Policy News Roundup: June 1, 2023

Key reads

Appeals court clears way for Purdue settlement that protects Sacklers from future lawsuits

A federal appeals court cleared the way for Purdue to settle thousands of lawsuits related to the opioid crisis while shielding the owners, the Sackler family, from future lawsuits. The Sackler family would give up ownership of Purdue, which would become a new company whose profits would go toward addiction prevention and treatment. Family members would contribute up to $6 billion in cash over time, with at least $750 million going to individual victims of the opioid crisis. The court’s ruling reversed a 2021 ruling that found that bankruptcy court judges did not have the authority to approve a settlement that would offer bankruptcy protections to those who have not filed for bankruptcy. While Purdue filed for bankruptcy, the Sacklers did not. The Justice Department did not say whether it would appeal the ruling to the Supreme Court, ask the Circuit Court to review its decision or accept the ruling.

Source: Ruling clears way for Purdue Pharma to settle opioid claims, protect Sacklers from lawsuits (Associated Press)

Studies show limited buprenorphine availability and how education can increase its prescribing

A study using data from a telehealth opioid use disorder treatment provider group found that only 57.9% of pharmacies called on behalf of patients reported stock of buprenorphine. Chain pharmacies were more likely to report stock compared with independent pharmacies, and there was variation between states and pharmacy brands. Findings supplement prior studies suggesting pharmacy-level barriers in accessing buprenorphine. Federal and state dispensing regulations may be contributing to lack of access at pharmacies. Another study, based on retail pharmacy claims data, found that the mean number of months of buprenorphine treatment per 1,000 persons nationally increased steadily between 2006 and 2018. Requiring that buprenorphine prescribers receive additional education beyond that required to obtain the X-waiver was associated with significant increases, as was requiring continuing medical education for physician licensure related to addiction. None of the other policies examined (Medicaid coverage of buprenorphine, Medicaid expansion, mandatory use of prescription drug monitoring programs, pain management clinic laws) was associated with significant change. Findings suggest requiring education of buprenorphine prescribers and training in addiction treatment for all prescribers could help increase buprenorphine use.

Source: Pharmacy Availability of Buprenorphine for Opioid Use Disorder Treatment in the US (JAMA); Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment (JAMA)

DEA moves to strip distributor Morris & Dickson of its license following yearslong delay

The Drug Enforcement Administration (DEA) has allowed Morris & Dickson Co., one of the nation’s largest drug distributors, to keep shipping opioids for nearly four years after a judge recommended it be stripped of its license for its “cavalier disregard” of suspicious orders fueling the opioid crisis. A high-profile consultant the company hired to stave off punishment is now the DEA administrator’s top deputy, raising concerns about the revolving door between government and industry. Two days after the initial AP report, the DEA formally said it would strip Morris & Dickson of its license to distribute controlled substances within 90 days if some kind of negotiated settlement is not reached. The company said it remains in talks with the agency. The DEA acknowledged its decision to revoke the license took “longer than typical for the agency,” and blamed the pandemic and actions by the company for delays.

Source: Pills flowed for years as DEA dragged feet on disciplining opioid distributor (Associated Press); DEA moves to revoke major drug distributor’s license over opioid crisis failures (NPR)

House passes bills aimed at financing of fentanyl trafficking and scheduling of fentanyl-related substances

The House passed the Preventing the Financing of Illegal Synthetic Drugs Act, which would direct the Comptroller General to study the illicit financing associated with synthetic drug trafficking. The study would lay out the business model of the trafficking organization, how they move and hide their illicit gains and what the government can do to address fentanyl money laundering. The House also passed the HALT Fentanyl Act, which would permanently classify fentanyl-related substances as Schedule I. The GOP-sponsored bill passed with support from 74 Democrats, who wanted to be on record as supporting legislation to address the opioid crisis. The majority of House Democrats, however, opposed the measure due to concerns that it would promote mass incarceration over prevention, treatment and recovery efforts through the establishment of mandatory minimum sentences for the distribution of fentanyl-related substances.

Source: House Passes Rep. Pettersen Bill to Prevent the Financing of Illegal Synthetic Drugs (Brittany Pettersen); Dozens of Democrats join GOP in passing bill on fentanyl-related drug penalties (The Hill)

HIV and substance use syndemics must be addressed together

National Institute on Drug Abuse Director Nora Volkow published a blog post on the syndemics of HIV and substance use. Research shows high rates of HIV transmission among people who use methamphetamine. Individuals who use meth are more likely to have sex without HIV prevention, mental health issues and detectable HIV viral loads, and less likely to take HIV treatment/prevention medication. There have been several recent HIV outbreaks associated with the sharing/reusing of syringes among people who inject substances. Syringe services programs are safe, effective ways to reduce syringe sharing. Many now also offer naloxone and addiction treatment, as well as HIV testing, prevention and treatment. HIV and addiction are both stigmatized. Policies that punish/criminalize substance use and HIV can lead to time in jail/prison, where access to HIV/SUD services may be limited. Immediately after incarceration, people are at greater risk of overdose and leaving HIV care. Integrated care is needed to address these factors, as well as trauma and others leading to poor outcomes.

Source: Still Reaching: The Syndemics that Complicate and Characterize How Drugs and HIV Intersect in People’s Lives (National Institute on Drug Abuse)

Minnesota legalizes recreational marijuana

Minnesota Governor Walz signed into law a bill legalizing adult-use marijuana, making the state the 23rd to legalize recreational marijuana. The law establishes a new Office of Cannabis Management to regulate the new industry and calls for the expungement or resentencing of cannabis-related convictions. It includes a 10% tax on recreational cannabis. Cannabis use and possession of certain amounts will be decriminalized starting August 1. That is also when the establishment of the Cannabis Expungement Board and provisions related to automatic expungement for low-level cannabis offenses take effect. The law allows sales of legal adult-use cannabis to begin in the first quarter of 2025. It also includes grants for cannabis growers; addiction treatment, recovery and prevention; and communities that have disproportionately suffered the effects of cannabis prohibition.

Source: Governor Walz Signs Bill Legalizing Adult-Use Cannabis in Minnesota Starting August 1, 2023 (Office of Governor Time Walz & Lt. Governor Peggy Flanagan)

DC Council considers bill to limit prior authorization

Medical professionals implored a D.C. Council committee this week to regulate prior authorization. Insurance companies say a relatively small percentage of medications and services require approval. Critics, including the American Medical Association, say prior authorization is overused, costs providers time and money and delays treatment to patients with mental health and substance use disorders, who are vulnerable to relapse when experiencing interruptions in care. The bill before the Council would set deadlines for insurers to respond to prior authorization requests and appeals, allow denials only by a District-licensed physician with the same specialty as the patient’s doctor, make approvals last at least a year and honor approvals for 60 days when a patient changes plans. Prior authorization reform bills were considered in 30 states this session, with at least a dozen still up for passage. Advocates for the bill highlighted the detrimental effect of barriers to medications for opioid use disorder amid a ballooning crisis.

Source: In D.C., a fight over ‘Kafkaesque absurdity’ of insurance delays, denials (Washington Post)

Minnesota approves creation of overdose prevention centers

Minnesota has become the second state, after Rhode Island, to officially support overdose prevention centers. Governor Walz signed into law the Human Services budget proposal, which includes language requiring the Minnesota Commissioner of Human Services to establish safe recovery sites that offer harm reduction services and supplies, including safe injection spaces. It also includes more than $14 million in one-time funding to be dispersed annually until 2029 for start-up and capacity-building grants to establish safe recovery sites.

Source: Minnesota Becomes 2nd State to Officially Support Overdose Prevention Centers (Drug Policy Alliance)

New York launches effort to provide free xylazine test strips

New York Governor Hochul announced new actions to address the spread of xylazine, including a new effort to supply free xylazine test strips through Office of Addiction Services and Supports (OASAS) and Office of Mental Health programs, as well as directly to the public. Providers and state residents will be able to order test strips through a partnership with NY MATTERS. OASAS is making xylazine test strips available to its network of Outreach and Engagement Services providers and through its ongoing training programs. Additional educational information for the public about xylazine is now available on the OASAS website. OASAS also recently issued guidance to providers and released a new training program regarding the risk of xylazine. The efforts are supported through the Opioid Settlement Fund and State Opioid Response grant.

Source: Governor Hochul Announces New Actions to Drive Down Growing Presence of Illicit Drug Xylazine and Prevent Overdoses (Governor Kathy Hochul)

Oregon bill would increase oversight of Measure 110 funding

Oregon officials are calling for closer monitoring of where money collected through the state’s drug decriminalization policy (Measure 110) to fund treatment centers is going. State officials recently terminated a grant agreement with a recovery nonprofit accused of failing to submit expenditure and data reports and buying a building for more than double the authorized amount. Few people have accessed treatment services after being ticketed for drug possession, and funding to treatment providers has been delayed. The Associated Press reports that $184 million has been handed out to behavioral health resource networks, in a state of 4.2 million people. Officials say the Measure 110 Oversight and Accountability Council needs more staff and that the Oregon Health Authority needs more leverage to address bureaucratic and administrative barriers to oversight. A bill to provide that remains stuck in the Senate because of a walkout by Republican senators to block Democratic initiatives on abortion rights, transgender care and gun safety.

Source: Oregon, awash in treatment funds after decriminalizing drugs, now must follow the money (Associated Press)

Vermont law allocates opioid settlement funding to harm reduction and treatment

Vermont Governor Scott signed into law a bill to bolster the state’s approach to reduce overdose deaths. The initiatives are the first to be funded by Opioid Settlement Abatement Funds. Funding recommendations were made by the Opioid Settlement Advisory Committee and supported by the governor and legislature. The new law makes Narcan more available and eliminates potential barriers to administration; facilitates access to treatment with buprenorphine and other medications; ensures access to telehealth options for treatment; codifies the decriminalization of personal amounts of un-prescribed buprenorphine; and facilitates disposal of unused needles/syringes through an expansion of the unused prescription drug disposal program. The law also includes a provision to address local zoning, which would allow recovery residences of up to eight people to be treated as permitted single family residential use of property.

Source: Action Taken by Governor Phil Scott on Legislation – May 25, 2023 (State of Vermont Office of Governor Phil Scott)