Policy News Roundup: March 14, 2024

Key reads

OTP rules make it harder to get treatment and maintain recovery

Many opioid treatment programs (OTPs) rely on controlling, punitive strategies that make it harder, not easier, for patients to maintain recovery. There is little evidence to support many of the practices. Methadone is accessible only at some 2,000 OTPs, many of which enforce outdated rules and offer low-quality care. Daily clinic visits can prevent patients from focusing on things that could aid recovery, like work, family or education. Many OTPs are required to supervise patients while they give urine samples; restricted from prescribing doses large enough to alleviate withdrawal symptoms; and encouraged to taper patients off the medication. Clinics say the rules are necessary to protect against intentional misuse, but evidence does not suggest this is a problem. Patients are often required to participate in frequent drug tests and counseling sessions as a condition of receiving medication. Even minor violations of OTP rules can result in major punishments. Little data is available about the quality of counseling at OTPs, and there is no federal standard for counselors’ qualifications. New federal regulations effective next month make more take-home doses a permanent option, allow for higher initial doses and warn OTPs against using toxicology testing punitively.

Source: Rigid rules at methadone clinics are jeopardizing patients’ path to recovery from opioid addiction (STAT)

Biden's State of the Union proposals address mental health and substance use

President Biden delivered his State of the Union address and proposed associated policies. Biden called on Congress to strengthen fentanyl trafficking penalties and pass the bipartisan border security bill, which would deliver 100 more drug detection machines to stop fentanyl from entering through ports of entry and provide additional tools to crack down on global criminal networks. He called on Congress to approve his budget, which includes more than $22 billion for addiction treatment. He called on Congress to enact legislation to expand coverage in Medicare and private insurance, apply parity protections in Medicare, strengthen parity enforcement capabilities and extend workforce development and incentive programs to address provider shortages. In coming weeks, the Department of Health and Human Services (HHS) will award $50 million for Medicaid school-based health services and issue guidance to ensure children receive behavioral health care they are entitled to under Medicaid. Later this year, the Education Department will award $38 million to increase the pipeline of school-based mental health professionals. The administration will release a roadmap for growing the behavioral health workforce. Biden called on Congress to pass bipartisan legislation to protect kids online. He reiterated that no one should go to jail for marijuana-related offenses and highlighted his efforts to ease restrictions on marijuana.

Source: FACT SHEET: President Biden’s Unity Agenda for the Nation (White House); Biden delivers State of the Union with fiery political tone (Washington Post)

President Biden's budget proposal increases mental health and addiction funding

President Biden released his FY 2025 budget proposal. It includes $44.5 billion for National Drug Control Program Agencies, including $21.8 billion for addiction treatment and recovery. It would require all health plans to cover mental health and substance use disorder benefits, ensure plans have adequate networks of behavioral health providers, improve parity enforcement capabilities, eliminate cost-sharing for three behavioral health visits per year and require parity in Medicare. The Budget invests in 988, school-based mental health care, the behavioral health workforce, certified community behavioral health clinics, health IT adoption for behavioral health providers, veterans’ and women’s behavioral health services, harm reduction activities, mobile crisis response, etc. It includes $2.3 billion for the Department of Justice to combat opioid trafficking and reduce supply and demand of fentanyl. The Budget invests in treatment and prevention of infectious diseases, including hepatitis C and HIV. It proposes changing “abuse” to “use” in certain agency names.

Source: FACT SHEET: The President’s Budget for Fiscal Year 2025 (White House); FACT SHEET: The President’s Budget Lowers Costs for the American People (White House); FACT SHEET: The President’s Budget Advances President Biden’s Unity Agenda (White House); FACT SHEET: The President’s Budget Protects and Strengthens Social Security and Medicare (White House); FACT SHEET: The President’s Budget Secures Our Border, Combats Fentanyl Trafficking, and Calls on Congress to Enact Critical Immigration Reform (White House); SAMHSA’s Fiscal Year 2025 Budget Seeks $8.1 Billion to Support Mental Health and Substance Use Services Across US (Substance Abuse and Mental Health Services Administration)

White House Challenge to Save Lives from Overdose aims to expand naloxone access

The Biden administration launched the White House Challenge to Save Lives from Overdose, a nationwide call-to-action to stakeholders across all sectors to save lives by committing to increase training on and access to opioid overdose reversal medication. It is calling on organizations and businesses across the country, big and small, public and private, to help ensure all communities are ready to use naloxone. The administration is encouraging leaders to commit to take simple measures that work, including training employees on opioid overdose reversal medications, keeping the medications in first aid kits and distributing the medications to employees and customers. Organizations may make a commitment here and share a story of how their efforts saved a life here. Several organizations and businesses are already stepping up across industries. The fact sheet highlights efforts of organizations within air travel, entertainment, hospitality, labor worksites, schools and places of learning and state and local transit systems.

Source: FACT SHEET: Biden-⁠Harris Administration Launches the White House Challenge to Save Lives from Overdose (White House)

NIDA study finds 11% of 12th graders used delta-8 THC in the past year

An analysis of data from the 2023 Monitoring the Future survey found that approximately 11% of 12th-grade students across the U.S. reported past-year use of delta-8 THC. Delta-8 use was measured for the first time in 2023 to investigate the drug’s popularity among teens as more hemp-derived THC products enter the market and become more accessible. Among those who reported use of delta-8, close to 91% also reported marijuana use. Delta-8 use was more common in the South and Midwest and in states without cannabis legalization or delta-8 regulations. Approximately 14% of 12th graders in the South and 15% in the Midwest reported delta-8 use, compared to 10% in the Northeast and 5% in the West. Around 14% of those in states without cannabis legalization reported delta-8 use, compared to 8% in states with legalization. In states without existing delta-8 regulations, 14% reported use, compared to 6% in states with delta-8 legislation.

Source: Delta-8-THC use reported by 11% of 12th graders in 2023 (National Institute on Drug Abuse)

Liberal states are reversing course to embrace hardline drug policies

Some of America’s bluest cities and states are abandoning progressive approaches to substance use and homelessness, instead embracing harder-line measures amid political backlash. The worsening overdose, mental health and housing crises are fueling the shift away from more compassionate approaches. Oregon is partially reversing its decriminalization measure. San Francisco approved a ballot measure requiring drug screening for people receiving public benefits suspected of illicit substance use. The outcome of a California ballot measure that could overhaul the state’s approach to mental health and homelessness, which some warn could force people into involuntary treatment, remains too close to call. Experts agree about the importance of harm reduction over punitive measures, but some advocates say lax policies have come at the expense of the general public, and that ensuing backlash will ultimately hurt people who use substances. Some advocates worry the recent reversals will make accessing treatment even more difficult, entangling more people in the criminal legal system with no connection to treatment.

Source: Blue states usher in tougher drug and mental health policies amid backlash (Axios)

Naloxone varies in accessibility after becoming OTC

NBC visited 64 stores in 15 states and D.C. looking for over-the-counter (OTC) Narcan. Stores stocked it in different locations – on display on the pharmacy counter, in the pain medication aisle, behind the pharmacy counter or behind the front register. Some were easy to spot and access, while other times, customers would have to hunt or ask for help. Most major drugstores and big-box store pharmacies carried Narcan, but none of the convenience stores or gas stations did. Since the launch of OTC Narcan last fall, it can be purchased at more than 32,000 retailers, according to maker Emergent BioSolutions. The stigma of walking into a store and asking the pharmacist or another employee for Narcan may be a major hurdle. Nearly all stores visited priced OTC Narcan at around $45, a lot for many people who use opioids.

Source: Where’s the Narcan? At pharmacies across the U.S., the OTC antidote can be hard to find (NBC)

Nebraska sustains veto of bill that would have allowed syringe service programs

Nebraska seemed poised last month to go against the national trend of tightening drug laws after a coalition of liberal and conservative legislators passed a bill to allow local governments to establish needle exchanges. But Gov. Pillen vetoed the bill, warning against bringing “the failed policies of drug-infested cities like San Francisco here” and arguing the bill would enable substance use, despite evidence otherwise and demonstrating their effectiveness. Lawmakers changed course and narrowly sustained his veto. The bill would have allowed cities and counties to create programs where people who use substances could discard old needles and pick up clean ones. Local governments would have been allowed, but not required, to set up exchanges. The sites would have offered access to treatment. Nebraska would have been far from the only Republican-led state allowing the sites – more than 40 states had some form of needle/syringe exchange in 2022.

Source: Nebraska Lawmakers Sustain Veto of Needle Exchange Bill (New York Times)

Missouri and Seattle launch EMS buprenorphine pilot programs

Six emergency medical districts in Missouri and Seattle have new pilots allowing EMS workers and paramedics to administer buprenorphine to people following overdose. The medication temporarily stabilizes patients and provides short-term relief from withdrawal symptoms to allow emergency responders to better engage in conversations about treatment, recovery and social services. When Missouri’s program is up and running, approximately 500 emergency medical personnel will have learned to administer buprenorphine. The state is using opioid settlement money to pay for the pilot.
The Seattle Fire Department’s program began on February 20. Currently, a total of 10 paramedics have received training to administer buprenorphine in the field, and the department plans to expand. Since launch, the department has administered the medicine eight times.

Source: Missouri pilot program trains EMS crews to give overdose victims addiction meds (St. Louis Public Radio); Seattle Fire Department launches pilot program allowing paramedics to administer buprenorphine in the field (Seattle Fire Line)

Oregon to recriminalize drug use despite lack of investment in treatment components of Measure 110

Oregon Governor Kotek vowed to sign into law a bill recriminalizing substance use. She intends to sign the bill and related prevention and treatment investments within 30 days. While the bill reimposes penalties, it also enables local governments and law enforcement agencies to choose whether they want to offer people who use substances the opportunity to pursue treatment before going to jail. Nearly two dozen of 36 counties have agreed. In 2020, the decriminalization measure was fueled by evidence that the punitive approach to substance use was not working. However, COVID and the spread of fentanyl coincided with implementation. The part of the measure that was supposed to increase investments in treatment was delayed and failed to get off the ground. Researchers have not found a link between Measure 110 and the rise in overdoses, but that didn’t stop the rollback. Measure 110 never functioned as it was supposed to, so it cannot serve as model for decriminalization and treatment to judge whether the approach works.

Source: Oregon governor to sign bill recriminalizing drug use (Reuters); The Daily: Oregon Decriminalized Drugs. Voters Now Regret It. (New York Times)

Some families push to use "poisoning" instead of "overdose" to describe loved ones' deaths

As fentanyl-tainted pills inundate the U.S., grieving families have been pressing to use “poisoning” instead of “overdose.” In their view, “overdose” suggests their loved ones were addicted and responsible for their own deaths, whereas “poisoning” shows they were victims. In September, Texas began requiring death certificates to say “poisoning” or “toxicity” rather than “overdose” if fentanyl was the leading cause. Legislation has been introduced in Ohio and Illinois for similar changes. A Tennessee bill would require cause of death to be listed as “accidental fentanyl poisoning” if fentanyl is implicated. Last year, efforts to describe fentanyl-related deaths as poisonings emerged in bills in several states, often establishing “Fentanyl Poisoning Awareness” weeks/months. While “poisoning” offers many families a buffer from stigma, others say using “poisoning” to distinguish certain deaths while letting others be labeled “overdose” creates a judgmental hierarchy of substance use fatalities. To many prosecutors, if someone was poisoned by fentanyl, the person who sold it was a “poisoner,” contributing to the proliferation of fentanyl homicide laws. However, many people who sell or share substances also have addiction, and they are usually unaware that these substances contain deadly fentanyl quantities. “Poisoning” reframes what is likely an accidental event as an intentional crime.

Source: Overdose or Poisoning? A New Debate Over What to Call a Drug Death. (New York Times)