Policy News Roundup: June 27, 2024

Key reads

Community strategies to reduce overdoses fall short

The National Institutes of Health HEALing Communities Study randomly assigned 67 communities in Kentucky, Massachusetts, New York and Ohio to deploy evidence-based practices to reduce overdose deaths. Intervention communities implemented 615 evidence-based practice strategies, including opioid education and naloxone distribution, the use of medications for opioid use disorder and prescription opioid safety. Implementing these strategies did not result in a statistically significant reduction in opioid overdose death rates during the evaluation period (July 2021-June 2022). The COVID-19 pandemic, short implementation period (10 months) and the increasing prevalence of fentanyl in the illicit drug supply likely weakened the impact of the intervention. Despite these challenges, the study successfully engaged communities to implement hundreds of evidence-based strategies, demonstrating how leveraging community partnerships and using data to inform public health decisions can effectively support uptake of evidence-based strategies at the local level.

Source: Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths (New England Journal of Medicine); NIH-funded intervention did not impact opioid-related overdose death rates over evaluation period (National Institutes of Health)

Some areas successfully use data to decrease overdose deaths

While fatal overdoses increased significantly during the pandemic on a national level, some areas saw decreases. This includes several participants in the HEALing Communities study, even though they did not hit the project’s 40% overdose death reduction goal. Leaders of a Lucas County, Ohio, initiative, for example, believe their data-driven approach to targeting resources could be a model, if they convince lawmakers to continue funding and eliminate red tape. The study and associated federal money ended last year, and communities are having a hard time getting states to invest in interventions and keep momentum going. Other barriers include workforce shortages, licensing requirements and prescribing limitations. Opioid settlement money could support infrastructure that HEALing Communities built, but much of that funding has not been deployed, and politicians are navigating competing demands for the money.

Source: Opioid deaths rose 50 percent during the pandemic. In these places, they fell. (Politico)

Surgeon General calls for social media warning labels

Surgeon General Vivek Murthy called for a warning label on social media platforms on the risks to adolescents’ mental health. Evidence is mixed on the impact of social media on youth mental health, but Murthy argues that it has not been proven to be safe and that the mental health crisis requires urgent action, even if research is incomplete. Congressional action is needed to require warning labels, however. Murthy also calls for Congress to restrict the use of features like push notifications, autoplay and infinite scroll; companies to be required to share data on health effects to allow independent safety audits; schools to ensure that classroom learning and social time are phone-free; parents to create phone-free zones, wait until after middle school to allow social media access and establish shared rules with other families; young people to support one another; public health leaders to demand healthy digital environments for young people; and clinicians to raise the issue of social media with kids and parents and guide them toward safer practices.

Source: Surgeon General Calls for Warning Labels on Social Media Platforms (New York Times); America’s Top Doctor on Why He Wants Warning Labels on Social Media (The New York Times)

Surgeon General issues advisory on firearm violence

Surgeon General Murthy released a Surgeon General’s Advisory on Firearm Violence, declaring firearm violence a public health crisis. The advisory details the impact of gun violence beyond death and injury, describing the cascading harm for youth, families and communities, including worrying about firearm violence and collective trauma. The effects of firearm violence and the threat it poses to young people negatively affect their mental health, and family members of victims of firearm violence experience increased risk of mental health challenges. More than half of firearm-related deaths in 2022 were from suicide. The advisory outlines a public health approach to addressing the crisis, which includes increased mental health access and support, such as increasing access to affordable, high quality mental health care and substance use treatment and building on investments to enhance safety measures and evidence-based violence prevention efforts in learning settings.

Source: U.S. Surgeon General Issues Advisory on the Public Health Crisis of Firearm Violence in the United States (Department of Health and Human Services)

Study shows gaps in Medicare's overdose treatment

A study by Department of Health and Human Services researchers found that among Medicare beneficiaries, in the 12 months following a nonfatal overdose, 17.4% experienced at least one subsequent nonfatal overdose, and 1% died of a fatal overdose. The odds of dying from a subsequent overdose decreased among those who received methadone (58% lower odds), buprenorphine (52% lower odds) or behavioral health assessment or crisis services (75% lower odds). The risk among those who filled a naloxone prescription decreased by 30%. However, only 4.1% received any medications for opioid use disorder, and 6.2% filled a naloxone prescription.

Source: Federal Study Examines Care Following Nonfatal Overdose Among Medicare Beneficiaries; Identifies Effective Interventions and Gaps in Care (Substance Abuse and Mental Health Services Administration)

FDA authorizes first menthol-flavored e-cigarettes

The Food and Drug Administration authorized the marketing of four menthol-flavored e-cigarette products made by NJOY. The authorizations are the first for non-tobacco-flavored e-cigarette products. The FDA said the evidence submitted by NJOY showed that the products provided a benefit for adults who smoke cigarettes beyond that of previously approved tobacco-flavored products and was sufficient to outweigh the risks of the product, including youth appeal. However, the FDA has placed stringent marketing restrictions on the products to prevent youth access and exposure. It will closely monitor how the menthol e-cigarettes are marketed and will take action if NJOY fails to comply with its restrictions. It may suspend or withdraw the marketing authorization if there is a significant increase in youth use of the products, if people who formerly smoked start to use the products or if people who smoke do not switch to the products.

Source: FDA Authorizes Marketing of Four Menthol-Flavored E-Cigarette Products After Extensive Scientific Review (Food and Drug Administration)

Bipartisan Safer Communities Act funding mental health in first two years

This week marks the second anniversary of the Bipartisan Safer Communities Act, which included unprecedented investment to address the mental health crisis and trauma related to gun violence. BSCA represents an important step to strengthen the mental health care system, improve access to behavioral health care and bring supports and services into schools, communities and areas that have experienced trauma or natural disasters. For the anniversary, the Department of Health and Human Services announced that 18 states will receive $50 million in BSCA funding to help expand Medicaid services in schools. The states will use the grants to support efforts to connect millions more children to critical health care services, especially mental health services.

Source: Statement from Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D. on Second Anniversary of the Bipartisan Safer Communities Act (Substance Abuse and Mental Health Services Administration)

Maryland pardons 175,000 marijuana convictions

Maryland Governor Moore issued a mass pardon of more than 175,000 marijuana convictions, one of the nation’s most sweeping acts of clemency involving marijuana. The pardon will automatically forgive misdemeanor marijuana possession charges, as well as misdemeanor paraphernalia charges tied to use or possession of marijuana (the only state to do so). Marijuana use is now legal in many places, but old criminal records stemming from marijuana possession are still often used to deny housing, employment and education, and Black and Brown people are disproportionately impacted. Nine other states and multiple cities have pardoned hundreds of thousands of marijuana convictions in recent years, but Maryland’s move will have a uniquely large impact on people of color. However, mass pardons do not have as great an impact as expungements, as they forgive a crime but do not erase the conviction records. State-level expungements are not always automatic, and people often do not have the time or means to petition a court to have their case stricken.

Source: Maryland governor pardons 175,000 marijuana convictions in sweeping order; Maryland’s marijuana pardons reflect uneven shift in U.S. drug policy (The Washington Post)

Arizona argues about opioid settlement fund spending

A judge temporarily blocked, and then permitted, the transfer of $115 million in Arizona opioid settlement funds to the Department of Corrections, Rehabilitation and Reentry that legislators approved as a key component of balancing a budget deficit. The court stepped in after Attorney General Mayes filed a lawsuit and asked a judge to take emergency action. The settlements gave sole authority to attorneys general to distribute the funds and required they be used for opioid abatement. Mayes noted that the state is obligated to spend at least 85% of the money for authorized uses, and that failure to do so would allow companies to claw back settlement money. Governor Hobbs’ administration said that the funds would be used for opioid use disorder (OUD) treatment for those involved in the criminal legal system, a population disproportionately impacted by the opioid crisis. The administration also said that the budget explicitly says the funds may only be used to “offset past and current department costs for care, treatment, programs, and other expenditures for individuals with OUD,” which are allowable uses under the settlement agreement. Mayes said she will be watching the department closely to ensure funds go toward addressing opioid use disorder.

Source: Judge blocks use of opioid settlement money to balance Arizona’s budget deficit (AZ Mirror)

WHO report finds over 3 million annual deaths due to alcohol and other substance use

A World Health Organization report provides 2019 data on the public health impact of alcohol and other substance use worldwide. An estimated 400 million people lived with alcohol and substance  use disorders, including 209 million with alcohol dependence. WHO said 2.6 million deaths per year were attributable to alcohol consumption (4.7% of deaths), and 0.6 million were due to other substance use. The proportion of people in contact with substance use disorder (SUD) treatment services ranged by country from less than 1% to no more than 35%. Most countries did not have a specific budget line or data on governmental expenditures for SUD treatment. Almost half reported that they do not offer mutual help or peer support groups for SUD. Governments and partners need to increase awareness through steps that include a global advocacy campaign; strengthening prevention and treatment capacity; scaling up health professional training; engaging civil society organizations, professional associations and people with lived experience; and improving monitoring and research.

Source: Over 3 million annual deaths due to alcohol and drug use, majority among men (World Health Organization)