Policy News Roundup: November 11, 2021

    Key reads

    Infrastructure bill mandates car technology to prevent drunk driving

    The infrastructure bill passed by Congress last week includes a mandate for automakers to implement technology to prevent drunk driving. Monitoring systems would roll out in all new vehicles as early as 2026, after the Transportation Department assesses the best form of technology to install in vehicles and automakers are given time to comply. The legislation does not specify technology, only that it must “passively monitor the performance of a driver of a motor vehicle to accurately identify whether that driver may be impaired.” One possibility is infrared cameras that monitor driver behavior, which are already being installed by some automakers (e.g., General Motors, BMW, Nissan) to track driver attentiveness while using partially automated driver-assist systems. The cameras make sure a driver is watching the road and look for signs of drowsiness, loss of consciousness or impairment. If signs are spotted, the cars will warn the driver. If the behavior persists, the car would turn on its hazard lights, slow down and pull to the side of the road.

    Source: Congress mandates new care technology to stop drunken driving (Associated Press)

    DEA's efforts to limit buprenorphine diversion are scaring pharmacies away from dispensing the medication

    The Drug Enforcement Administration’s (DEA) efforts to limit buprenorphine diversion and unscrupulous prescribing may be exacerbating the addiction crisis by scaring pharmacies away from dispensing the medication due to fear of DEA investigations. While the government has taken steps to increase the number of clinicians prescribing buprenorphine, a study found that one in five pharmacies do not provide the medication. Buprenorphine misuse has decreased in recent years even as prescribing has increased, and most people who use diverted buprenorphine do so to avoid withdrawal symptoms because they cannot get a prescription. The DEA requires wholesalers to flag suspicious orders, and wholesalers limit how much a pharmacy can buy or create algorithms to detect orders that exceed projected need. Pharmacies are usually not privy to how the limits are set, so many order small batches out of caution. This creates a “prescribing cliff,” in which doctors may prescribe buprenorphine to more patients, but pharmacies order enough for only a certain number of customers, meaning they rarely have openings for new patients.

    Source: DEA takes aggressive stance toward pharmacies trying to dispense addiction medicine (NPR)

    Federal news

    Congress launches investigation into McKinsey over its role in the opioid crisis

    Congress launched an investigation into consulting firm McKinsey’s role in the opioid crisis. The House Committee on Oversight and Reform sent a letter demanding records related to its “business practices, conflicts of interest and management standards.” The letter asked for names of McKinsey clients in the health care industry and documents connected to its work with opioid manufacturers, distributors and retailers. The committee is also looking at how McKinsey’s work for drugmakers may conflict with its work for the Food and Drug Administration. The committee also wants an enumeration of all investments of McKinsey Investment Office Partners, an in-house pension hedge fund and investment vehicle for partners that has held indirect investments in companies including its drugmaker clients, as well as employees who have done work with it since 2005.

    Source: Congress Is Investigating McKinsey Over Its Role in the Opioid Crisis (New York Times)

    House Oversight Committee investigating the production and sale of synthetic nicotine

    Rep. Raja Krishnamoorthi, chairman of the House Oversight Subcommittee on Economic and Consumer Policy, sent letters requesting documents and interviews from Puff Bar and Next Generation Labs, two companies that make or sell synthetic nicotine products, which are not regulated by the Food and Drug Administration (FDA). Puff Bar was pulled from the market last year, but it reformulated its disposable e-cigarettes with synthetic nicotine to avoid FDA regulation. Krishnamoorthi wrote, “You have apparently made the vile decision to continue enriching yourselves by poisoning children…Puff Bar should not be allowed to continue harming children due to FDA’s failure to regulate synthetic nicotine, and I intend to put an end to your predatory practices.” Next Generation Labs claims to be “the market leader” in synthetic nicotine, supplying both e-cigarette manufacturers and vape shops.

    Source: Chairman Krishnamoorthi Launches Investigation into the Production, Sale of Unregulated Synthetic Nicotine (House Committee on Oversight and Reform)

    NIDA's Nora Volkow explains the need to address stigma

    National Institute on Drug Abuse Director Nora Volkow explains stigma as a barrier to addressing the drug crisis. She highlights how stigma pervades medicine, policy and communities in a variety of ways. These include inadequate training in medical schools, lack of treatment programs offering medications, inadequate insurance coverage, lack of medications in justice settings, communities’ failure to provide harm reduction, fear of judgement and discrimination that prevents people from seeking treatment, policies that penalize people with addiction and buprenorphine prescribing restrictions. She argues that we need a large-scale social intervention to change public attitudes toward addiction and those who struggle with it. Besides ensuring proper training and resources to help patients with addiction, she says, we need to reconsider policies that promote substance use as wrongdoing. Addressing stigma must be a central prong of public health efforts, she writes, treating pushing back against stigma as no less important than new prevention and treatment tools.

    Source: To end the drug crisis, bring addiction out of the shadows (Association of Americans Medical Colleges)

    State and local news

    Oklahoma Supreme Court tosses opioid ruling against J&J

    The Oklahoma Supreme Court threw out a ruling that required Johnson & Johnson to pay the state $465 million for its role in the opioid crisis, rejecting the argument that the company violated public nuisance laws. The judges gave weight to the company’s defense that it had not promoted its products in recent years and had sold off one of its product lines in 2015, saying manufacturers could not be held “perpetually liable” for their products. They said the state failed to identify a public right under the nuisance law and had attempted to apply a “novel theory” that was more likely a products liability case. They said that the harm alleged stemmed from a legal product, and individuals suffered, rather than the public at large. The judges said the company had no control over the distribution and use of its product once the drug left its purview. While the ruling could be a harbinger of future rulings, the decision cannot be interpreted too broadly, as states have their own public nuisance laws.

    Source: Oklahoma Supreme Court Throws Out $465 Million Opioid Ruling Against J.&J. (New York Times)

    Bloomberg Philanthropies commits $120 million to addressing the overdose crisis

    Bloomberg Philanthropies is making a five-year, $120 million investment to help combat the overdose crisis in Kentucky, New Jersey, New Mexico, North Carolina and Wisconsin. The Bloomberg Opioid Overdose Prevention Initiative was launched in 2018 with $50 million, originally providing funds to Pennsylvania and Michigan. The five new states will each receive $10 million over five years. Pennsylvania and Michigan will receive an additional $4 million over three years. States will focus on ensuring medication access and availability, engaging local communities and supporting people who use substances, as well as emphasizing a health equity approach to overdoses.

    Source: Bloomberg Philanthropies Commits Additional $120 Million to Reduce Overdose Deaths in U.S. (Bloomberg Philanthropies)

    Detroit decriminalizes entheogenic plants

    Detroit voters passed Proposal E last week to decriminalize entheogenic plants and fungi, with 61% support. Entheogenic plants include psilocybin mushrooms, ibogaine from Africa, ayahuasca from South America and peyote and mescaline from certain cacti. The proposal asked whether the city code should be amended to “decriminalize to the fullest extent permitted under Michigan law the personal possession and therapeutic use of Entheogenic Plants by adults and make the personal possession and therapeutic use of Entheogenic Plants by adults the city’s lowest law-enforcement priority.” Denver was the first city to decriminalize psychedelic mushrooms in 2019. Since then, Oregon, Rhode Island, New Jersey, the District of Columbia and eight other U.S. cities have decriminalized entheogenic plants and fungi in some way.

    Source: Detroit just decriminalized psychedelics and ‘magic mushrooms.’ Here’s what that means (PBS)

    Decriminalization may spread, despite unclear outcomes in Oregon

    Progressive lawmakers and civil rights groups want more states to follow Oregon’s example and drop criminal penalties for carrying small amounts of drugs and spend more on addiction services. Maine, Massachusetts, Rhode Island and Vermont proposed decriminalization bills this year. Advocates hope to get decriminalization measures on the ballot in Washington in 2022 and California in 2024. However, Oregon’s experience shows that it is easier to eliminate criminal penalties than to ramp up behavioral health services and get more people to use them, particularly as treatment providers are battered by COVID-19 and workforce shortages. Oregon’s drug arrests and convictions have plummeted, and decriminalization does not appear to be increasing drug-related crime. It is unclear whether decriminalization has led more people to seek treatment. The law created a hotline that people ticketed for possession can call to undergo a health assessment to get their citations waived, even without further treatment. Few have used it so far, though it is still early.

    Source: Oregon’s Drug Decriminalization May Spread, Despite Unclear Results (Pew Stateline)

    Other news in addiction policy

    The mental health care system needs investment

    In an op-ed written for The Hill, contributors argue that the U.S. has never invested in its mental health care systems the way it has for physical health. Low reimbursement rates and systemic underfunding have led to a fractured, overworked, poorly trained and poorly paid workforce. This in turn has led to provider shortages. Many facilities are rundown and overcrowded, with long wait lists and poor access. Low reimbursement rates lead many providers not to accept insurance. There is little oversight over training and therapies clinicians provide, no compensation to learn strategies needed to address complex needs and little monitoring to ensure treatment is consistent with evidence. The writers argue that we must require insurance to cover services for licensed mental health providers and enforce penalties for violating parity; make permanent the emergency provisions that reimburse telehealth comparably to in-person therapy and provide policy and financial support to telehealth; raise reimbursement rates to attract clinicians and make it financially viable for them to take insurance; and invest in training professionals to deliver quality care, hold them accountable for providing this care and incentivize them to work in the public sector.

    Source: It’s time to pay for mental health care in America (The Hill)

    Take action to ensure health care providers receive addiction training

    Ask your members of Congress to cosponsor the Medication Access and Training Expansion (MATE) Act, which would require prescribers to undergo training on substance use disorder before receiving or renewing their license to prescribe controlled substances.

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    November 2021