Policy News Roundup: March 7, 2024

Key reads

All sectors are obstructing use of medications for addiction treatment

Buprenorphine and methadone are cheap, easy to distribute and effective, but virtually every sector of society obstructs their use. Narcotics Anonymous opposes the use of medications for OUD (MOUD). Jails/prisons and judges, even in drug courts, often bar their use. Opioid treatment programs (OTPs) make access all but impossible by requiring daily trips and imposing other restrictions. Few doctors prescribe buprenorphine, and many pharmacies decline to stock it. Many medical schools do not require training on addiction. Many hospitals do not offer MOUD even after an overdose. Insurers sometimes refuse to pay for injectable buprenorphine, which helps treatment retention but costs more than daily formulations. Many rehab and sober living facilities refuse to admit people taking MOUD. Many employers, labor unions and professional societies disallow members from using MOUD. America’s view of MOUD is built on stigma. While some progress has been made, to make MOUD universally accessible, hospitals, pharmacies and insurers would need to shift policy/practice to encourage use and provide a less hostile environment; lawmakers would need to mandate access; prisons, courts and law enforcement would need to overhaul rules; and the addiction treatment infrastructure would need to adopt a different tone.

Source: The War on Recovery: How the U.S. is sabotaging its best tools to prevent deaths in the opioid epidemic (STAT)

Biden administration has acted to address the opioid crisis, but overdoses remain high

President Biden is expected to play up health care successes in his State of the Union address Thursday, but many are partial and may not endure if he does not win a second term. To address overdoses, Biden aimed to expand access to treatment and decrease fatal overdoses, which appear to be leveling off after hitting a record high in 2022 but remain higher than before COVID. Biden helped to extend rules easing access to medications for addiction treatment via telemedicine and signed legislation removing the buprenorphine waiver requirement. The administration has worked to make naloxone available in more places, such as federal facilities and schools, and approved over-the-counter Narcan. Biden and Chinese President Xi agreed to restart counternarcotics cooperation, and the White House and State Department have continued putting pressure on the Mexican government to crack down on fentanyl production and trafficking. Congress has not extended the SUPPORT Act, however. Drug use and homelessness have prompted backlash against emphasizing harm reduction and treatment over law enforcement.

Source: What Biden did on health care (Politico)

Endo reaches bankruptcy settlement

Pharmaceutical company Endo will pay up to $465 million to settle the federal government’s law enforcement, tax and health care cost claims. Endo will ask a U.S. bankruptcy judge to approve the sale and allow the company to emerge from bankruptcy. Endo filed for bankruptcy in 2022 to address debt and opioid lawsuits. As part of its bankruptcy restructuring, the company has agreed to pay about $600 million in settlements to states and people affected by the opioid crisis and to stop promoting opioids to prescribers. Endo agreed to pay the government $364.9 million over 10 years, plus a contingent payment of up to $100 million. The settlement allows Endo to opt for a lower, one-time payment of $200 million immediately upon its exit from bankruptcy. The settlement resolves over $7 billion in claims the Justice Department asserted against Endo for tax debts, a Department of Justice criminal investigation into its opioid marketing, and the government’s possible overpayment for Endo medications. Subsidiary Endo Health Solutions agreed to plead guilty to a misdemeanor over its marketing of Opana ER.

Source: Drugmaker Endo reaches $465 mln bankruptcy settlement with US (Reuters)

CDC study finds increase in alcohol deaths in recent years

The Centers for Disease Control and Prevention estimates the average annual number of deaths from excessive alcohol use increased 29.3%, from 137,927 during 2016-2017 to 178,307 during 2020-2021. Deaths increased 5.3% from 2016-2017 to 2018-2019 and 22.8% from 2018-2019 to 2020-2021. Age-standardized alcohol-related death rates increased from 38.1 to 47.6 per 100,000 population. Approximately two-thirds of these deaths resulted from chronic causes. During 2020-2021, fully alcohol-attributable causes accounted for 29% of all alcohol-attributable deaths, a 46.2% increase from 2016-2017. Deaths from excessive alcohol use increased 26.8% among males (94,362 to 119,606) and 34.7% among females (43,565 to 58,701). Rates among males were highest from 100% alcohol-attributable chronic conditions, while rates among females were highest from heart disease and stroke. Implementation of evidence-based policies that reduce the availability and accessibility of alcohol and increase its price, integration of screening and brief intervention into routine clinical services and campaigns to support drinking less could reduce excessive alcohol use and alcohol-related deaths.

Source: Deaths from Excessive Alcohol Use — United States, 2016–2021 (Centers for Disease Control and Prevention)

Spending bill includes efforts to expand SUD treatment access but not SUPPORT Act reauthorization

Lawmakers released the text of a deal to fund a portion of the federal government through the end of the fiscal year. The minibus totals about $460 billion for six federal agencies. Congress has until Friday to get the bill signed to avoid a shutdown. The bill includes legislation to permanently require state Medicaid plans to cover medications for substance use disorder (SUD) treatment (a provision that expired in the SUPPORT Act) and to create a permanent state Medicaid option allowing SUD treatment at institutions for medical diseases (Expanding Access to Addiction Treatment Act and Securing Advances and a Variety of Evidence-Based IMD Options Act). The package also has provisions aimed at reducing barriers to care for patients on Medicaid related to incarceration. It increases funding to the Drug Enforcement Administration and for combatting fentanyl trafficking. The legislation does not reauthorize the SUPPORT Act, however.

Source: What’s in – and out – of Congress’ spending bill for health care (Politico); Congress releases six funding bills ahead of Friday shutdown deadline (The Washington Post)

State lawmakers propose bills to address xylazine

State legislators are proposing bills to address the rise in intentional xylazine misuse, including classifying xylazine as a controlled substance, stiffening criminal penalties and legalizing testing strips. Florida, Ohio, Pennsylvania and West Virginia have already made xylazine a controlled substance. Public health experts warn that criminalizing xylazine will exacerbate stigma and discourage people from seeking treatment. Yet several states are embracing this approach. A new South Dakota law classifies xylazine as a controlled substance, with fines and penalties of up to two years in prison for use, manufacture and distribution, while still allowing veterinary use. A similar bill is pending in South Carolina, with penalties including a felony charge and up to 10 years imprisonment. Virginia lawmakers are considering legislation with similar penalties. New York legislation would place xylazine in Schedule I, which would carry stiffer criminal penalties. An Indiana bill would criminalize possession and distribution, with potential punishment of jail time and steeper penalties for repeat offenders. A bill that would have legalized test strips for all controlled substances, including xylazine, died in the state Senate. Wisconsin passed a bill to legalize test strips, awaiting the governor’s signature.

Source: As xylazine surges, some lawmakers want jail time for dealers and people who use the drug (Stateline)

Oregon House votes to reverse drug decriminalization measure

The Oregon House voted 51-7 to roll back the state’s drug decriminalization measure and again make possession of a minor amount of substances a misdemeanor. The bill now goes to the Senate before it goes to Gov. Kotek, who has suggested she may sign the legislation. The bill would make possession of substances a misdemeanor punishable by up to 180 days in jail or 18 months of probation. It would also encourage police officers and district attorneys to refer defendants to state-funded deflection programs that could get them into treatment instead of facing arrest or conviction. Judges could not order fines or fees as part of the sentence. The state is also providing grants for medication for substance use disorder treatment in jails. Officials estimate the law would eventually add about 2,257 convictions for misdemeanor possession a year to Oregon’s justice system, with Black and Hispanic defendants represented at a disproportionate rate.

Source: Oregon’s pioneering drug decriminalization effort faces rollback (The Washington Post)

California behavioral health navigators program limited by uncertain funding

Health providers warn the funding structure is unstable for California Bridge’s behavioral health navigator program, which steers patients with substance use disorder (SUD) into long-term treatment after they are discharged from emergency rooms. Supporters of the program, which launched in 2022, say reliance on one-time funding makes it hard for hospitals to retain navigators. California Bridge funds training for doctors and nurses to increase the use of medications for SUD treatment, and its navigator program pays hospitals up to $120,000 to contract with behavioral health workers. Currently, 248 navigators have been assigned to place patients into long-term treatment after they are discharged from an emergency room. After a year, hospitals have the option to bring navigators on staff or allow contracts to expire. More than 100 navigators have left their positions. State officials are trying to expand the use of Medi-Cal to help pay for navigators and to secure additional federal grants. Hospital industry representatives say more members would join the program if they knew it would have sustainable long-term funding.

Source: California Hospitals, Advocates Seek Stable Funding to Retain Behavioral Health Navigators (KFF Health News)

San Francisco approves measure to require drug screening for welfare payments

San Francisco voters yesterday approved Proposition F, a controversial measure to tie San Francisco welfare payments to drug screening and treatment. The measure needed a simple majority to pass, and 63% of voters voted in favor. Supporters said the measure would help push back against overdose deaths, while opponents said it could take away vital monetary assistance from low-income people. Prop F will affect single adults with no children who are recipients of County Adult Assistance Programs. If an individual is suspected of being dependent on illegal substances, they will be required to undergo screening for substance use disorder and agree to some form of treatment as a condition of continuing to receive benefits.

Source: Prop. F, requiring drug screening for welfare aid, approved by voters (The San Francisco Standard)

AMA/Manatt report outlines state recommendations for addressing opioid use disorder among pregnant and postpartum people

The American Medical Association and Manatt released a report with recommendations for state policymakers to improve access to evidence-based care for pregnant and postpartum people with opioid use disorder. Key policy recommendations include supporting access to medications for opioid use disorder (MOUD); ensuring pregnant and postpartum people are supported and not punished for receiving MOUD; improving data collection and state partnerships to ensure equitable access to treatment; requiring correctional facilities and diversion programs to provide access to MOUD and universal screening; and guaranteeing Medicaid coverage and access to pre-release services for all incarcerated people. The report includes examples of states’ efforts to remove barriers to care for pregnant and postpartum people with opioid use disorder. These include increasing education and training opportunities to address misconceptions about MOUD in pregnancy; linking data sets to obtain a comprehensive analysis of racial/ethnic disparities in access to MOUD among pregnant people; and establishing community-based care teams to support pregnant and postpartum individuals coming out of incarceration.

Source: AMA report on overdose crisis in pregnant and postpartum people (American Medical Association)