Policy News Roundup: July 20, 2023

    Key reads

    White House releases plan to respond to xylazine

    The Office of National Drug Control Policy (ONDCP) released a National Response Plan to address xylazine mixed with fentanyl. ONDCP declared xylazine-laced fentanyl an emerging threat in April and called for a national strategy to combat it. The plan focuses on 6 pillars – testing; data collection; evidence-based prevention, harm reduction and treatment; supply reduction; scheduling; and research. It calls for exploring making xylazine a scheduled drug but does not recommend new restrictions on the veterinary medication. The plan calls for a standardized testing approach for medical examiners and health departments and for the development of rapid tests for use by hospitals and community workers who treat people experiencing overdoses. It also calls for developing medical billing codes for treatment of xylazine-impacted patients; developing and educating health professionals on best practices to treat xylazine withdrawal, addiction and wounds; identifying and disrupting illegal imports of xylazine; and researching new drug options to reverse xylazine overdoses. The goal is reducing xylazine-related overdose deaths by 15% by 2025.

    Source: White House lays out effort against animal sedative xylazine but doesn’t call for new restrictions (Associated Press)

    House committee advances SUPPORT Act reauthorization

    The House Energy and Commerce Committee voted to advance the SUPPORT Reauthorization Act to reauthorize expiring programs addressing prevention, treatment and recovery services. It would include fentanyl or xylazine test strips as an allowable use of grant funds in states where they are legal, clarify that grants may be used for other substance use disorders that co-occur with opioid or stimulant use disorder, provide for the review of scheduling of buprenorphine-naloxone products, and place xylazine in Schedule III but exclude certain animal uses. It would make permanent requirements for state Medicaid programs to cover all forms of medication for addiction treatment and for annual data on the utilization of substance use and mental health services by Medicaid beneficiaries. The Committee added provisions to eliminate the IMD exclusion that prohibited Medicaid coverage for facilities with more than 16 beds, maintain Medicaid coverage for pregnant individuals in pretrial detention, and prohibit states from disenrolling people from Medicaid when they are incarcerated, so coverage would automatically resume upon release. The bill now goes to the full House.

    Source: Support for Patients and Communities Reauthorization Act Section-by-Section Summary (Congressman Brett Guthrie); House committee moves to reauthorize landmark opioid treatment bill (Politico)

    Federal news

    CMS rules aim to improve access to behavioral health care

    Through the Physician Fee Schedule and Hospital Outpatient Prospective Payment System proposed rules, the Centers for Medicare and Medicaid Services (CMS) proposed changes to promote access to behavioral health. CMS proposed procedures to allow Marriage and Family Therapists and Mental Health Counselors (including Addiction Counselors who meet all the requirements to be a Mental Health Counselor) to enroll as Medicare providers and to provide Medicare coverage for intensive outpatient services (including at opioid treatment programs), as required by the Consolidated Appropriations Act, 2023. CMS proposed allowing general, rather than direct, supervision for behavioral health services at rural health clinics and federally qualified health centers, which could expand access to services. CMS proposed continuing to allow opioid treatment providers to provide certain services via audio-only technology. CMS proposed changes to more accurately value and pay for behavioral health services, including increasing the payment rate for substance use disorder treatment to better reflect costs of counseling services.

    Source: Important New Changes to Improve Access to Behavioral Health in Medicare (Centers for Medicare and Medicaid Services)

    SAMHSA announces Spanish text and chat services for 988

    The Department of Health and Human Services announced the addition of Spanish text and chat services through 988. Specialized services for LGBTQI+ youth and young adults were also added earlier this month, following a successful pilot test. 988 answered nearly 5 million calls, texts and chats since launching last July, 2 million more than the lifeline received in the previous 12 months. Text contacts increased by 1135%, chats answered increased by 141% and calls answered increased by 46%. Average speed to answer decreased from 2 minutes and 39 seconds to 41 seconds. 988 also uses Language Line Solutions to provide translation services in more than 240 additional languages, and later this year, 988 plans to add video phone service to better serve deaf and hard of hearing individuals. The administration has invested nearly $1 billion into 988 to date.

    Source: 988 Suicide & Crisis Lifeline Adds Spanish Text and Chat Service Ahead of One-Year Anniversary (Substance Abuse and Mental Health Services Administration)

    ONDCP director and surgeon general provide steps to help kids amid the mental health and substance use crisis

    Office of National Drug Control Policy Director Rahul Gupta and Surgeon General Vivek Murthy outline the youth mental health/substance use crisis and recommendations in an opinion article. The crises of untreated mental illness and unsafe substance use are driven by a deadly drug supply and the lack of access to prevention and care. Parents can look for warning signs, open a conversation with their kids about risks of substance use and the importance of caring for mental health, talk to their pediatrician about screening for substance use and mental health conditions and get trained on how to administer naloxone and keep it on hand. Educators can promote positive, safe school environments and lead evidence-based awareness campaigns, learn to recognize warning signs, advocate to have naloxone present at their school and expand school-based prevention programs. Pediatricians can regularly ask patients about mental health and substance use, follow the Screening, Brief Intervention and Referral to Treatment protocol and ensure patients receive care for co-occurring disorders.

    Source: Drugs and untreated mental health issues are killing America’s kids. You can help stop it. (USA Today)

    FTC sends cease and desist letters to companies selling edible delta-8 products that resemble popular snacks

    The Federal Trade Commission (FTC) sent cease and desist letters to six companies marketing edible products containing Delta-8 THC in packaging that is almost identical to many snacks and candy that children eat, including Doritos, Cheetos and Nerds. After reviewing online marketing for Delta-8 THC products sold by the companies, the FTC determined that their advertising may violate Section 5 of the FTC Act, which prohibits unfair or deceptive acts in or affecting commerce, including practices that present unwarranted health or safety risks. The letters stress that preventing practices that present such risks, particularly to children, is one of FTC’s highest priorities, and that imitating non-THC-containing food products that children consume is misleading. The FTC demands the companies stop marketing edible Delta-8 THC products that imitate conventional foods using advertising or packaging that is likely to appeal to young children. The FTC also strongly encourages the sellers to review all of their marketing and packaging for similar products and take swift action to protect consumers, especially young children.

    Source: FTC Sends Cease and Desist Letters with FDA to Companies Selling Edible Products Containing Delta-8 THC in Packaging Nearly Identical to Food Children Eat (Federal Trade Commission)

    Federal policies are changing the landscape of addiction treatment

    A KFF brief examines key federal policies addressing opioid treatment. COVID flexibilities to allow buprenorphine initiation via telehealth was temporarily extended, and policies allowing up to 28 days of take-home methadone doses may become permanent. A 2021 rule authorizes opioid treatment programs to add mobile components, but uptake has been limited. Recent legislation increased the potential treatment workforce by eliminating the X-waiver, allowing all Drug Enforcement Administration (DEA)-registered prescribers to prescribe buprenorphine. However, it is unclear how many will use the authority. Issues such as stigma, lack of time, insufficient reimbursement rates, lack of professional and mental health support, concerns over DEA monitoring and inconsistent access to buprenorphine in pharmacies remain. Recent legislation also requires an eight-hour training on addiction for most DEA-registered providers. Fentanyl has increased demand for harm reduction measures such as fentanyl test strips and naloxone, but they can be expensive and challenging to obtain. Recent demonstration opportunities allow Medicaid to cover pre-release services, including addiction treatment, to address the high risk of overdose after release from incarceration.

    Source: Addressing the Opioid Crisis: A Look at the Evolving Landscape of Federal OUD Treatment Policies (KFF)

    State and local news

    988 continues to make improvements one year in

    One year after 988 launched, the people behind the system say they are still working out some kinks. For example, a caller would ideally be routed to a call center in their area so that hotline workers could direct them to local resources. However, calls currently are routed by area code, not where they are made from. Calls, texts and online chats to 988 have continued to increase since the launch last July. Each center strives to answer calls at least 95% of the time, with varied success. In May, 18 states had phone answer rates above 90%, and 89% of calls nationally were answered. Call centers have struggled to forecast volume and plan staffing accordingly. Workforce shortages remain a problem. Many centers still do not have permanent funding. Crisis centers are working to build mobile response teams, but for now, they still work with 911 operators and police for the small percentage (less than 2%) of calls in which someone is in acute danger and needs immediate assistance.

    Source: One year into 988 hotline, staff push for fixes to ambitious new system (STAT)

    Concerns raised about state councils in charge of opioid settlement funds

    There are concerns about the state councils that wield immense power over how opioid settlement funds are spent. In 14 states, councils have the ultimate say. In 24 others, plus D.C., councils establish budget priorities and make recommendations. They affect whether funds go, for example, to treatment and recovery programs or narcotics detectives and prisons. Councils vary in size, power and the amount of funds they oversee. Members include doctors, researchers, county health directors, law enforcement officers, town managers, business owners, people in recovery and parents who have lost children to addiction. Council membership does not always align with states’ hardest-hit populations, by race or geography. Heavy presence of specific professional groups (such as treatment providers, health care executives and law enforcement officials) may mean money gets directed to those interests at the expense of others. Few seats are reserved for people with lived experience. In most states, law enforcement and criminal justice officials make up fewer than one-fifth of council members, and in some, they are not represented at all.

    Source: Meet the People Deciding How to Spend $50 Billion in Opioid Settlement Cash (KFF Health News)

    Delaware pilots combination fentanyl and xylazine test strip

    Delaware announced a pilot program to distribute the nation’s first combination fentanyl and xylazine test strip. Currently, fentanyl and xylazine test strips are only offered as two separate tests. The new test strips will be distributed at three clinic locations statewide, through mobile syringe services vans and in the community. The new strip, HarmGuard FX, was developed by a Delaware-based company and validated by a Food and Drug Administration-registered testing lab. The product uses a QR code and artificial intelligence-driven portal with geolocation to help people find local resources like counseling, emergency services and free naloxone distribution locations.

    Source: Lt. Governor Bethany Hall-Long, SIVAD, Community Partners Announce Groundbreaking Pilot Program to Reduce Opioid Deaths (Delaware.gov)

    Other news in addiction policy

    Portugal's drug policy approach can provide lessons for the U.S.

    The O’Neill Institute’s Regina LaBelle outlines what the U.S. can learn from Portugal’s drug policies. In 2001, Portugal implemented a comprehensive public health-based drug policy approach that included decriminalization of personal drug possession while maintaining criminal penalties for drug trafficking. It shows that a comprehensive public health approach that is consistently funded and supported can yield positive outcomes and save lives. Key lessons include that substance use disorder should be treated as a matter of public health, not a crime; that substantial and consistent funding should be invested in public health services, including treatment and harm reduction; and that robust financial investments should be allocated to data collection and reporting.

    Source: The US can learn from Portugal’s drug policies, including decriminalization (The Hill)

    Familiarity with 988 is still low after one year, but awareness is growing

    A survey found that only 33% of Americans are at least somewhat familiar with 988 and its services. The survey found 63% had at least heard of 988 in June 2023, compared to only 44% in September 2022. Only 22% said they trust the service “a great deal,” compared to 43% for 911. Sixty percent said they were afraid that they or a loved one could be hurt by police intervening in a mental health crisis, and this is an even bigger fear among LGBTQ+, Black and Hispanic people. 988 only deploys a mobile crisis unit in about 2% of cases, and even then, intervention is led by mental health specialists, but potential callers may not be aware of that. Black respondents were almost twice as likely as White respondents to say mental health services should be the highest priority for federal funding, and more than twice as likely to say federal funding for 988 should be the highest priority.

    Source: Why more Americans aren’t using the 988 mental-health crisis hotline (STAT)