Policy News Roundup: May 4, 2023

Key reads

Fentanyl overdose death rate more than tripled 2016-2021

A Centers for Disease Control and Prevention report found that the rate of overdose deaths involving fentanyl increased by 279% from 2016 through 2021. The rate involving methamphetamine more than quadrupled, and the rate involving cocaine more than doubled. The rate involving oxycodone decreased 21%. In 2021, rates were higher among men than women for all drugs analyzed. Death rates were highest for fentanyl among all age groups, but for those under 25 and over 65, rates were not significantly different from other drugs. Rates were also highest for fentanyl across all race/ethnicity groups analyzed, but groups have been affected by different drugs. The death rate involving fentanyl was closely followed by that for meth among American Indian/Alaska Natives, for example, while it was followed by cocaine for Black Americans. Fentanyl death rates for American Indian/Alaska Native and Black people were higher than those for White, Hispanic and Asian people. Deaths involving fentanyl were highest for all except two regions, where deaths involving both fentanyl and methamphetamine were highest.

Source: Fentanyl overdose deaths surged 279% since 2016 while heroin deaths fell: CDC (ABC)

CDC releases findings from Youth Risk Behavior Survey

The Centers for Disease Control and Prevention released findings from the 2021 Youth Risk Behavior Survey. Current alcohol use, marijuana use, and binge drinking and lifetime use of alcohol, marijuana, and cocaine and prescription opioid misuse among high school students decreased between 2019 and 2021, while lifetime inhalant use increased. The survey found 29% reported current use of alcohol or marijuana or prescription opioid misuse, and among those, 34% used two or more substances. Alcohol and marijuana were the most commonly used. Nearly half reported lifetime alcohol use and over a quarter reported lifetime marijuana use. Females and students identifying as lesbian, gay or bisexual had higher prevalences of most substance use. The survey found 36.2% had ever used vape products, 18% currently used them and 5% used them daily. Prevalence was lower among Asian students and higher among bisexual students. Lifetime use decreased between 2015 and 2021, but current use was stable and daily use increased. The survey also found that school connectedness and high parental monitoring were associated with lower prevalence of risk behaviors including marijuana use and opioid misuse, while witnessing community violence and experiencing unstable housing were associated with increased odds of substance use.

Source: MMWR Supplements: Current Volume (72): Youth Risk Behavior Surveillance – United States, 2021 (Centers for Disease Control and Prevention)

Surgeon General issues advisory on loneliness and isolation

The Surgeon General released a new Surgeon General Advisory on the public health crisis of loneliness, isolation and lack of connection. Disconnection fundamentally affects mental, physical and societal health. Loneliness and isolation can increase the risk for mental health challenges and can increase the risk for premature death by levels comparable to daily smoking. The advisory lays out a framework for a National Strategy to Advance Social Connection and details recommendations that individuals, governments, workplaces, health systems and community organizations can take to increase connection. The framework is based on six foundational pillars – strengthen social infrastructure, enact pro-connection public policies, mobilize the health sector, reform digital environments, deepen our knowledge and cultivate a culture of connection.

Source: New Surgeon General Advisory Raises Alarm about the Devastating Impact of the Epidemic of Loneliness and Isolation in the United States (Department of Health and Human Services)

DEA seeks to temporarily extend pandemic telehealth prescribing flexibilities before finalizing proposed rules

The Drug Enforcement Administration (DEA) is seeking to temporarily extend pandemic telehealth flexibilities for controlled substances prescribing set to expire with the COVID public health emergency on May 11. The request follows a barrage of complaints lobbed at the DEA for a February proposal to reinstate stricter limits around telehealth prescribing. The flood of public comments on the proposal (nearly 40,000) are just one factor delaying the release of a final rule (the DEA is legally required to consider all of the comments it received on the proposed rule and respond to a substantial portion of them). Dueling priorities between the federal agencies involved are also complicating the ongoing negotiation process. It is clear the administration will not roll out final telehealth prescribing rules by May 11, but it is unclear how long the temporary flexibilities will be extended or when the DEA will release the final rules.

Source: DEA seeks to temporarily extend virtual prescribing for controlled substances (Washington Post)

NIDA ensuring social determinants of health are considered in addiction research

National Institute on Drug Abuse (NIDA) Director Nora Volkow explains that addiction treatment is not just about the delivery of a medication or intervention that works in ideal laboratory settings, but also about the social and economic factors that shape people’s lives. Understanding and finding ways to intervene in social determinants of health is a central priority at NIDA. Mitigating the adverse effects of environmental risk factors like socioeconomic disadvantage has long been a target of NIDA-funded substance use prevention research. With projects like the HEALing Communities study, NIDA is now bringing a similar mindset to addiction care and recovery. Measuring social determinants of health can help researchers better design treatment interventions and services and make addiction care more equitable. In clinical trials of new medications to treat addiction, it is crucial to consider social determinants that influence access to quality health care. Measuring such factors could help personalize addiction treatment approaches.

Source: Social Determinants of Health Can’t Be Extricated from Addiction Science (National Institute on Drug Abuse)

Safety net programs help lower disparities in children's brain development and mental health

A National Institute on Drug Abuse (NIDA) study found that states that provide stronger social safety nets have lower socioeconomic disparities in brain development and mental health of children aged 9-11. The disparity in brain structure between children from high- vs. low-income households was more than a third lower in states with greater cash assistance, and the disparity in mental health symptoms was reduced by nearly a half. The study highlights the impact that socioeconomic inequities can have on a child’s brain development but demonstrates that the gap can be mitigated through state anti-poverty programs, such as the Earned Income Tax Credit, Temporary Assistance for Needy Families and Medicaid. The availability and value of monetary assistance programs in higher cost-of-living states reduced the disparity in hippocampal volume by 34%. In states with Medicaid expansion, the disparity was reduced by 43%. Disparity in some mental health symptoms like anxiety and depression was 48% lower in states with larger cash benefits.

Source: Anti-poverty programs may help reduce disparities in brain development and mental health symptoms in children (National Institute on Drug Abuse)

Federal government begins to relax hiring rules on past drug use

The federal government, the nation’s largest employer, has been a major holdout in removing drug testing requirements in hiring but is now significantly relaxing its rules as agencies struggle to replenish a rapidly aging workforce in a tight job market. During the past five years, the U.S. military gave more than 3,400 new recruits who failed a drug test on their first day a grace period to try again. Agencies like the Central Intelligence Agency and Federal Bureau of Investigation have adopted more lenient rules regarding past use of marijuana among job candidates. Later this year, the Biden administration is expected to scale back how deeply the government delves into the drug histories of people applying for a security clearance. Proposed rules would limit the time frame for reporting use of illegal drugs to five years for drugs other than marijuana and only 90 days for marijuana (down from seven years).

Source: Needing Younger Workers, Federal Officials Relax Rules on Past Drug Use (New York Times)

Purdue settlement still awaiting appeals court ruling after a year

More than a year after Purdue reached a tentative opioid settlement, parties are still waiting for a court to rule on the legality of whether members of the Sackler family can be protected from lawsuits over OxyContin in exchange for handing over up to $6 billion in cash plus the company itself. Last month, lawyers on multiple sides of the case, including those representing Purdue, asked the 2nd U.S. Circuit Court of Appeals to issue a ruling or provide an update soon. It is not unusual for an appeals panel to take a year or more from a hearing until it releases a decision, but this case was originally fast-tracked by the court. The wait is preventing money from going towards opioid abatement, and the vast majority of the more than $6 billion that could be put toward that purpose is continuing to accrue interest in Sackler accounts. With the case stretching out, the legal costs continue to mount.

Source: Frustration grows over wait on OxyContin maker’s settlement (Associated Press)

California lawmakers debating a punitive or a treatment approach to fentanyl

The California legislature is considering more than 30 bills to address the fentanyl crisis. About half focus on public safety measures, such as punishing dealers with longer prison sentences, while others aim to increase accessibility to fentanyl overdose treatments and create education and prevention programs. A number of the bills have stalled, caught in a philosophical dispute about the best way to address the crisis. The bills focusing on public safety measures were at risk of getting lost until protestors converged on the state Capitol demanding they be heard. Six of those bills, including four that would increase fentanyl penalties, received a public hearing last week. Imposing tougher prison sentences on fentanyl dealers has been a common strategy for lawmakers across the U.S., including those in Democratic-controlled legislatures, but the tactic has drawn opposition from health and harm reduction advocates. In California, it has divided the Democratic caucus.

Source: Punishment or prevention: California debates fentanyl crisis (Associated Press)

Increase in waivered clinicians prescribing buprenorphine not indicative of more treatment

A new study looked at trends in buprenorphine-waivered clinicians’ active participation in prescribing, overall and by patient limits, between January 2017 and May 2021. Waivered clinicians increased from 34,149 to 96,415, and clinicians actively prescribing buprenorphine increased from 15,232 to 31,391 but represented a declining proportion of waivered clinicians. In May 2021, clinicians with a 30-patient limit were less likely to actively prescribe compared to clinicians with 100- and 275-patient limits. They represented the largest share of active prescribers and prescribed the lowest percentage of monthly total prescription volume. There was an increase in the number of waivered clinicians but limited participation in prescribing. The 2021 elimination of training requirements to obtain a waiver to treat 30 patients resulted in an increase in waivered clinicians but not in buprenorphine uptake. The findings bring into question the assumption that last year’s removal of the waiver requirement will lead to substantial increases in buprenorphine access. Additional investments may be needed to support clinicians treating opioid use disorder.

Source: Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit (JAMA)

Insurance coverage lacking for extended-release buprenorphine

A study on insurance-imposed utilization restrictions for buprenorphine for opioid use disorder between 2017 and 2021 found that almost all plans (Medicaid, Medicare Advantage and commercial insurance) covered immediate-release buprenorphine in 2021, with a general trend of decreasing prior authorization requirements and quantity limits since 2017. However, only 46% of commercial plans and 19% of Medicare Advantage plans covered extended-release buprenorphine. Even though most Medicaid plans covered extended-release buprenorphine in 2021, 37% required prior authorization. Policymakers and researchers concerned with buprenorphine insurance barriers should shift their attention to extended-release buprenorphine. State lawmakers could mandate that insurers include extended-release buprenorphine on their preferred drug lists.

Source: Buprenorphine Treatment For Opioid Use Disorder: Comparison Of Insurance Restrictions, 2017–21 (Health Affairs)