Policy News Roundup: November 21, 2024

STAT: Many opioid recovery programs reject effective treatments

The main point: Much of Narcotics Anonymous (NA) and the addiction recovery world more broadly reject medications for opioid use disorder (MOUD), even though MOUD is the gold standard of treatment. That’s according to a new article in STAT.

The details:

• As the death toll of the drug crisis has climbed, much of the U.S. has grown more accepting of long-stigmatized but highly effective medications like buprenorphine or methadone. But many of the institutions that claim to offer help for opioid addiction are among those most hostile to the medications.
• STAT found examples of recovery housing programs that evicted residents for taking methadone or buprenorphine; rehab and detox facilities that only admitted residents not taking medication or pledging to wean off; and NA chapter meetings where people taking MOUD have not been welcome.

But: Hostility to medication is not universal. Many NA chapters now tolerate medications, and an increasing share of rehab facilities and sober living homes recognize medications as an essential element of recovery.

• But interventions rooted in the abstinence-only ideology remain the default response to addiction.

The policies:

• There is little oversight of sober living houses or addiction treatment providers. No federal standard prohibits substance use treatment that bans the standard-of-care medications, and there is no hard rule requiring facilities providing rehab services to offer them.
• The Substance Abuse and Mental Health Services Administration requires sober living facilities receiving certain federal grants to allow MOUD, but the language is nonbinding and routinely ignored.
• Accreditation organizations that certify rehab programs and provide training for substance use treatment professionals continue to greenlight abstinence-only approaches.

Why it matters:

• Around 100,000 people are still dying from overdoses every year, the vast majority of which involve opioids. We have medications to treat this disease that can be lifesaving and are incredibly effective.
• But some parts of the opioid use disorder (OUD) treatment and recovery system still do not offer, or even prohibit, this crucial treatment option.
• People with OUD often feel forced to choose between medications or a supportive community.

Source: The recovery community says it offers refuge from opioid addiction. But it’s still hostile to lifesaving addiction medications (STAT)

The main point: ProPublica found that several states have investigated insurers and found widespread ghost networks for mental health providers, but penalties rarely follow.

• Most states have not fined a single company for publishing directory errors since 2019. When they do, the penalties have been small and sporadic. In an average year, fewer than a dozen fines are issued by insurance regulators for directory errors.

The details:

• The problem is not one of awareness – states, federal agencies, researchers and advocates have documented ghost networks for years. But regulators have resisted penalizing insurers for not fixing them.
• Limited funding restricts how often states can conduct secret-shopper surveys, one of the best ways to unmask errors. Many states wait for a complaint to be filed before investigating errors.
• Even upon learning that insurers may not be following the law, some regulators still take a hands-off approach to enforcement. They may ask insurers to fix the problem without issuing fines. Some insurance commissioners fear that stricter enforcement could drive companies out of their states, leaving constituents with fewer plans to choose from.
• State attorneys general and federal regulators also have not adequately addressed the problem. Some have required insurers to audit directories but not to report their findings, for example. The federal Centers for Medicare and Medicaid Services is tasked with enforcement of federal ghost network regulations in at least 15 states, but since the requirements went into effect in 2022, it has not fined any insurers.

Why it’s important:

• The few fines that are issued represent a tiny fraction of the companies’ profits, and insurers treat the fines as a “cost of doing business.”
• Unless agencies can crack down and issue bigger fines, insurers will keep selling error-ridden plans.
• When people are unable to find a provider that participates with their health plan, they are often unable to access needed care.

Source: State Regulators Know Health Insurance Directories Are Full of Wrong Information. They’re Doing Little to Fix It. (ProPublica)

The data: Provisional data from the Centers for Disease Control and Prevention suggests a 14.5% decrease in overdose deaths (to 96,801) from the year ending June 2023 to the year ending June 2024.

The details:

• Overdose deaths were down in 45 states, with increases in Alaska, Nevada, Oregon, Utah and Washington.
• Opioids still accounted for the vast majority (73%) of overdose deaths, and synthetic opioids, specifically, were involved in two-thirds of overdose deaths. More than a third of deaths involved psychostimulants with abuse potential (methamphetamine), and more than a quarter involved cocaine.
• Experts are not certain about the reasons for the decline but cite a combination of possible factors, including the end of COVID restrictions, increased availability of naloxone and treatment, and changes in the drug supply.

The main point: This is the largest recorded reduction in overdose deaths and the seventh consecutive month of reported decreases. The U.S. is on pace for its first year with fewer than 100,000 overdose deaths since 2020.

• There have been other times when overdose deaths seemed to have plateaued or decreased, only to rise again, but this seems to be a substantial and sustained decrease.

Why it’s important: The continued decline is giving experts hope the nation is seeing sustained improvement. It could be a sign that overdose prevention efforts are working.

• But: The toll remains immense. And any progress made could be fleeting if there are changes to federal resources or policies.

Source: White House Drug Policy Director Statement on Historic Decline in Drug Overdose Deaths Over the Past Year (Office of National Drug Control Policy); U.S. overdose deaths are down, giving experts hope for an enduring decline (Associated Press); U.S. drug overdose deaths on pace to fall below 100,000 this year (STAT)

President-elect Trump has selected Robert F. Kennedy, Jr. as his nominee for Department of Health and Human Services (HHS) secretary.

The details: There are few details so far on Kennedy’s views related to addiction, and his plans for federal health care programs that pay for addiction treatment (e.g., the Affordable Care Act, Medicaid) are largely unknown.

• Addiction: Kennedy is himself in long-term recovery from opioid addiction, but he has not outlined how he would address substance use and addiction.
• Agencies under HHS: In this role, Kennedy would be responsible for overseeing 13 divisions, including many that oversee addiction-related policies and funding. He has noted he wants to make significant reforms to the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and the Food and Drug Administration (FDA), including changing their focus, altering budgets and reducing staff.
• Psychedelics: Kennedy expressed favor for psychedelics and changing FDA regulations to make them more available.

The next step: Kennedy’s appointment will need to be confirmed by the Senate.

Why it’s important:

• HHS and many of its agencies — including CDC, NIH, FDA, the Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid Services — provide funding and create and oversee policies and programs to address addiction and the overdose crisis. They fund prevention, harm reduction, treatment and recovery services; provide insurance coverage; regulate addictive products like tobacco and opioids (and other medications); and fund and conduct research on substance use and addiction.
• Kennedy has often expressed opposition to the public health agencies he would oversee, has spread misinformation, and has contradicted recommendations and warnings from CDC and FDA on various health issues. Public health officials fear that interventions with rigorous scientific backing could come under fire and that debunked notions could be adopted as policy.

Source: ‘Quack,’ or ‘disruptor’: Trump pick RFK Jr. gets mixed reviews (Politico); 1 big thing: Complete chaos is an option (Axios); Trump Picks R.F.K. Jr. to Be Head of Health and Human Services Dept. (The New York Times)