Affordability and availability are important barriers to care
Bipartisan Policy Center and Morning Consult conducted a poll on patients’ experiences receiving mental health and substance use disorder treatment services during the pandemic. A majority say the cost of a provider and whether the provider is in their insurance network are their top priorities when seeking treatment. However, they consider affordability and availability of providers taking new patients to be the largest barriers. During the pandemic, nearly as many adults received treatment through their primary care provider as through a behavioral health specialist, and adults were equally satisfied with care from both types of providers. Those living in rural areas were more likely to get care through a primary care provider and those in urban and suburban areas from a behavioral health specialist. Seventy percent agree it would be more convenient if treatment were integrated into their primary care. People want more flexibility in the way they receive treatment, with around equal numbers saying they prefer telehealth or hybrid care versus in-person care.
Systems repeatedly fail individuals with mental health and addiction
Lizzie Feliciano writes about her brother Louis’s struggle with mental health and alcohol use disorder, highlighting issues such as lack of early identification of mental health and addiction issues, stigma, lack of affordable care and adequate insurance coverage, lack of treatment for co-occurring mental health, and substance use disorders. The article stresses the need to treat mental health and substance use disorder early, eliminate stigma, address socioeconomic and cultural factors, teach parents to recognize early warning signs of mental illness, provide behavioral health resources in schools, fund routine training and education for health care providers on mental health and addiction symptoms and treatment, and address cost barriers.
Representatives urge the inclusion of behavioral health providers in COVID-19 relief public health workforce funding
Reps. Napolitano, Kaptur and Lee, along with 16 other House members, sent a letter to HHS urging the inclusion of mental health and substance use disorder providers within the $7.66 billion public health workforce expansion in the American Rescue Plan. The funding is estimated to be able to support around 100,000 new positions, and the letter recommends that one-third of those new public health positions be devoted to behavioral health, noting that the historic expansion needs to fully integrate behavioral health providers to avoid undercutting the nation’s COVID-19 recovery and continuing the long-standing and stigmatizing separation of mental health from physical health.
Source: Napolitano, Kaptur, Lee Urge HHS to Expand Mental Health Workforce (Congresswoman Grace F. Napolitano)
COVID-19 relief funding to expand pediatric mental health care access announced
HHS announced the availability of $14.2 million from the American Rescue Plan to expand pediatric mental health care access by integrating telehealth services into pediatric primary care. The funding will expand Pediatric Mental Health Care Access projects into new states and geographic areas, including tribal areas. The new networks of pediatric mental health care teams will provide teleconsultations, training, technical assistance and care coordination for pediatric primary care providers to diagnose, treat and refer youth with mental health and substance use disorders. Pediatric mental health care teams will include child and adolescent psychiatrists, licensed mental health professionals and care coordinators, who will use telehealth to consult with pediatric primary care providers.
Source: HHS Announces $14.2 Million from American Rescue Plan to Expand Pediatric Mental Health Care Access (U.S. Department of Health and Human Services)
Chiquita Brooks-LaSure confirmed as CMS administrator
The Senate confirmed Chiquita Brooks-LaSure as Centers for Medicare & Medicaid Services Administrator. The 55-44 vote largely split along party lines, with 5 Republicans (Collins, Murkowski, Blunt, Moran, Burr) joining Democrats after Republicans had previously held up her nomination in response to the Biden administration’s decision to revoke Texas’s Medicaid waiver previously approved by the Trump administration. Brooks-LaSure helped implement the Affordable Care Act during the Obama administration, and she will be the first Black woman to run CMS. She is expected to leverage the agency’s regulatory powers to fill gaps in the ACA, reverse Trump-era policies and advance Biden’s health care agenda. The Biden administration is now expected to quickly fill other top roles at CMS that do not require Senate approval.
Source: Senate confirms Biden pick to lead Medicare, Medicaid office (The Hill); Brooks-LaSure confirmed as CMS administrator (Politico)
Labor Secretary Walsh discusses his struggle with addiction for Mental Health Action Day
Labor Secretary Marty Walsh tweeted a video of himself for Mental Health Action Day talking publicly about his struggle with alcoholism, something none of his predecessors have ever done. In the video, Walsh discussed getting help, noted that everyone has to deal with mental health, especially given the pandemic, and stated that there should be not stigma. He also stated that the Department of Labor is taking action to remove barriers to coverage for mental health and substance use disorder treatment. Walsh has talked before about his alcoholism, but his comments are a reminder that he represents another first in Biden’s historically diverse Cabinet — the first Cabinet member openly in recovery. Even Betty Ford, whose open discussion of her addiction helped destigmatize the issue, did not talk about her experiences until after leaving the White House.
Source: Another Biden Cabinet First (Politico)
State and local news
States have various ways of taxing marijuana
States are looking to draw new tax revenue from marijuana legalization as they emerge from the pandemic, but even for mature markets, marijuana revenues remain a tiny portion of state budgets. There are three types of cannabis taxes: a sales-based tax determined by retail price, a fixed-price weight-based tax and a potency-based tax assessed by the amount of THC in the product. So far, most states have a sales tax, a weight-based tax or a combination. New York is the first state to enact a tax based on THC potency, and the outcomes could influence other states as they consider legalization. Federal cannabis legalization, which is still unlikely, would upend state tax regimes and introduce interstate commerce that could potentially shrink revenue for state coffers by driving down prices. Most statehouses have adjourned their 2021 sessions, but several states are still debating recreational legalization, including Connecticut and Delaware, or plan to have the issue on the ballot.
Source: What You Need to Know About Taxing Marijuana (Politico)
Edibles designed to imitate candy pose risks, particularly to youth
Mars Inc. filed a lawsuit against companies for selling cannabis-infused edibles that look like their candy products. The suit focuses on intellectual property rights but also argues that copycat products could lead children to mistakenly ingest substances. Similar lawsuits have been brought by the other candy companies. While many edible companies operating in states where cannabis is legal strive to comply with regulations, the illegal market is thriving.
Edibles have become the fastest-growing category in cannabis, and overconsumption and accidental consumption are both concerns. Some states, such as Washington and Colorado, have taken steps such as including warning labels on products, prohibiting the word “candy” on packaging and prohibiting edibles that look like people, animals or fruit. Other ways to reduce accidental ingestion include mandating childproof packaging, requiring each edible to be individually wrapped, limiting potency, educating consumers on safe storage and making packaging that will not catch the eye of children. Canada requires packaging to have a uniform color and a smooth texture, and not to have cutout windows, scents, sounds or inserts, among other requirements. Laws in the U.S. are far less strict, mostly prohibiting the use of cartoon characters and making general statements about how the packaging should not appeal to children.
Source: Big Candy is Angry (New York Times)
San Francisco has a new Street Overdose Response Team
San Francisco announced a new Street Overdose Response Team (SORT), an immediate, street-based response for people experiencing homelessness who have recently experienced a non-fatal overdose, with the aim of engaging them in the behavioral health system of care. SORT is part of San Francisco’s system of Street Response Teams, which includes the Street Crisis Response Team and the new Street Wellness Response Team. EMS will handle immediate response and a specialized care team will provide follow-up care. Clinical members will include peer, medical and behavioral health specialists. $11.4 million over two years will create two response units (i.e., real-time response to provide initial treatment and prevention tools, including medications), three follow-up units (i.e., to engage clients within 72 hours of initial contact from Response Units to provide continued care involving withdrawal management, long-term treatment referral, physical and and mental health services, shelter and housing), and a supervisory team.
Source: Mayor London Breed Proposes New Street Overdose Response Team to Stem Rise of Overdose Deaths (City and County of San Francisco)
Other news in addiction policy
Policies should support low-threshold buprenorphine prescribing
State and federal policymakers can support low-threshold buprenorphine prescribing in a variety of ways, including creating policies to encourage timely and convenient initiation, removing prior authorization requirements, amending state billing requirements and allowing buprenorphine to be prescribed prior to a completed initial intake assessment, funding emergency department initiation of buprenorphine, and making permanent COVID-19 flexibilities. Support of patient retention can also facilitate low-threshold buprenorphine prescription, by removing state regulations that require clinicians to taper buprenorphine overtime, eliminating counseling requirements, and prohibiting discharge of patients who continue to use substances. Finally, policymakers can also fund supplemental health and social services that facilitate initiation and continuation of treatment, including allowing Medicaid reimbursement for support services and dedicating grant money to services that facilitate low-threshold prescribing (e.g., outreach, transportation, case management).
Pandemic-related factors negatively impacting children's mental health
Several pandemic-related factors may negatively impact children’s mental health, such as social distancing and stay-at-home orders. Adolescents, young children, LGBTQ youth, and children of color may be particularly vulnerable to negative mental health consequences of the pandemic. These factors can also lead to loneliness and isolation, income insecurity, and poor mental health for parents.
Prior to the pandemic, many children were not receiving mental health care, and access may have worsened, with school closures limiting a commonly utilized site of care for children and adolescents. The American Rescue Plan Act and the proposed American Jobs Plan and American Families Plan include funding for children’s mental health.
Source: Mental Health and Substance Use Considerations Among Children During the COVID-19 Pandemic (Kaiser Family Foundation)