Strategies and recommendations for allocation of opioid litigation funds
The RAND-USC Schaeffer Opioid Policy Tools and Information Center (OPTIC) has created a compilation of guiding principles for allocating opioid settlement funds, recommendations for addressing the root causes of overdose death and profiles of studies assessing the effectiveness of specific programs and policies. The report aims to help states and communities effectively allocate opioid settlement funds and avoid the missteps of the tobacco settlement. It provides several takeaways and recommendations, including a warning that no single policy or program can address the unique characteristics in a community and noting that access to evidence-based treatment for opioid use disorder reduces opioid-related harms and does not necessarily require large spending. The report also states that the opioid crisis has evolved into a polysubstance crisis and strategies should be comprehensive to address this rather than narrowly targeted to opioids. It includes both a chapter Partnership to End Addiction wrote on treatment in a report on opioid abatement and principles that 30 organizations, including Partnership, have signed on to.
Source: Strategies for Effectively Allocating Opioid Settlement Funds (The RAND Corporation)
Clinical trial tests "one-stop" mobile clinics for integrated HIV and substance use disorder services
A NIDA clinical trial is underway in five cities to determine whether delivering integrated health services through mobile clinics can improve HIV and substance use disorder outcomes among people with opioid use disorder who inject drugs. If effective, mobile clinics could serve as an innovative strategy for expanding access to care and providing uninterrupted treatment in this underserved population. The study aims to address challenges to treatment in this population by providing holistic health services delivered in accessible mobile clinics, including access to buprenorphine, naloxone, syringe services, HIV testing, antiretroviral therapy for HIV, PrEP for HIV prevention, testing for hepatitis and sexually transmitted infections, and primary care services. The clinics will be placed in residential areas determined to be accessible to the population. Participants will also receive access to trained peer navigators to help coordinate and facilitate care visits. Investigators will analyze health outcomes, as well as cost-effectiveness and the logistical value of delivering care through mobile clinics as compared to community-based agencies.
NIDA director encourages COVID-19 vaccination for people with substance use disorder
NIDA Director Nora Volkow has written a blog post on ensuring people with substance use disorder receive the COVID-19 vaccine. She writes that People with SUD are at greater risk for becoming severely ill from COVID-19, making it especially important that people who use substances are vaccinated. Volkow’s post states that community leaders, health care providers and others in the community must encourage and facilitate vaccination for people who use substances, who have a history of experiencing stigma from the health care system and may be hesitant. The benefits go beyond protection from COVID-19, as vaccination will help begin a return to normalcy, including greater access to services for people with substance use disorder and other mental health issues. Volkow argues that health care providers, pharmacies, treatment centers and others who are part of the vaccine-dispensing effort should prioritize trying to reach people who use substances, and opioid treatment programs and syringe services programs should also make vaccines available. She suggests that mobile vans dispensing medications for opioid use disorder during the pandemic could be leveraged to provide COVID-19 vaccines.
Supreme Court rules for a limited application of the First Step Act
This week, the Supreme Court unanimously ruled that the 2018 First Step Act, aimed at reducing sentences for drug offenders and addressing racial disparities in punishment, offers no relief to many serving long federal prison terms. The justices held that while the First Step Act allows retroactive reductions for those serving mandatory minimum drug sentences, it does not apply to cases where judges had greater discretion but still imposed long terms. The decision means some sentenced for distribution of relatively small quantities of crack cocaine may see no benefit from the law, while those who dealt larger amounts got their sentences shortened by an average of almost six years. During the Trump administration, the Justice Department endorsed this narrower view of the law, but it reversed its position in the case after President Biden took office, arguing that the law does allow sentence reductions for lower-level offenders. Authors of the law and drug sentencing reform advocates also endorsed that interpretation, but no members of the court agreed.
Source: Supreme Court: First Step Act snubs some drug offenders (Politico)
HRSA is working to bolster the behavioral health workforce
The Health Resources & Services Administration (HRSA) announced $22 million in awards to 56 recipients as part of the Behavioral Health Workforce and Education Training Program for Professionals, bringing the total awards to $66 million for 169 organizations through to the American Rescue Plan. Recipient organizations will train graduate students of social work, psychology and other behavioral health disciplines to work with vulnerable populations, particularly children, adolescents and transitional-aged youth at risk for behavioral health disorders. Trainees will gain experience working in underserved communities where services are most urgently needed through placements in community-based settings. HRSA also launched a new program to encourage more medical students and health care professionals to pursue a career treating addiction. The Substance Use Disorder Treatment and Recovery Loan Repayment Program, established by the SUPPORT Act in 2018, will provide up to $250,000 in educational loans to individuals who pledge a six-year, full-time minimum service commitment to treating addiction.
Source: HRSA awards nearly $66 million to bolster the nation’s behavioral health workforce for underserved communities (HRSA); ASAM Applauds Launch of HRSA Substance Use Disorder Treatment and Recovery Loan Repayment Program (American Society of Addiction Medicine)
State and local news
States are increasingly using Medicaid waivers to improve behavioral health services
As the nation experiences unprecedented levels of behavioral health needs, state Medicaid programs have increasingly looked for flexibility to craft services and payment models that support improved access and outcomes. The Centers for Medicare and Medicaid Services has waived restrictions on inpatient mental health and substance use disorder services and permitted states to leverage 1,115 waiver demonstrations to support broad reform. States are using these demonstrations to provide additional treatment and recovery services, targeted delivery system reform with behavioral health components and coverage expansion for individuals with behavioral health needs.
Five bills to address the overdose crisis pass in New York
A package of five bills to address the overdose crisis in New York have passed the Senate and Assembly and now await signature from the governor. S6683/A2466 would establish a state opioid settlement fund to ensure that dollars from forthcoming lawsuits go directly to treatment, prevention, recovery and harm reduction efforts without supplanting existing funds. A533/S1795 would ensure that medications for opioid use disorder are available for everyone in jails and prisons in the state. S649/A02030 would ban prior authorization for addiction treatment in the state’s Medicaid program, mirroring legislation passed last year to do the same in commercial insurance. S2523/A868 would decriminalize syringes, repealing the law that criminalized their possession. S1144/A5576 would curtail the use of technical parole violations, including substance use, to reincarcerate individuals who have not committed a new criminal offense.
Source: LAC Celebrates Passage of Several Bills to End Overdose in New York State (Legal Action Center)
Health center in Washington state offers low-barrier treatment for opioid use disorder
Capital Recovery Center’s Olympia Bupe Clinic in Olympia, Washington, is a walk-in evening clinic set up to reduce barriers to accessing buprenorphine. Capital Recovery Center uses a peer-to-peer model of support, offering services including peer counseling, support groups, employment support and outreach to individuals facing homelessness, the risk of continued substance use and involvement with the justice system. At the Bupe Clinic, medical professionals work with peers who assist patients in obtaining insurance, ID cards and transportation; act as patients’ advocates in clinical decision-making; and help transfer them to residential and outpatient treatment as needed. The clinic is designed on harm reduction principles. Visits and medication are provided at no cost regardless of insurance status. In addition, community medical professionals prescribe medications and dispense them on site starting with the initial visit, and continued substance use does not exclude patients from ongoing buprenorphine prescriptions. The center will conduct an evaluation of its program to assess patient outcomes, processes and clinic experience, among other factors.
North Carolina is working to expand buprenorphine training for health care providers
North Carolina’s rate of buprenorphine prescribers per opioid death falls well below the national average. However, the state’s Opioid Action Plan addresses the provider shortage through coordinated residency training in family medicine, internal medicine, OB-GYN, psychiatry, emergency medicine and pediatrics. So far, over 1,000 residents in over 50 residencies in the state have been trained. Additionally, the schools of medicine at UNC Chapel Hill, East Carolina University, Wake Forest University and Campbell University have all integrated the eight hours of training for buprenorphine prescribing into their standard medical school curriculum. Seven of the state’s nurse practitioner programs and one physician assistant program have integrated the required 24 hours of training.
Source: Expanding medication-assisted therapy training for health care professionals (North Carolina Health News)
Other news in addiction policy
AMA changes policies to help ensure addiction treatment is available in correctional facilities
To help ensure that substance use disorder treatment is available in correctional facilities and upon release, the American Medical Association Board of Trustees modified policy to endorse medications for opioid use disorder (MOUD) as the standard of care for persons with OUD who are incarcerated; to advocate for legislation, standards, policies and funding that require correctional facilities to increase access to treatment; to work with addiction treatment physician-led teams, case managers, social workers and pharmacies to offer post-incarceration treatment plans; and to advocate that all correctional facilities use a validated screening tool to identify opioid withdrawal and determine potential need for treatment for all upon entry. They amended another policy to advocate and require a smooth transition between correction systems, community health systems and state insurance programs to provide access to a continuum of care; to advocate that Congress repeal the exclusions for Medicare and Medicaid coverage for inmates; to collaborate with medical societies and regulators to emphasize the importance of information sessions on addiction, treatment and stigma for individuals who are incarcerated and correctional staff; to advocate for continued funding for health insurance benefits for individuals in pre-trial detention; and to advocate for the prohibition of co-payments for health care services in correctional facilities.
Syringe services programs increasingly in danger of being shut down
Public health experts are increasingly warning that recent efforts to shutter needle exchanges in Republican-led areas could indicate renewed Republican backlash to the programs. The pushback is happening amid increases in overdose deaths, HIV outbreaks, and rates of hepatitis. Many Republicans have long accused the programs of encouraging addiction, despite research that shows otherwise. Their opposition softened in the last decade as the opioid crisis devastated communities and Trump pledged to defeat it, but health experts fear the country is witnessing the start of a broader Republican rebellion against such programs, fueled in part by anti-science backlash to COVID-19 restrictions. Jerome Adams, Surgeon General under Trump, has worked to implement and save syringe services programs and said there is an element of fatigue among Republicans, who are more likely to believe addiction is a moral failing rather than a treatable disease. After seeing the crisis persist despite Congress and states committing billions of dollars for prevention and treatment, they feel people need to take responsibility for their actions.
Source: Republicans rebel against a powerful anti-opioid tool (Politico)
Demand Equitable Insurance Coverage for Addiction Treatment
Ask your members of Congress to cosponsor legislation to strengthen parity enforcement. The Parity Enforcement Act would allow the Department of Labor to investigate and levy penalties against insurers that offer plans that violate parity, and the Parity Implementation Assistance Act would increase parity enforcement at the state level by providing grants to states to support their oversight of health plans’ compliance.