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    Policy News Roundup: March 23, 2023

    Key reads

    Family Support Services for Addiction Act to be reintroduced

    Senators Kirsten Gillibrand (D-NY) and Shelley Moore Capito (R-WV) are reintroducing the Family Support Services for Addiction Act. The measure would provide $25 million in grant funding to help nonprofits and community organizations provide support services to families with loved ones with addiction, including caregiver peer support, education and training, systems navigation for families, counseling services, support groups for those in crisis and for those who have lost loved ones and skill-building. Representatives David Trone (D-MD) and Dan Meuser (R-PA) are leading companion legislation in the House. Partnership to End Addiction endorsed the bill.

    Source: Gillibrand, Capito Announce Bipartisan, Bicameral Legislation To Support Families Of Individuals Struggling With Substance Use Disorder (Kirsten Gillibrand)

    DEA issues public safety alert on xylazine

    The Drug Enforcement Administration (DEA) issued a public safety alert about the widespread threat of fentanyl mixed with xylazine. DEA has seized xylazine and fentanyl mixtures in 48 of 50 states. The DEA Laboratory System is reporting that in 2022, approximately 23% of fentanyl powder and 7% of fentanyl pills seized by DEA contained xylazine. When combined, fentanyl and xylazine can make overdoses even deadlier, and people who inject mixtures containing xylazine may develop severe necrotic skin wounds.

    Source: DEA issues alert about widespread threat of xylazine (CNN)

    Federal news

    Sen. Casey and Rep. Dean introduce bill to lower costs for OUD treatment

    Senator Bob Casey (D-PA) introduced the Maximizing Opioid Recovery Emergency (MORE) Savings Act. The measure would eliminate costs for opioid treatment and recovery support services for people with private insurance plans and for people enrolled under a new Medicare pilot program and increase funding for Medicaid treatment programs. It would require insurers who are offering individual or group health insurance to cover prescriptions and support services used to treat opioid use disorder and to reverse overdoses; require those insurers to cover recovery support services in conjunction with treatment at no cost; establish a five-year pilot program in 15 states to eliminate costs for people using Medicare services to treat opioid use disorder, reverse overdoses and provide recovery support; and increase federal investment in Medicaid programs providing those treatment services. Representative Madeleine Dean (D-PA) will introduce companion legislation in the House.

    Source: Casey, Dean Introduce Bill to Lower Costs of Treatment for Opioid Use Disorder (Bob Casey)

    Wyden reintroduces bill to address homelessness and provide wraparound services

    Senator Ron Wyden (D-OR) reintroduced the Decent, Affordable, Safe Housing for All (DASH) Act (summary; section-by-section summary), which would make a landmark investment to house all people experiencing homelessness, tackle the housing affordability crisis by increasing supply and expand homeownership opportunities, especially for young people, by creating a new down payment tax credit for first-time homebuyers. It would house everyone experiencing homelessness within five years, prioritizing children and families for placement by issuing them a Housing Choice Voucher because young children are heavily impacted by housing instability and because housing is a chief determinant of health. It would expand health (including mental health and addiction), child care, financial and nutrition services for families and individuals to stay on a path to unassisted housing stability.

    Source: Wyden Reintroduces Comprehensive Bill to End Homelessness and Tackle Housing Affordability Crisis (United States Senate Committee on Finance)

    Members of Congress launch Addiction, Treatment, and Recovery Caucus and Bipartisan Fentanyl Prevention Caucus

    Representatives Paul Tonko (D-NY) and Dave Joyce (R-OH) announced the relaunch of the Addiction, Treatment, and Recovery Caucus for the 118th Congress. Tonko and Joyce will serve as co-chairs. The caucus includes over 50 Members of Congress from both sides of the aisle. It will serve as a clearinghouse for legislation aimed at expanding access to treatment for addiction, supporting Americans recovering from addiction and bolstering the health workforce on the frontlines of the addiction crisis. It is the first and longest running Congressional caucus that recognizes addiction as a disease. Representatives Madeleine Dean (D-PA), Joe Neguse (D-CO), Darrell Issa (R-CA) and Ken Calvert (R-CA) also announced the new Bipartisan Fentanyl Prevention Caucus. The co-chairs will coordinate with members on both sides of the aisle to combat the spike in fentanyl overdoses and will work with federal and state law enforcement. Members will also work to educate the public and Congress, in cooperation with prevention and awareness groups, to better understand the ongoing threat of fentanyl.

    Source: Tonko, Joyce Announce Relaunch of Addiction, Treatment, and Recovery Caucus (Paul D. Tonko); Reps. Dean, Neguse, Issa, and Calvert Launch Bipartisan Fentanyl Prevention Caucus (Congresswoman Madeleine Dean)

    Proposed regulations would allow increased methadone doses to help people who use fentanyl

    A new federal regulation would make it easier for some patients to begin methadone treatment on significantly higher doses, which may help people transitioning from ultra-potent fentanyl. Current regulations recommend clinicians start patients on just 30 mg of methadone, which experts say would leave people who regularly use fentanyl in significant discomfort. The proposal would allow for slightly larger doses and, more significantly, emphasizes that doctors can use their discretion to go substantially higher, if necessary. In the fentanyl era, daily doses often reach 150-200 mg. Insufficient doses can force patients into unbearable withdrawal and illicit substance use. While the new regulation would eliminate red tape and emphasizes that prescribers should use their judgement when choosing a starting dose, critics argue methadone clinics will not feel empowered unless dosing limits, whether guidelines or hard caps, are eliminated altogether. The regulations would force clinicians to jump through fewer hoops before exceeding the 30 mg recommendation. They would allow all prescribers at methadone clinics to select an appropriate starting dose, a privilege previously restricted to clinics’ medical/program directors.

    Source: Methadone doses haven’t kept up in the age of fentanyl. A new rule aims to help (STAT)

    State and local news

    States shift strategy toward imposing harsher penalties for fentanyl, alarming advocates

    State lawmakers nationwide are pushing harsher penalties for possessing fentanyl and other synthetic opioids. Imposing longer prison sentences for possessing smaller amounts of substances represents a shift in states that in recent years have rolled back drug possession penalties. Proponents of tougher penalties say this crisis is different and that, in most places, the stiffer sentences are intended to punish drug dealers, not just users. However, the strategy is alarming advocates who say focusing on the criminal angle of substances has historically backfired. Incarcerated people often continue getting substances, often without receiving quality addiction treatment, and then emerge to find it is harder to work. Before this year’s legislative sessions began, a dozen states had already adopted fentanyl possession measures, and this year, more states are moving in that direction.

    Source: With overdoses up, states look at harsher fentanyl penalties (Associated Press)

    California releases plan to address the opioid crisis

    California Governor Gavin Newsom released a Master Plan for Tackling the Fentanyl and Opioid Crisis. It outlines steps to support overdose prevention efforts, hold the pharmaceutical industry accountable, crack down on trafficking and raise awareness about the dangers of opioids. The plan includes a new CalRx effort in which California will seek to manufacture its own naloxone. Newsom’s proposed 2023-2024 budget includes an additional $96 million in funding, including $79 million for the Naloxone Distribution Project; $10 million for grants for education, testing, recovery and support services; $4 million to make fentanyl test strips more widely available; and $3.5 million to provide naloxone to all middle and high schools. The plan includes $30 million to expand the California National Guard’s work to prevent trafficking and supports street medicine/Medi-Cal mobile behavioral health, a youth opioid education/awareness campaign, workforce grants, etc. Newsom also will ask the legislature for a 2024 ballot measure to authorize funding to build residential facilities where up to 12,000 people a year could live and be treated for mental health and substance use disorders.

    Source: Governor Newsom Releases Master Plan for Tackling the Fentanyl and Opioid Crisis (Office of Governor Gavin Newsom); California to seek beds for mental health, drug treatment (Associated Press)

    Mississippi decriminalizes fentanyl test strips

    Mississippi Governor Tate Reeves signed a bill that will decriminalize materials that allow people to test illegal substances to detect if they are spiked with fentanyl. It becomes law July 1. The bill passed with broad bipartisan support. Current law considers fentanyl testing products drug paraphernalia, and possession of the products can result in up to six months in jail.

    Source: Fentanyl testing materials will be legalized in Mississippi (Associated Press)

    Other news in addiction policy

    LAPPA releases Model Substance Use Disorder Treatment in Emergency Settings Act

    The Legislative Analysis and Public Policy Association and the O’Neill Institute for National and Global Health Law at Georgetown University developed a Model Substance Use Disorder Treatment in Emergency Settings Act, which establishes and aligns mechanisms for maximizing emergency medical settings as intervention points for people who experience a substance use-related emergency, people with substance use disorder and their families. The act intends to address barriers to implementing protocols in emergency medical settings that would ensure evidence-based treatment of patients with substance use-related emergencies. It intends to address barriers to expedited connection to the appropriate level of care following discharge, and incorporates best practices and promising innovations from research analyzing protocols for emergency medical care delivery for people most at risk of dying after emergency room discharge.

    Source: Model Substance Use Disorder Treatment in Emergency Settings Act (Legislative Analysis and Public Policy Association)

    RAND report outlines opioid ecosystem

    RAND issued a report assessing America’s opioid ecosystem, highlighting how leveraging system interactions can reduce addiction, overdose, suffering and other harms. At the core of the opioid ecosystem are the individuals who use opioids and their families. The report includes chapters on 10 major components of the opioid ecosystem – addiction treatment, harm reduction, medical care, the criminal legal system, illegal supply and supply control, first responders, the child welfare system, income support and homeless services, employment and education. The report offers nine areas of action for decisionmakers – support individuals as they move between ecosystems; coordinate across components and address different priorities; address legal consequences and stigma associated with substance use/possession; prevent nonprescribed opioid use and escalation to opioid use disorder; identify individuals who need treatment, increase access to effective treatment and enhance support to make treatment more effective; reduce the probability that an overdose is fatal; address nontreatment needs of individuals using opioids; mitigate the burdens on family members; and improve data infrastructure.

    Source: America’s Opioid Ecosystem: How Leveraging System Interactions Can Help Curb Addiction, Overdose, and Other Harms (RAND)