White House to meet with naloxone manufacturers on increasing access and reducing costs
The Biden administration is seeking to meet with naloxone manufacturers in an effort to increase access and reduce cost. Office of National Drug Control Policy Director Rahul Gupta plans to have conversations with manufacturers emphasizing that the easier it is for people to access naloxone, the more lives will be saved. Emergent BioSolutions, the manufacturer of Narcan, was recently approved for over-the-counter sales, and said it welcomes the opportunity to discuss the true out-of-pocket costs for patients, including how Medicare and private insurers will cover Narcan as an over-the-counter product.
Congressional briefing focuses on national strategy to address the addiction crisis
Five mental health/addiction organizations, in coordination with the Bipartisan Mental Health and Substance Use Disorder Task Force, held a congressional briefing. Reps. Kuster (D-NH) and Trone (D-MD) delivered remarks on their legislative priorities. An expert panel highlighted four ideas – prioritize prevention, health, wellness and equity; establish universal access to addiction medications as a standard of care; ensure appropriate coverage of, and reimbursement for, effective addiction care; and strengthen the addiction care workforce. Panelists advocated for a set-aside in the substance use block grant for recovery support services; expanding access to methadone; closing the Medicare and Medicaid coverage gaps for addiction services; reauthorizing and bolstering the Substance Use Disorder Treatment and Recovery Loan Repayment Program; and improving education and training for clinicians that treat those with mental health and substance use disorders. They also advocated for ensuring parity; establishing a safe harbor in the anti-kickback statute and addressing grant limitations to reduce barriers to contingency management; and issuing clarifications related to Suspicious Orders to ensure buprenorphine is stocked in pharmacies and emergency departments.
Source: At Congressional Briefing, Expert Panel Suggests Innovative Solutions to National Addiction Crisis (American Society of Addiction Medicine)
FDA and SAMHSA reiterate that counseling is not required to receive MOUD
The Food and Drug Administration and Substance Abuse and Mental Health Services Administration sent a Dear Colleague letter reiterating that the provision of medication for opioid use disorder (OUD) should not be contingent upon participation in counseling and other services, though such services are an important part of comprehensive treatment. The decision on when counseling and other services, such as case management and peer support, are provided should be made with the individual patient. The evidence base does not provide direction on the type of counseling or services that might be optimal for different patients and at different stages of treatment and recovery, reflecting the person-centered nature of interventions and the need for practitioners to work with patients and meet them where they are. Given the elevated risk of fatal overdose without medication, any difficulty in connecting patients with counseling or other resources should not prevent practitioners from prescribing buprenorphine. While counseling should always be offered, treatment can begin with medication.
Source: Dear Colleague Letter (Substance Abuse and Mental Health Services Administration)
SAMHSA announces over $11 million for grants addressing the overdose crisis
The Substance Abuse and Mental Health Services Administration announced $11.3 million for four grant programs devoted to combating the overdose epidemic. Nearly $6.9 million will go toward screening, brief intervention and referral to treatment (SBIRT) services for children, adolescents and/or adults in primary care and community health settings; $2.6 million will go toward Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths to reduce prescription drug overdose-related deaths and adverse events by training first responders and other key community sectors on the prevention of prescription overdose deaths and implementing secondary prevention strategies, including naloxone for first responders; $1.1 million will go toward the Target Capacity Expansion-Special Projects program to provide harm reduction, treatment and/or recovery support services to under-resourced populations; and $725,000 will go toward the Provider’s Clinical Support System-Universities program to provide to graduate-level health professional students training required to treat opioid use disorder (OUD) and prescribe medications for OUD in office-based settings upon graduation and licensure.
Source: SAMHSA Distributes Additional Grant Funding for Programs That Combat Overdose and Substance Use on Multiple Fronts (Substance Abuse and Mental Health Services Administration)
House passes TRANQ Research Act
The House unanimously passed the Testing, Rapid Analysis and Narcotic Quality (TRANQ) Research Act, which would direct the National Institute of Standards and Technology to focus its research on existing and emerging illicit substances containing xylazine and other emerging substances.
Source: Congresswoman Caraveo Passes Her First Bill on House Floor With Unanimous Support (Yadira Caraveo)
State and local news
LAPPA releases model law on school responses to drug-related incidents
The Legislative Analysis and Public Policy Association released the Model School Response to Drugs and Drug-Related Incidents Act to guide states in establishing a consistent and positive response for public schools to best support students who have substance-related incidents on school premises or at school-related functions. It aims to decrease the number of youth funneled into the justice system for substance-related incidents. Much of the research on the issue explores unwanted outcomes associated with exclusionary discipline (out-of-school suspensions and expulsions), which remain common, despite evidence that it is harmful and ineffective. There are tremendous racial disparities. The law would require public schools to establish and implement administrative processes and supportive protocols to evaluate substance-related incidents and take appropriate non-juridical action when addressing non-violent incidents. It would require notification of parents/guardians at the time of evaluation. It proposes a decision tree that evaluates risk level of the incident and requires that the protocols for supporting students include education, mentorship and counseling commensurate with the level of the incident.
Source: Model School Response to Drugs and Drug-related Incidents Act (Legislative Analysis and Public Policy Association)
Tennessee county not using opioid settlement funds to address addiction
Greene County, Tennessee, has collected more than $2.7 million from opioid settlements, but $2.4 million has gone toward paying off debt, and $1 million in future funds have been directed into a capital projects fund, $50,000 of which was used to buy a truck to drive inmates to collect trash along county roads. The mayor said the county has borne direct and indirect costs of the opioid epidemic for years and that the funds need to be used to pay bills that have been due. States are required to spend at least 85% of the money on opioid-related programs, but there is wide interpretation of that standard and little oversight. In many rural communities, officials justify using the funds to reimburse past expenses. In Tennessee, 15% of the funds are controlled by the state legislature and 15% by local governments, buckets with few restrictions, while 70% is controlled by an Opioid Abatement Council, which has more rigorous standards requiring funds be spent on a list of approved interventions.
Nevada reaches settlement with CVS over opioid claims
Nevada and CVS reached a nearly $152 million opioid litigation settlement to be paid over the next decade. The settlement is one of the 10 largest between a single state and a single company over opioid claims. A lawsuit against Teva remains to be settled, and the state is preparing to go to trial in August. Nevada did not join last year’s national settlement with CVS in order to pursue the single-state settlement. About $80 million of the settlement will go to a coalition of county and city governments, and the state will retain nearly $70 million. A panel of experts will make recommendations for using the money to mitigate the opioid crisis. CVS agreed to develop an oversight program with a list of prescriptions, patients and prescriber “red flags” to help stop the opioid crisis.
Source: Nevada secures $152 million opioid settlement with pharmacy chain CVS (Associated Press)
Kansas law decriminalizes fentanyl test strips
Kansas Governor Kelly signed into law a bill that decriminalizes fentanyl test strips. The bill also increases criminal penalties for manufacturing or distributing fentanyl and for committing battery against a health care provider.
Source: Governor Kelly Signs Bipartisan Bill to Decriminalize Fentanyl Test Strips in Kansas (Kansas Office of the Governor)
Other news in addiction policy
Racial disparities in MOUD receipt are substantial and persistent
A study on racial and ethnic disparities in the use of medications for opioid use disorder (MOUD) found racial differences in the receipt of MOUD were substantial and did not change appreciably between 2016 and 2019. The researchers used Medicare fee-for-service claims data for beneficiaries eligible for Medicare due to disability with an index event related to opioid use disorder (nonfatal overdose treated in an emergency department or inpatient setting, hospitalization with injection-related infection or inpatient or residential rehabilitation or detoxification care). They found that in the 180 days after the index event, Black patients received buprenorphine after 12.7% of events, Hispanic patients after 18.7% and White patients after 23.3%. Patients received naloxone after 14.4%, 20.7% and 22.9%, respectively. Patients received benzodiazepines after 23.4%, 29.6% and 37.1%, respectively. A high incidence of ambulatory visits in all groups showed disparities persisted despite frequent health care contact.
Source: Racial Inequality in Receipt of Medications for Opioid Use Disorder (New England Journal of Medicine)