make better informed decisions.
Source: FDA Approves First Test to Help Identify Elevated Risk of Developing Opioid Use Disorder (Food and Drug Administration)
National Harm Reduction TA Center falls apart after contract given to defense industry contractor
The Centers for Disease Control and Prevention (CDC) National Harm Reduction Technical Assistance Center was founded in 2019 as a coalition of harm reduction groups partnered with CDC to offer training, funding and guidance to harm reduction providers. Its success rested on the experience and trust community members had for the main partners, the National Alliance of State and Territorial AIDS Directors, National Harm Reduction Coalition and University of Washington’s Supporting Harm Reduction Programs. In December, the Center switched to a contract, which went to H2 PCI, a new contractor with close links to the defense industry and military special operations. H2 PCI entered negotiations with the Center’s primary partners to make them subcontractors, but it did not send proposed subcontracts until early November, and talks broke down. The H2 PCI contract went into effect December 1, and the partner organizations left the project. The partners say it was clear H2 PCI had no experience in public health or harm reduction. Advocates fear the takeover could wash away years of work of building up the Center and sever its connection to providers. To many advocates who worked on the Center, the saga highlights that private firms are clamoring for a piece of the increased federal funding and opioid settlement money.
State and local news
Missouri launches statewide PDMP
Missouri launched its statewide prescription drug monitoring program (PDMP) last month. Under the program, pharmacists must now report when they provide controlled substances. The information is collected in a database that doctors and other pharmacists can check to see if patients have been receiving opioids from multiple providers. Prescription information can only be used for patient care and cannot be shared with law enforcement. The legislature passed a law creating the program in 2021 after years of resistance from a small number of lawmakers who raised concerns about sensitive patient data being misused. Missouri was the last state to adopt a statewide PDMP. Most Missouri health care providers had already been using a St. Louis County PDMP following local buy-in from 75 cities and other municipalities. That system will now be absorbed into the statewide system.
Source: Missouri launches a prescription drug database to help doctors spot opioid addictions (Associated Press)
Corporations are going after opioid settlement funds
Some fear that corporations, with flashy products, robust marketing budgets and hunger for profits, will gobble up opioid settlement funds. Marketing specialists are targeting those overseeing settlement funds, offering phone calls, informational presentations and meetings with their companies. Not all marketing efforts should prompt concern, as they are one way people learn about innovative products/services. Partnering with industry is crucial, as pharmaceutical companies manufacture medications to treat opioid use disorder, and corporations run treatment facilities and telehealth services. Experts agree that the key is to critically evaluate products/services to see if they are necessary, evidence-based and sustainable, instead of flocking to companies with the best marketing. Some localities are using funds for Deterra drug disposal pouches, DisposeRx disposal packets and SafeRx locking pill bottles. Critics say this is not worthwhile, as today’s crisis is driven by fentanyl, while the companies say they address the root cause. Some localities are using funds for Wrap Technologies’ BolaWrap, which shoots a Kevlar tether to wrap around a person’s limbs/torso. The company says it can be an alternative to Tasers or pepper spray when officers need to detain someone experiencing a mental health crisis or committing crimes related to opioid use disorder, but advocates oppose use of such law enforcement tools.
Source: ‘They See a Cash Cow’: Corporations Could Consume $50 Billion of Opioid Settlements (KFF Health News)
Opioid settlement money is starting to flow, but uses and transparency vary among states and localities
About $1.5 billion has landed in state/local coffers from opioid settlements. Most states are participating in settlements with manufacturers J&J, Teva and Allergan; distributors AmerisourceBergen, Cardinal Health and McKesson; and pharmacies Walmart, Walgreens and CVS. Many are settling with Kroger. Mallinckrodt originally agreed to pay $1.7 billion, but its August bankruptcy filing slashes $1 billion from that. Purdue agreed to pay $6 billion, but the case is with the Supreme Court. Only 16 states have promised to publicly report how they are using all the settlement dollars, and 15 have not committed to publicly reporting anything. Many jurisdictions are building rehab facilities, covering the cost of care for uninsured people, trying to increase the number of treatment providers and providing naloxone. Controversially, some used funds for law enforcement or shoring up budgets. Many places have not decided what to do with funds yet, and some officials say they need more guidance. Parts of the settlements aiming to prevent further intentional prescription opioid misuse (such as manufacturing restrictions, requirements on suspicious order identification and pharmacy reporting) have led to unintended consequences, such as pharmacies being hesitant to fill any controlled substance prescription for new patients, including for buprenorphine.
Source: The Year in Opioid Settlements: 5 Things You Need to Know (KFF Health News)
Massachusetts is spending its settlement funds on 5 priorities, but cities/towns are slower to spend
Most cities/towns in Massachusetts have not spent any of the opioid settlement funding received in the first year. Boston said it is reviewing input collected from listening sessions and surveys and plans to announce spending strategies in early 2024. Cambridge’s community survey about how to use the money is still open. Worcester is one of the few municipalities that spent all of its first-year payments, worth $845,000. Of that funding, $500,000 paid for a mobile crisis team, and the balance covered staff that provides outreach for people experiencing homelessness and substance use. Some municipal leaders may have little or no experience with opioid use disorder treatment and policies. The state has hired a consulting firm to assist cities/towns. The state is spending its share more quickly, tying grant proposals to priorities set by an advisory council – equity (funding for community advisory boards, research and prison reentry programs to address racial disparities), treatment (funding for walk-in clinics, addiction specialists in hospitals serving high-need areas and contingency management), workforce development (funding for loan forgiveness and other incentives), family support (funding for families coping with addiction or who have lost loved ones) and data collection and analysis.
Other news in addiction policy
McKinsey reaches opioid settlement with health plans
McKinsey has agreed to pay $78 million to resolve claims by health insurers and benefit plans that it fueled the opioid crisis through its work for pharmaceutical companies including Purdue. The settlement marked the last in a series of settlements McKinsey has reached resolving lawsuits over the opioid crisis. McKinsey previously paid $641.5 million to resolve claims by state attorneys general and another $230 million to resolve claims by local governments. It has also settled cases by Native American tribes. This class action settlement, which requires a judge’s approval, resolves claims by third-party payers like insurers that provide health and welfare benefits. McKinsey did not admit wrongdoing.
Source: McKinsey to pay $78 million in US opioid settlement with health plans (Reuters)