Policy News Roundup: June 22, 2023

Key reads

Opioid settlement amounts paid to localities made public

Finding out the precise amount each city or county is receiving from opioid settlements has been nearly impossible because the firm administering the settlement has not made the information public, but KFF Health News has now obtained documents showing the amounts local governments were allocated for 2022 and 2023. Some states have posted distribution specifics online, but in most places, tracking payment amounts requires phone calls, emails and public records requests with local governments. State attorneys general have touted these deals as big achievements, but if one community compares its several-hundred-dollar payout to another’s multi-thousand-dollar payout, there may be political fallout. Concerns have arisen in hard-hit rural areas that the distribution formula weighs population numbers too heavily. Experts say making the data public is crucial, as solutions have to be community-led, but in order to do that, communities need to know how much money they are getting. Knowing the amount also allows people to track the funds and ensure they are not misspent.

Source: Opioid Settlement Payouts to Localities Made Public for First Time (KFF Health News)

White House meets with pharmaceutical companies on naloxone cost

White House officials met with pharmaceutical company representatives to address concerns about the affordability of overdose reversal drugs. The meeting included Emergent BioSolutions, Pfizer, Hikma, Padagis, Amphastar Pharmaceuticals, US WorldMeds, Aptar Pharma, Indivior, Adamis Pharmaceuticals Corporation and Teva. Administration officials reiterated the urgent directive to increase access and affordability of overdose reversal medications. They called on manufacturers to take robust actions in support of the administration’s guiding principles, which include that no one who needs overdose reversal medications should lack access because of cost or availability; that at-risk communities should be saturated with these medications; that organizations serving high-risk individuals should not need to ration these medications; that more must be done to raise public awareness; and that public health agencies need timely, actionable data on distribution and gaps in access. Experts applauded the effort but cautioned that the summit would not lead manufacturers to dramatically lower prices, especially when other factors affect prices, including costs of manufacturing and insurance coverage.

Source: White House meets with drug firms on cost of overdose-reversal drugs (Washington Post); Readout of White House Meeting on Increasing Access and Affordability of FDA-Approved Overdose Reversal Medications (White House)

House Energy and Commerce Committee holds hearing on legislation to address addiction

The House Energy and Commerce Committee’s Health Subcommittee held a hearing on legislation to build upon the SUPPORT Act to respond to the overdose crisis. Nearly 30 bills were up for discussion, including many to reauthorize key SUPPORT Act programs set to expire September 30. Witnesses included officials from the Drug Enforcement Administration, Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, Health Resources and Services Administration and Centers for Medicare and Medicaid Services.

Source: Chairs Rodgers, Guthrie Announce Subcommittee Legislative Hearing on Solutions to Address Substance Use Disorder (House Energy & Commerce Committee)

White House regulatory agenda released

The Office of Information and Regulatory Review released its Spring Regulatory Agenda, which details actions federal agencies are considering over the coming months. The agenda is a nonbinding list of the administration’s priorities. It includes potential policies aimed at prescribing certain medications through telemedicine (including buprenorphine), rules to establish maximum nicotine levels in cigarettes and other tobacco products, rules to ban menthol cigarettes and prohibit flavors in cigars, proposed revisions to opioid treatment program rules (such as making permanent take-home and telehealth COVID flexibilities and reviewing admission criteria), proposed updates to parity rules, rules on prescribing medications for opioid use disorder and substance use disorder patient record confidentiality rules, among many others.

Source: The 2023 Spring Regulatory Agenda (White House); The White House’s regulatory roundup (The Washington Post)

Education Department and HHS send letter to governors on mental health efforts

The Department of Education and Department of Health and Human Services (HHS) took steps to advance the investments and efforts set forth by the Bipartisan Safer Communities Act, which included crucial mental health investments. The Departments sent a joint letter to governors highlighting resources to help states, communities and schools support students’ mental health and wellbeing, particularly students impacted by gun violence. The letter highlights the Department of Education’s investments and capacity-building efforts that will expand and improve school-based mental health services, address community violence, provide wraparound supports and promote a safe and supportive school climate. The letter also outlines HHS’s efforts to support the development of school-based mental health supports; prepare and train school personnel, emergency first responders, law enforcement and others to recognize the signs and symptoms of mental health impacts from gun violence; and increase treatment and support services for individuals and communities affected by trauma, including trauma caused by gun violence.

Source: The Biden-Harris Administration Takes Additional Actions to Address Mental Health Needs of Young People and Make Communities Safer from Gun Violence (Department of Health and Human Services)

Process for local organizations to receive opioid settlement funds is unclear

When money from opioid settlements will be paid out, and who will get it, remains unclear. Many working in the field say they are in the dark about how, and whether, their work will benefit. Reuters reached out to all 50 states and D.C. to ask whether they had a process for non-governmental organizations to apply for funding from the settlements and looked online for information. Out of 40 states and D.C. with responses/information, Reuters could only confirm that 16 had central, statewide, publicly available processes for organizations to apply for funding. Some of the remaining states said they planned to open an application process soon. Others offered no specific details about future plans. Money is already reaching organizations on the ground in some states, but other states do not even expect to open up grant applications until next year.

Source: For groups fighting U.S. opioid crisis, settlement money can be hard to come by (Reuters)

Few states have published plans for initial spending of opioid settlement funds

A National Academy for State Health Policy brief provides an overview of published statewide opioid settlement spending plans and appropriations made to date and highlights initial priorities and investments outlined. Seventeen states have now approved and published their plans for a first year of spending, which often include priority areas or approved uses for funds. A smaller subset (10) have awarded settlement funds to specific abatement programs. At least 10 states have published annual reports on settlement-related activities. At least five have created spending recommendations awaiting approval or legislative action, and at least seven are currently reviewing applications from local governments and treatment programs as part of open requests for applications.

Source: An Early Look at State Opioid Settlement Spending Decisions (National Academy for State Health Policy)

Governors address mental health and substance use in their State of the State addresses

In 2023, governors used their State of the State addresses to discuss issues concerning criminal justice and public safety, including substance use disorder (SUD) and mental health services and community response. At least 20 states and territories mentioned opioid or stimulant substance use. At least eight referenced initiatives for providing increased access to treatment and services for those affected by SUD. Others adopted a public safety-focused approach to the opioid crisis by addressing the illicit drug trade and the role of law enforcement. More than half of the nation’s governors spoke about mental health and the need to increase investments, opportunities for co-responder models with law enforcement and utilization of diversion and community-based treatment models to prevent individuals struggling with mental illness from being incarcerated.

Source: 2023 State Of The State Addresses: Criminal Justice And Public Safety Priorities (National Governors Association)

Minnesota plans to spend $200 million over four years to address substance use

Minnesota is pumping $200 million over the next four years into fighting the addiction crisis. Laws passed in the recent legislative session will require overdose reversal medication for schools, jails and law enforcement; dedicate $10 million to housing for people with substance use disorder; and allow the sale of fentanyl test strips at liquor stores. The budget earmarks $26 million for harm reduction services such as sterile needle exchange, access to health care and personal hygiene facilities. Grants could eventually go to safe injection sites. Peer-to-peer recovery and groups working within communities at greater risk of overdose, including Black and Native American communities, will get more funding. Minnesota will become one of the first states to fully decriminalize possession of drug paraphernalia. Criminal penalties will increase for people selling fentanyl.

Source: Inside Minnesota’s $200 million push to combat the substance abuse crisis (Axios)

Opioid overdose reversal complicated by xylazine

Xylazine is not an opioid, so its effects cannot be reversed with naloxone. As xylazine grows more common, harm reduction groups have reported that overdoses are becoming more difficult to reverse, saying that people experiencing overdoses from a combination of opioids and xylazine are requiring more time and care before they regain consciousness. Emergency responders and harm reduction workers are increasingly using whatever tools and techniques available to make sure oxygen is reaching overdose victims’ brains, including mouth-to-mouth breathing and oxygen masks. Doctors, first responders, public health officials and nonprofits have scrambled to formalize new overdose response protocols and new instructions for bystanders. Rather than just administering naloxone and calling 911, new instructions also include immediately starting rescue breathing. Awareness remains an issue for potential bystanders and first responders, as well as for people who use substances and those recovering from an overdose. Some are still responding with large, repeated doses of naloxone and little else. Administering too much naloxone, though, can be dangerous, as the larger the dose, the worse the withdrawal symptoms.

Source: Xylazine, or ‘tranq,’ is making opioid overdoses harder to reverse (STAT)