Policy News Roundup: March 10, 2022

    Key reads

    Purdue reaches new settlement agreement with states

    Purdue reached a nationwide settlement over its role in the opioid crisis, with the Sacklers increasing their cash contribution to as much as $6 billion. In all, the plan could be worth more than $10 billion over time. It calls for the Sacklers to give up control of the company, which will be turned into a new entity with profits used to fight the crisis. It would protect the Sacklers from civil lawsuits but not criminal charges. Under the new settlement, victims of the opioid crisis will have a forum in court to address the Sacklers, and the Sacklers agreed that they will not fight when institutions attempt to take their names off buildings funded by their support. Additional company documents will be made public. The plan must still be approved by the bankruptcy judge.

    Source: Purdue Pharma, US states agree to new opioid settlement (Associated Press)

    Opioid settlement and federal funding should be used for youth mental health and substance use prevention

    Linda Richter and Lindsey Vuolo of Partnership to End Addiction, along with Johns Hopkins’ Tamar Mendelson, advocate for using COVID-19 and opioid settlement funding for youth mental health and addiction prevention. States should spend opioid litigation funds on preventing the use of all harmful substances, not just opioids, and should ensure the efforts incorporate mental health promotion. Federal youth mental health funds should include substance use prevention. As investment in treatment, harm reduction and recovery services helps abate the crises, states should increase the percentage of funds spent on prevention. Selected strategies should be delivered across childhood and adolescence in a coordinated fashion. They should be aimed at promoting positive youth development and preventing risk factors, implemented in youth-serving settings, delivered in a tiered fashion, inclusive of parents/caregivers and implemented in a trauma-informed, culturally sensitive and equitable manner. Funding recipients should be required to create Community Advisory Boards, which should conduct community needs assessments and develop data infrastructure. Ensuring sustainability will require investment in prevention infrastructure.

    Source: How To Invest Opioid Settlement And Federal Funding To Prevent Substance Use And Promote Youth Mental Health (Health Affairs)

    Federal news

    HHS launches National Tour to Strengthen Mental Health

    Following the State of the Union, the Department of Health and Human Services (HHS) launched the National Tour to Strengthen Mental Health to hear from Americans about the behavioral health challenges they are facing and engage with local leaders to strengthen communities’ mental health and crisis care systems. Over the next few months, HHS Secretary Becerra will announce new initiatives and resources. These include increasing the number of behavioral health professionals and community/behavioral health support workers in underserved communities, expanding pediatric mental health care access through telehealth and the transition to 988. Becerra will listen and gather ideas about ways to partner with states and communities. The tour will promote health equity and prioritize hearing from diverse voices. The first stop on the tour was Amoskeag Health, a federal qualified health center focused on behavioral health services, which Becerra visited last week. A roundtable discussion with federal, state and local leaders examined innovative ways to address the crisis.

    Source: Secretary Becerra Kicks Off National Tour to Strengthen Mental Health; In New Hampshire, Secretary Becerra Highlighted the Importance of Family Planning and Mental Health Funding (Department of Health and Human Services)

    ONDCP releases model state law to expand deflection programs

    The Office of National Drug Control Policy released the Model Law Enforcement and Other First Responders Deflection Act, which provides a template of suggested legislative provisions that encourage the use and establishment of deflection programs. In a growing number of states, public safety and public health partnerships “deflect” people with substance use and/or mental health disorders away from traditional criminal justice programs and connect them to evidence-based treatment, harm reduction, recovery and prevention services. The measure would authorize law enforcement and first responders to develop and implement collaborative deflection programs; offer immediate pathways to treatment, recovery services, housing, medications for addiction treatment, whole family services and other needed supports, via peer support and case management; require deflection programs to have certain elements to be eligible for grants; and require agencies establishing deflection programs to develop comprehensive memoranda of understanding with all program partners. An accompanying report by the Legislative Analysis and Public Policy Association explores efforts to reduce stigma toward individuals with addiction in public safety and justice settings.

    Source: White House Announces State Model Law to Expand Programs that Deflect People with Addiction to Care (Office of National Drug Control Policy)

    State and local news

    State legislation is supporting school-based mental health

    A national scan of state legislation found that since the onset of the pandemic, 38 states have enacted nearly 100 laws to support children’s mental health through schools. The laws provide funding for school-based mental health services (26 states), strategic planning to improve school mental health systems (12 states), training and resources for school staff and students (24 states) and guidance for school policies (10 states).

    Source: States Take Action to Address Children’s Mental Health in Schools (National Academy for State Health Policy)

    Attorneys general launch investigation into TikTok's harms on youth mental health

    California Attorney General Bonta announced a nationwide investigation into TikTok for promoting its social media platform to children and young adults despite being associated with physical and mental health harms. Attorneys general nationwide are examining whether the company is violating state consumer protection laws and putting children at risk. The investigation will look into the harms using TikTok can cause to young users and what TikTok knew about those harms. It focuses on the techniques used by TikTok to boost young user engagement, including strategies to increase the duration of time spent on the platform and frequency of engagement with the platform.

    Source: Attorney General Bonta Announces Nationwide Investigation into TikTok (California Attorney General Rob Bonta)

    Rhode Island legislature introduces new cannabis legalization bill

    The Rhode Island House and Senate introduced legislation to legalize recreational cannabis, kicking off what will be months of debate before a final bill is potentially approved. The new legislation includes a new framework to oversee the cannabis industry modeled on the system in New York. The plan is a result of talks between the two chambers but does not yet represent a compromise with Governor McKee. The bill would allow adults 21+ to possess up to an ounce of marijuana and grow small amounts at home. It would allow prior marijuana possession charges to be expunged, but only upon request of the convicted person. The debate over who should oversee licensing of stores has been the main disagreement between Senate leaders and McKee and has not been resolved. McKee’s bill also includes automatic expungement.

    Source: New cannabis legalization bill introduced in RI House, Senate (WPRI)

    Other news in addiction policy

    Consensus growing to reform methadone regulations

    Consensus is growing on reforming methadone regulations, which are stigmatizing and create barriers to care by requiring daily clinic visits and other strict requirements for the medication. The Substance Abuse and Mental Health Services Administration is considering permanent changes to the rules. The Opioid Treatment Access Act would allow flexibility on take-home doses, telehealth and treatment vans and allow pharmacies to dispense methadone. However, changes could face resistance from methadone clinics, many of which are for-profit. Their financial models are built on daily patient encounters, counseling and regular drug tests. Opioid treatment programs generally get reimbursed on a fee-for-service model, meaning the more services they provide and the more tests they run, the more they get paid. A shift to a model in which a person comes only once a month could severely restrict revenue. Clinics are also reluctant to loosen rules due to fear of repercussions if doses are diverted or the patient overdoses.

    Source: Calls to Overhaul Methadone Distribution Intensify, but Clinics Resist (Kaiser Health News)

    Pandemic highlights mental health services system beyond its capacity

    It has been difficult to find mental health counseling in much of the U.S. for years, but many seeking help are now confronting a system beyond its capacity. Options are especially limited for children, those with lower income, in rural areas and for those seeking a Black or Latino therapist. In addition to increasing mental health needs caused by the pandemic, more people may be seeking care due to lessening stigma. However, insurance coverage and training slots for new psychiatrists lag behind demand. Online therapy has reduced no-shows and dropouts, cutting into counselors’ availability to accept new clients. People gave up insurance and employee assistance programs when they lost or left jobs during the pandemic. The return to school is leading to a surge in referrals to a pediatric mental health workforce that has not expanded. Some hope the crisis will be used to overhaul the system, and Biden’s recently released plan contains some elements of this.

    Source: This is why it’s so hard to find mental health counseling right now (Washington Post)

    Efforts growing to make pandemic telehealth rules for addiction treatment permanent

    Addiction doctors and telehealth companies are pushing Congress to make COVID-19 telehealth flexibilities for prescribing medications for opioid use disorder permanent. Loosening the rules helped eliminate barriers to care, such as lack of transportation or shortage of prescribers. Republicans and Democrats in both chambers have introduced bills aimed at preserving the flexibility, but none has yet gained traction. Rep. Donald Norcross of New Jersey introduced a bill to allow local pharmacies to distribute methadone. In his State of the Union address, President Biden said it is time to get rid of outdated rules that stop doctors from prescribing treatment. Critics say telehealth makes it more difficult for doctors to determine whether patients are intentionally misusing prescriptions and that the medications will be diverted. There are also concerns about reaching patients without access to smartphones or computers and about privacy. However, emerging research has found that prescribing these medications via telemedicine is not worsening outcomes or leading to intentional prescription medication misuse.

    Source: Doctors, companies push to keep looser, pandemic-era rules for prescribing opioid addiction treatment via telemedicine (STAT)

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    March 2022