Policy News Roundup: March 3, 2022

    Key reads

    Biden highlights plans to address mental health and addiction in State of the Union

    In his State of the Union Address, President Biden outlined a Unity Agenda, which includes efforts to beat the opioid epidemic and take on mental health. On the opioid crisis, Biden called for increasing funding for prevention, treatment, harm reduction and recovery; eliminating outdated rules that stop doctors from prescribing treatments; and stopping the flow of illicit substances. He said, “If you’re suffering from addiction, know you are not alone. I believe in recovery, and I celebrate the 23 million Americans in recovery.” On mental health, he highlighted the role of social media, calling for strengthening privacy protections, banning targeted advertising to children and demanding tech companies stop collecting children’s personal data. He called for getting all Americans the mental health services they need, more people they can turn to for help and parity. He released more specific plans for mental health, which outline actions to strengthen system capacity, connect more Americans to care and create a continuum of support and create healthy environments. For addiction, the president’s plans would increase funding for public health and supply reduction, remove barriers to treatment, reduce harm and save lives and stop the trafficking of illicit substances.

    Source: State of the Union Address: Remarks of President Joe Biden – State of the Union Address As Prepared for Delivery (White House)

    Supreme Court hears case on doctors' convictions for opioid overprescribing

    The Supreme Court heard arguments in an appeal by two doctors of lower court rulings upholding their convictions on narcotics violations and related crimes stemming from what prosecutors called the misuse of medical licenses to engage in drug trafficking. Lawyers for the doctors argued that jurors convicted the doctors of unlawfully overprescribing opioids without allowing the doctors to argue that they acted in good faith. Some of the justices, including Chief Justice Roberts, questioned why jurors should be instructed to consider doctors’ beliefs about the medical validity of their prescriptions when determining if they violated the Controlled Substances Act. Justice Alito said the Controlled Substances Act had no mention of a requirement for jurors to consider good faith defenses from doctors, while Justice Kavanaugh appeared open to instructing jurors to hear such defenses.

    Source: U.S. Supreme Court mulls ‘pill mill’ doctors’ opioid convictions (Reuters)

    Federal news

    Sen. Warnock introduces behavioral health legislation

    Senator Raphael Warnock of Georgia introduced a package of four bills and a resolution to improve mental health care and access. The Advancing Student Services in Schools Today (ASSIST) Act would increase funding for mental health providers and services in schools. The Improving Access to Tele-Behavioral Health Services Act would help better provide community-based and peer support services virtually during and after the pandemic. The Crisis Counseling Act would allow automatic approval for disaster areas for the Crisis Counseling and Training Program. The Behavioral Health Coordination and Communication Act would establish a Behavioral Health Coordinator within the Executive Office of the President to coordinate all mental health and addiction activities. The Behavioral Health Resolution expresses the sense that in order to effectively address mental health and substance use disorder, the U.S. needs to make historic investments in care and acknowledge it as a priority in health care equal to physical health.

    Source: Senator Reverend Warnock Introduces Series of Mental Health Bills to Increase Access to Mental Health Services in Georgia, Nationwide (Reverend Raphael Warnock)

    Supreme Court nominee has expertise in drug sentencing

    Ketanji Brown Jackson, President Biden’s nominee to the Supreme Court, has a relatively limited record on health issues, but she has expertise on drug sentencing. Jackson’s uncle was serving a life sentence in Florida for a nonviolent drug crime as a result of a “three strikes” law, until President Obama later commuted his sentence (without involvement from Jackson) as part of a national bipartisan effort to undo harsh mandatory sentences. As the Justice Department was focusing on clemency, the U.S. Sentencing Commission, with Jackson as a member, was taking steps to adjust sentencing guidelines. In 2014, as a vice chair of the commission, Jackson backed a proposal to make sentencing guidelines for most federal drug trafficking offenders less severe. The commission voted to apply the reductions retroactively, which expedited the release of tens of thousands from federal prisons. She spent four years on the commission and also served as a criminal defense attorney.

    Source: The Health 202: A quick guide to Ketanji Brown Jackson’s health-related rulings (Washington Post); Possible Supreme Court nominee, former defender, saw impact of harsh drug sentence firsthand (Washington Post)

    FDA's menthol cigarette ban regulations take next step

    The Food and Drug Administration (FDA) is moving forward with a long-promised regulation banning menthol cigarettes. The agency submitted regulations to the White House Office of Management and Budget (OMB), which reviews them before they are published. Even this step is a major victory for public health groups, which have been locked in a multi-year legal battle with the FDA on the issue. However, OMB has the power to kill or water down regulations. The Obama administration’s efforts to ban flavored vaping products were stymied by OMB amid a pressure campaign from tobacco companies. The review process will be one of the first tests for Robert Califf, the new FDA commissioner, who likely will have to work political levers to make sure the regulation is released quickly. Califf oversaw earlier efforts to ban flavored products during his last stint at the FDA, and was then unable to combat the tobacco industry’s pressure.

    Source: The FDA’s promised menthol ban is about to face a critical test (STAT)

    White House investments in rural America help address behavioral health

    The White House outlined its actions and plans to create opportunity and build wealth in rural America. The plans include ensuring effective treatment and recovery for substance use disorder and addressing the mental health crisis. They also include efforts such as lowering child care costs and supporting child care providers, lowering costs and improving access to an education beyond high school for students (including funding for rural colleges/universities that can be used for mental health services), safely reopening rural schools and helping students make up for lost learning time (including addressing the mental health impacts of the pandemic on students), lowering health care costs and expanding coverage, increasing the number of health care providers (e.g., Substance Use Disorder Treatment and Recovery Loan Repayment Program), increasing access to telehealth (including tele-mental health) and supporting states in making public health investments (including training for providers in rural areas on mental health and addiction).

    Source: FACT SHEET: The Biden Administration’s Historic Investments To Create Opportunity and Build Wealth in Rural America (White House)

    State and local news

    Distributors and J&J finalize opioid settlement with states and localities

    McKesson, AmerisourceBergen, Cardinal Health and Johnson & Johnson have agreed to finalize a proposed $26 billion opioid settlement. The companies had until last week to decide whether enough cities and counties nationally had opted to join the settlement to justify moving forward. The announcement paves the way for the companies to begin making payments to the governments in April. The distributors will pay up to $21 billion over 18 years, and Johnson & Johnson will pay up to $5 billion over nine years. All four companies continue to face claims in Alabama, Oklahoma, Washington and West Virginia. New Hampshire declined to settle with Johnson & Johnson.

    Source: Drug distributors, J&J agree to finalize $26 bln opioid settlement (Reuters)

    Workers who use cannabis can lose their jobs even in states that have legalized

    Medical and/or recreational marijuana use is now allowed in 37 states, but in most, people can be fired or denied a job for using cannabis. Cannabis legalization advocates note that workplace drug tests do not measure whether someone is high, just whether they have used marijuana recently. They say workplace drug testing is an equity issue, as tests are more common in blue-collar jobs and disproportionately affect non-White workers. Certain employers are required to test for marijuana under federal law, however, and others are concerned about workplace safety. Fourteen states and DC have banned employers from discriminating against workers who use marijuana for medical reasons, and New Jersey and New York ban employers from discriminating against workers who legally use marijuana medically or recreationally. Nevada bans employers from refusing to hire someone solely because they fail a marijuana test. Bills have stumbled elsewhere because of opposition from business groups and disagreements over how to measure marijuana intoxication.

    Source: Workers Who Legally Use Cannabis Can Still Lose Their Jobs (Pew Stateline)

    States unlikely to change opioid prescribing limits despite new CDC guidelines

    The Centers for Disease Control and Prevention (CDC) last month proposed new opioid prescribing guidelines that ease restrictions, but states might balk at lifting limits on opioids. The proposed recommendations aim to give millions of Americans suffering from pain better access to opioids, while also cautioning against starting new patients on opioids unless nothing else works. For the guidelines to have their intended effect, states would need to amend or repeal existing statutes that limit opioid prescriptions to three to seven days and set ceilings on the daily dose doctors can prescribe. Few governors or lawmakers are likely to be eager to do so, especially with the overdose crisis still raging. Since the CDC’s initial guidelines in 2016, 40 states have enacted laws limiting the length of initial opioid prescriptions, and 11 have laws capping the daily allowable dose.

    Source: States Likely to Resist CDC Proposal Easing Opioid Access (Pew Stateline)

    Other news in addiction policy

    Primary care is critical in treating opioid use disorder

    Primary care has a critical role to play in the identification and ongoing treatment of opioid use disorder. Effective treatment requires that patients have access to health care teams not only when initiating treatment, but for regular care and support to stabilize and transition to long-term maintenance. However, policymakers continue to choose to disproportionately fund short-term, unsustainable fixes. While efforts to expand mobile units that provide medications for opioid use disorder are well intentioned, they have the unintended consequence of diminishing primary care’s role in opioid use disorder treatment and too often leave patients stranded and disengaged. Policymakers must invest in primary care.

    Source: Mobile Van Medication-Assisted Treatment For Opioid Use Disorder Is Not Enough (Health Affairs)

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    March 2022