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    Policy News Roundup: July 21, 2022

    Key reads

    Overdose deaths and racial disparities continue to increase

    A report from the Centers for Disease Control and Prevention found that while overall overdose deaths increased by 30% from 2019 to 2020, rates increased by 44% among Black individuals and 39% among American Indian/Alaska Native (AI/AN) people. Rates among White, Asian/Pacific Islander and Hispanic people all increased by about 22%. In 2020, the highest overdose death rates were also among Black and AI/AN individuals. Black men 65 and older died from overdoses at nearly seven times the rates as White men 65 and older. Black individuals 15-24 had the biggest rate increase, 86%, compared to 34% for White individuals that age. The vast majority of people who died did not have evidence of past treatment, though White people had higher rates of treatment than people of other races/ethnicities. Disparities in overdose deaths, particularly among Black individuals, were larger in counties with greater income inequality.

    Source: As overdose deaths exploded during the pandemic, racial disparities widened, CDC report shows (STAT)

    Take-home methadone policies did not lead to increased overdoses

    A study found that the flexibilities allowing for increased methadone take-home doses during COVID-19 did not lead to more methadone overdose deaths. Overdose deaths both with and without methadone increased during March 2020, but overdose deaths that did not involve methadone continued to rise after the policy change, while overdoses involving methadone held steady. The percentage of overdose deaths involving methadone declined at similar rates before and after the take-home policy change. Findings suggest that the modest increase in methadone-involved overdose deaths in March 2020 was associated with the spike in overall overdose deaths driven by fentanyl early in the pandemic, rather than associated with take-home policy changes. Coupled with research demonstrating improved patient satisfaction, treatment access and engagement from these policies, these findings can inform decisions about permanently expanding take-home methadone.

    Source: Methadone ODs Didn’t Rise in Pandemic, Supporting Use as At-Home Treatment (HealthDay)

    Federal news

    988 crisis line launches

    On Saturday, the U.S. transitioned the 10-digit National Suicide Prevention Lifeline to 988 for 24/7 crisis care. Since January 2021, the Biden administration has invested $432 million to scale crisis center capacity, increasing investments in the lifeline by 18-fold. The funding has helped scale up crisis centers and back-up center capacity and provide special services, including a sub-network for Spanish-speakers. The funding included $105 million in grants to state and territories, through the American Rescue Plan, to improve response rates, increase capacity and ensure calls are first routed to local, regional or state crisis call centers. In 2021, the Lifeline received 3.6 million calls, chats and texts. That number is expected to at least double within the first full year of 988.

    Source: U.S. Transition to 988 Suicide & Crisis Lifeline Begins Saturday (Substance Abuse and Mental Health Services Administration)

    Survey reports on patient placement criteria usage

    A survey of Single State Agencies (SSA) and Medicaid agencies for every state and D.C. found that almost all respondents said they require use of substance use disorder patient placement criteria (PPC). American Society of Addiction Medicine (ASAM) PPC were required among 87% of SSA respondents and 73% of Medicaid agency respondents. The most common mechanism for requiring the use of PPC is through contracts with providers or managed care organizations. However, many states do not require the use of a specific assessment tool. The most commonly required assessment tool is the ASAM Continuum, which is required by only 17% of SSA and 22% of Medicaid respondents. States are collecting patient placement criteria data that can help them understand treatment needs and access by levels of care, but it is more common among SSAs than Medicaid.

    Source: Survey on Substance Use Disorder Patient Placement Criteria and Assessments (Assistant Secretary for Planning and Evaluation)

    State and local news

    Rite Aid reaches opioid settlements

    Rite Aid reached a $10.5 million settlement with counties in three states, allowing it to sit out the next wave of opioid trials, which are slated to begin against national pharmacy chains next year. Rite Aid will pay $3.5 million each to Georgia’s Cobb County, North Carolina’s Durham County and Ohio’s Montgomery County, exiting all scheduled opioid trials in which it is a defendant.

    Source: Rite Aid reaches opioid litigation ceasefire in $10.5 million settlement (Reuters)

    California can serve as example for states implementing 988

    By 988’s launch, only Colorado, Nevada and Washington had passed adequate legislation to facilitate implementation (i.e., having a comprehensive plan for a full behavioral health crisis continuum and ongoing funding to see the systems built out). Eighteen states have introduced 988 fee legislation that has not moved forward. California, a potential model, has approved funding for call centers for year one operations, $7.5 million for start-up funding and $6 million for ongoing funding to implement technical components of 988 and 911-988 interoperability. The state has also approved funding for a new Medicaid benefit that allows a federal match of 85% for mobile crisis intervention services, and additional funding for the Behavioral Health Continuum Infrastructure Program and the Behavioral Health Crisis Continuum Planning program. If passed, AB 988 would establish fees. Remaining states must ensure 988 call centers are equipped to respond, take advantage of federal mobile crisis team funding, launch a statewide planning process and establish sustainable funding.

    Source: The promise of 988 is real. Can states like California set the bar? (Kennedy Forum)

    Data released on first two months of NYC's overdose prevention centers

    In the first two months of the overdose prevention centers (OPC) in New York City (Nov. 30, 2021 to Jan. 31, 2022), 613 individuals used services 5,975 times. Most identified as male, and over half as Hispanic/Latino/Latina. The mean age was 42.5 years. Over 35% reported being street homeless. Fewer than 20% were living in their own rooms or apartments. The substance most commonly used was heroin or fentanyl, and the most frequent route of administration was injection. Over 75% reported that they would have used substances in a public or semipublic location if OPC services had not been available. Staff responded 125 times to mitigate overdose risk. For opioid overdose risk, naloxone was administered 19 times and oxygen 35 times. Staff responded 45 times to stimulant-involved overdose. No fatal overdoses occurred. More than half of individuals using OPC services received additional support during their visit, including naloxone distribution, counseling, hepatitis C testing, medical care and holistic services.

    Source: First 2 Months of Operation at First Publicly Recognized Overdose Prevention Centers in US (JAMA)

    Philadelphia expands bereavement care program to children who have lost a loved one to overdose

    Philadelphia HEALs (Healing and Empowerment After Loss), the Philadelphia Department of Public Health’s Bereavement Care Program, is extending their services to include bereavement counseling to children and adolescents (ages 4-21) who are grieving the loss of a loved one or caregiver to a fatal overdose. To kick off the introduction of this new support service, PhillyHEALs hosted a workshop for caregivers of youth who have experienced sudden or traumatic loss due to fatal overdose.

    Source: Health Department’s Bereavement Care Program Announces New Service Offering Counseling to Child Survivors of Loss Due to Substance Use (City of Philadelphia)

    Other news in addiction policy

    Increased investment in prevention is needed to address the addiction crisis

    Prevention is an often-overlooked strategy for addressing the opioid crisis. Substance use disorders are commonly preceded by psychological and behavioral problems, which can often be traced back to adverse social determinants of health (e.g., poverty, family dysfunction, racism and economic insecurity). While we know the best practices that foster healthy child development and help prevent substance use, broad and consistent investment in preventive strategies is needed. Proactive strategies for early identification of warning signs and preventing childhood exposure to contributory conditions not only reduce substance use, but also have added benefits such as improved academic performance, reduced bullying and violence, healthier relationships and better emotional and physical health.

    Source: Prevention is our best — and most underrated — weapon against opioids (The Hill)

    Debate rises over whether wilderness therapy has enough evidence to require its coverage by insurance companies

    Some parents are turning to the legal system to force payment from insurers who denied coverage for wilderness therapy they claim helped their children. Judges must decide whether the therapy has enough evidence behind it to warrant coverage. After the Mental Health Parity and Addiction Equity Act was enacted, many insurers eliminated residential exclusions, but wilderness therapy was not mentioned, so those exclusions remained. It is hard to find a medical analogue to wilderness therapy, making it difficult to prove a parity violation. The burden is on the person suing to prove the insurer acted in an “arbitrary and capricious” manner. Insurers typically only reimburse for treatment from licensed providers, and not all states have licensing programs that include wilderness therapy. There have been a handful of cases in which judges have agreed that insurers violated parity. There is also a large contingent trying to shut down the industry after stories of abuse.

    Source: Insurers, courts grapple with how and when to pay for wilderness therapy — a polarizing industry with a sordid past (STAT)

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