Policy News Roundup: March 28, 2024

Key reads

Overdose deaths reach record high but level off in 2022

In 2022, there were 107,941 overdose deaths in the United States, an age-adjusted rate of 32.6 per 100,000. The rate of overdose deaths quadrupled between 2002 and 2022 to a record high. But it did not significantly change between 2021 and 2022, suggesting deaths may be leveling off after years of increase. The rate decreased among adults 15-24 and 25-34 but increased among adults 35+ between 2021 and 2022. In both 2021 and 2022, rates were highest for adults 35-44 and lowest for adults 65+, but adults 65+ experienced the largest percent increase. In both 2021 and 2022, rates were highest among American Indian and Alaska Native people, who also experienced the largest percent increase. The rate of overdose deaths involving synthetic opioids increased, while the rates involving heroin and natural and semisynthetic opioids decreased. The rate of overdose deaths involving cocaine increased 12.3% between 2021 and 2022. The rate involving psychostimulants with abuse potential increased 4% 2021-2022 but increased more than 34 times between 2002 and 2022.

Source: Drug Overdose Deaths in the United States, 2002–2022 (Centers for Disease Control and Prevention)

Switzerland and other European countries have easier access to MOUD than the U.S.

Unlike in the U.S., where there are only a few, restricted medications to treat opioid use disorder, at Switzerland’s Arud Centre for Addiction Medicine, all patients are given instant access to weeks’ worth of medication. These can include methadone, buprenorphine, slow-release morphine or, in limited cases, prescription heroin. Patients are not required to participate in counseling, subjected to drug tests or punished if they use illicit substances. Methadone was once controversial in Switzerland, too. But in response to high HIV/AIDS and overdose rates three decades ago, lawmakers emphasized treatment and harm reduction, particularly easy access to clinics offering medications. Overdose, HIV and hepatitis C rates plummeted. Visible substance use in public spaces has been all but eliminated. Defenders of the U.S. approach argue that solutions employed elsewhere would be riskier or less effective in the U.S. Most European nations have universal health insurance, and the U.S. illicit drug market is dominated by fentanyl. Supervised consumption and prescription heroin are political nonstarters in the U.S., and even practices like syringe exchange or test strips still face resistance.

Source: How expanded methadone access helped Switzerland defuse its drug crisis (STAT)

Congress passes FY 2024 appropriations bills

Congress passed the FY 2024 appropriations bills. The Labor-HHS-Education bill will provide more than $4.6 billion to support substance use prevention and treatment efforts. It will provide $2 billion for the Substance Use Prevention, Treatment and Recovery Services Block Grant, $1.575 billion for the State Opioid Response grants and $145 million for the Rural Communities Opioid Response Program. It includes $1 billion for the Mental Health Block Grant, $153 million for the Behavioral Health Workforce Education and Training Program, an $18 million increase for 988, $385 million for certified community behavioral health clinics (maintaining FY 2023 increase) and $98.8 million for the National Child Traumatic Stress Initiative ($5 million increase). It also includes more than $160 million in investments within the Education Department to address the shortage of school-based mental health professionals in K-12 schools.

Source: BILL SUMMARY: Labor, Health and Human Services, Education, and Related Agencies Fiscal Year 2024 Appropriations Bill (U.S. Senate Committee on Appropriations)

Energy and Commerce Committee Republicans call for GAO investigation into unspent mental health funding

Republican leaders of the House Energy and Commerce Committee asked the Government Accountability Office (GAO) to investigate federal officials’ oversight of mental health funding, citing documents showing that more than $3.8 billion intended for emergency COVID response and for 988 remained unspent as of late last year. They obtained funding documents from the Substance Abuse and Mental Health Services Administration (SAMHSA) and found that only 54% of emergency COVID funds had been spent and about 17% of money intended to help states, territories and tribes implement 988 had been spent. The leaders asked GAO to examine why the money has not been spent more quickly to address mental health needs. While SAMHSA has designated most of the funding, states, territories and other recipients have yet to spend much of the funds. Experts have said organizations that historically have had limited resources may be overwhelmed by the sudden influx of funding and cautioned that some of SAMHSA’s efforts are significant undertakings.

Source: House Republicans call for probe into unspent mental health funds (The Washington Post)

Court says graphic images on cigarette packaging and advertising do not violate First Amendment

An appeals court ruled that a federal requirement that cigarette packs and advertising include graphic images demonstrating the effects of smoking does not violate the First Amendment. The ruling was a partial victory for federal regulators seeking to toughen warning labels. But the court kept alive a tobacco industry challenge of the rule, saying a lower court should review whether it was adopted in accordance with the federal Administrative Procedure Act (APA), which governs the development of regulations. The appeals court rejected industry arguments that the rule violates free speech rights or that it requires images and lettering to take up so much space that they overcome branding and messaging on packages and ads. The ruling overturns a lower court order that found the requirements violate the First Amendment. The appeals court sent the case back to the lower court to rule on the APA-based challenge.

Source: Requiring ugly images of smoking’s harm on cigarettes won’t breach First Amendment, court says (Associated Press)

SAMHSA announces $39.4 million for behavioral health grants

The Substance Abuse and Mental Health Services Administration announced notices of funding opportunities for $39.4 million in grant programs addressing behavioral health. This includes $6 million for Building Communities of Recovery; $6 million for Promoting the Integration of Primary and Behavioral Health: States; $15.2 million for Assisted Outpatient Treatment Program for Individuals with Serious Mental Illness; $5.2 million for Promoting the Integration of Primary and Behavioral Health Care: Collaborative Care Model; $4.6 million for Sober Truth on Preventing Underage Drinking Act (STOP Act) Grant Program; and $2.4 million for Garrett Lee Smith Campus Suicide Prevention Grant Program.

Source: Biden-Harris Administration Announces $39.4 Million in Funding Opportunities for Grants to Help Advance the President’s Unity Agenda (Substance Abuse and Mental Health Services Administration)

FCC proposes routing 988 calls by location to give access to local resources

The Federal Communications Commission (FCC) shared a proposal to improve how wireless calls to 988 are routed to ensure that callers have access to behavioral health resources in the state/territory they are calling from while protecting their privacy. Calls to 988 are currently routed based on the caller’s area code and exchange, which presents obstacles to callers whose area code does not correspond with their location when in crisis. Under the FCC’s proposal, the call would be routed to a local crisis center near the caller’s physical location instead. The proposed rule would require georouting wireless calls to 988, enabling calls to be directed based on the location of the caller without transmitting caller’s precise location information. Such solutions would permit a wireless call to 988 to be directed to nearby crisis centers based on factors such as the cell tower that originated the call.

Source: FCC Chairwoman Calls for Improved Routing of Wireless Calls to the 988 Lifeline (Federal Communications Commission)

Some states and OTPs are rolling back methadone flexibilities

States and local opioid treatment programs (OTPs) have broad discretion over their treatment programs. Six states (Arizona, Florida, Indiana, Ohio, Michigan and Mississippi) and a growing number of OTPs throughout the country have rescinded extensions of take-home privileges first allowed during COVID, even though the federal government finalized rules allowing the flexibilities to be permanent. Critics of the take-home policy have argued that it leads to intentional methadone misuse and diversion, despite evidence to the contrary. Addressing diversion as a reflection of unmet community need will be more effective than criminalizing it. Cutting back or eliminating take-home doses may push people enrolled in OTPs toward illicit substance use. It may heighten feelings of frustration and hopelessness for those in treatment, resulting in more relapses, greater health care costs and lives lost.

Source: Methadone treatment has been reformed for the better. States shouldn’t go back to the old ways (STAT)

Washington enacts laws to address fentanyl crisis

Washington Governor Inslee signed a slate of bills to address the fentanyl crisis. The 2023-25 supplemental budget to be signed by Inslee later this month contributes an additional $79.4 million to the biennial budget’s allocation of $174.7 million toward addiction programs, bringing the 2023-25 investment to over $254 million to fight addiction. Inslee signed laws to incorporate fentanyl education into state health learning standards and create a statewide education campaign; require that schools carry overdose-reversal medications; require colleges/universities to stock naloxone and fentanyl test strips; establish a Tribal opioid prevention and treatment account, including with funds from the opioid settlements; and improve telehealth access and maternal health care for parents with addiction.

Source: Fentanyl is deadly. Washington’s newest laws respond to the crisis (Washington State Governor’s Office); New laws aim to prevent youth opioid overdoses (Axios)

Wisconsin decriminalizes xylazine test strips

Wisconsin Governor Evers signed into law a bill to decriminalize the use of xylazine test strips. The law exempts materials to test for the presence of xylazine or a xylazine analog in a substance from the definition of “drug paraphernalia” under the state’s Uniform Controlled Substances Act and creates certain civil and criminal liability exemptions for people distributing or administering such testing products. In 2021, Evers signed legislation decriminalizing the use of fentanyl test strips.

Source: Gov. Evers Signs Senate Bill 875 (Tony Evers)