Policy News Roundup: May 20, 2021

Key reads

HHS creates Behavioral Health Coordinating Council and distributes American Rescue Plan funds

SAMHSA is distributing $3 billion in American Rescue Plan funding, the largest aggregate amount of funding to date for the Community Mental Health Services and Substance Abuse Prevention and Treatment Block Grants to states. This follows the March announcement of supplemental funding of nearly $2.5 billion. HHS also announced the establishment of a new Behavioral Health Coordinating Council. The Assistant Secretary for Mental Health and Substance Use and the Assistant Secretary for Health will serve as co-chairs of the coordinating body, which is comprised of senior leadership from across HHS. Its primary goal is to facilitate collaborative, innovative, transparent, equitable and action-oriented approaches to addressing the HHS behavioral health agenda.

Source: HHS Announces $3 Billion in American Rescue Plan Funding for SAMHSA Block Grants to Address Addiction, Mental Health Crisis (Substance Abuse and Mental Health Services Administration)

Federal opioid grant money inequitably distributed to states

A study compared the amount of federal opioid grant money awarded to each state in 2017 and 2018 to the severity of the states’ opioid problems, finding that around one-sixth of the funds, approximately $1.5 billion, would have needed to be reallocated in order to distribute funding equitably. When compared to the severity of the problem, the most poorly funded states tended to be in the Rust Belt, Appalachia, the Northeast and Florida, and the most generously funded were in the northern mountain states, parts of New England, Alaska and Hawaii. Less populous states were consistently overfunded compared to the national average. Three main factors cause unequal funding levels: some major grant programs contain minimum amounts of funding that each state is eligible for; special set-asides are sometimes reserved for a limited number of states with especially severe problems, creating sharp disparities around the cutoff; and awards are sometimes based on indicators that are poorly measured. Recommendations to improve targeting include auditing yearly, allocating with precision in mind and avoiding standardizing award amounts.

Source: How to target opioid funding to states that need it most (The Hill)

Biden developing a clemency strategy likely to help those incarcerated due to harsh drug policies

Administration officials have begun quietly evaluating clemency requests and have signaled that Biden could begin issuing pardons or commutations by the midpoint of his term. The effort, overseen by the White House Counsel’s Office and the Department of Justice, is an implicit rebuke to Trump’s approach, which bypassed the Justice Department and resulted in a wave of late pardons and commutations to people with wealth and connections. Biden’s team has signaled that it is establishing a more deliberate process geared toward identifying entire classes of people who deserve clemency, helping address racial equity. Biden’s criminal justice campaign platform indicated that he intended to use clemency to “secure the release of individuals facing unduly long sentences for certain nonviolent and drug crimes.” In outreach sessions with the White House, criminal justice activists have recommended prioritizing clemency for those swept up in the war on drugs.

Source: Biden Is Developing a Pardon Process With a Focus on Racial Equity (New York Times)

DEA approves new growers of research marijuana

The U.S. government has approved new growers of research marijuana for the first time in more than 50 years, widening the capacity to study the substance’s medical value. The DEA’s action after years of delay means researchers will be able to study marijuana from more than one grower, the University of Mississippi, which the government approved in 1968 as the only legal source of marijuana for federal research. At least two applicants received initial approval. More than 30 applicants have been waiting for over four years to find out if they were approved. Scientists have said that University of Mississippi’s cannabis is not varied enough or does not have a high enough THC concentration to reflect what average Americans are using, and that expanding the number of cultivators will improve the nation’s ability to study the effects of cannabis use.

Source: Marijuana Medical Research Growers Receive U.S. Approval (Wall Street Journal); DEA begins approving marijuana cultivation applicants (Politico)

CMS data shows people are forgoing mental health and substance use disorder care during the COVID-19 pandemic

CMS released data highlighting the continued impact of COVID-19 on Medicaid and CHIP beneficiaries and the utilization of health services. In March-October 2020, beneficiaries have foregone millions of primary, preventive and mental health care visits, compared to the same time period in 2019. Although utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services show the slowest rebound, despite worsening mental health conditions. There was a 34% decline in the number of mental health services utilized by children under 19 and a 22% decline among adults ages 19-64. Substance use disorder service utilization declined 13%.

Source: CMS Data Shows Vulnerable Americans Forgoing Mental Health Care During COVID-19 Pandemic (Centers for Medicare & Medicaid Services)

Emergency departments can help initiate OUD treatment and coordinate care

According to an article published by the nonprofit The Pew Charitable Trusts, state health care decisionmakers should adopt, and Medicaid agencies should fund, a range of care coordination strategies based on successful approaches around the country in order to support emergency departments (EDs) as they care for and engage patients following overdoses. The authors suggest that EDs should initiate medication for opioid use disorder and facilitate transitions to community-based care, citing research that care coordination models, which organize patient care and share information among all concerned with an individual’s treatment plan, improve health outcomes. Many exemplary care coordination programs based in EDs use peer recovery coaches to ensure that people with OUD receive continued treatment after emergency care. States are funding such models through funding sources such as the STR/SOR grants. California, Colorado, Kentucky, New Jersey, Ohio, Rhode Island, South Carolina and Washington, among other states, have examples of such programs.

Source: Emergency Departments Can Help People with Opioid Use Disorder Start Treatment (Pew)

States are considering legislation to ban flavored tobacco products, even with federal action coming

At least eight states are considering legislation this year that would ban sales of all flavored tobacco products, including cigarettes, cigars, vaping products and smokeless tobacco. Backers of the state legislation say the FDA’s announcement last month that it would move within a year to ban the sale of menthol cigarettes and flavored cigars boosts momentum for the state bans, while opponents from the tobacco industry argue that since FDA is set to act, states do not have to. Sponsors of the state bills note the measures could go further than the proposed FDA rule by banning other flavors and other tobacco products and that the FDA rule could be delayed by court challenges, while new state laws would be more immediate. Legislation is under consideration in Hawaii, Indiana, Maine, Maryland, New Mexico, New York, Texas and Vermont.

Source: As Feds Push Menthol Cigarette Ban, States Weigh Broader Measures (Pew Stateline)

Kentucky jail provides treatment and aftercare for inmates with addiction

It is rare for jails and prisons to offer a full continuum of treatment for addiction or to offer medications for opioid use disorder, even though such options are the standard of care. The Kenton County Detention Center in Kentucky, however, has embraced treatment for inmates with addiction since 2015. In 2015, the jail hired a certified drug and alcohol addiction counselor as the new Addiction Services Director. In 2018, it partnered with Hazelden Betty Ford Foundation for the Strong Start Comprehensive Opioid Response with 12 Steps and Reentry program, which includes three months of treatment — including offering a range of OUD medications — followed by three months of aftercare, which can include continued medication and an array of wraparound services. Lindsey Vuolo, Vice President of Health Law and Policy at Partnership to End Addiction, explains the importance of including medical professionals and individuals with lived experience in such programs and allowing individuals with addiction to form connections, as this program does. The program is showing success, as it is helping inmates, reducing recidivism, and saving money.

Source: Treatment, aftercare is part of plan for inmates with addiction in this jail (Cincinnati Enquirer)

Washington makes drug possession a misdemeanor

Washington Gov. Inslee signed a bill overhauling the state’s approach to drug possession after the Washington Supreme Court struck down its previous law as unconstitutional. The new law reclassifies possession of controlled substances as a misdemeanor punishable by up to 90 days in jail. The previous law had made it a felony. The new law also requires that police divert individuals to treatment for their first two offenses, and prosecutors can choose to divert individuals beyond that as well. The law aims to expand treatment services and outreach, including to homeless people with behavioral health issues. Regional recovery navigator teams will be set up to help provide “continual, rapid and widespread access to a comprehensive continuum of care” for people with addiction.

Source: New Washington State Law Makes Drug Possession a Misdemeanor (U.S. News & World Report)

Naloxone prescriptions down during the COVID-19 pandemic

A study analyzing the trends in filled naloxone prescriptions during COVID-19 found that in March 2020, the average number of individuals filling naloxone prescriptions per week abruptly declined by 26%, exceeding the decline in the number filling prescriptions for any medication (15%) and for opioids (9%). There has been no statistically significant recovery in naloxone prescriptions since. Naloxone prescriptions declined for those with commercial insurance and Medicare, but not those with Medicaid or cash payment. The decline is not explained by a decline in opioid prescriptions, where naloxone co-prescription is recommended. Increasing naloxone distribution in densely populated areas and via mail order and delivery though community-based organizations could help mitigate some of the reductions in naloxone distribution via pharmacies and could reduce some of the increases in fatal overdoses during COVID-19.

Source: Trends in Filled Naloxone Prescriptions Before and During the COVID-19 Pandemic in the United States (JAMA)

Behavioral health integration faces barriers to implementation

Despite the potential of behavioral health integration to improve outcomes, its implementation has faced significant operational and financial impediments, such as lack of direct reimbursement (only direct patient contact is reimbursable, not care coordination, warm handoffs or collaborative efforts between primary care and behavioral health providers) and limitations on billable providers (discrepancies between Medicaid and Medicare reimbursement for providers such as licensed social workers, marriage and family therapists and licensed professional counselors). To address these barriers and promote the sustainability of integration, recommendations include reimbursement augmentation by Medicaid (alternative payment structures such as bundled or capitated payments) and expanding billable providers (increasing recognition of all master’s level, licensed mental health clinicians as reimbursable, such as through the Mental Health Access Improvement Act).

Source: Policies to Improve Implementation and Sustainability of Behavioral Health Integration (Health Affairs)