Policy News Roundup: November 30, 2023

Key reads

Opioid settlement funds should go toward public health

Authors from Open Society Foundations and Community Education Group write in Health Affairs that to ensure opioid settlement funds are spent as effectively and equitably as possible, funds should be spent on public health, not law enforcement. Funds should be targeted to underfunded, high-impact public health programs. This includes funding community-based harm reduction programs, programs that provide or facilitate access to medications for substance use disorder treatment and housing programs. For all programs, decisionmakers should make a special effort to reach Black, Indigenous and People of Color (BIPOC) populations. Settlement funds should not be spent on interventions that focus on arrests and punishment. They should not go to law enforcement coffers or to support capital expenditures, expansion or renovation of jails/prisons. Louisiana allocated 20% of funds to sheriffs, the most blatant illustration, but law enforcement spending is common across the country. Some states, however, are using funds to expand harm reduction programs and services for BIPOC communities. Some are using funds for legal aid for people who use substances. States/localities should have processes for getting public input on spending priorities and should make public all final decisions.

Source: How Are Opioid Settlement Funds Being Spent So Far? (Health Affairs)

Overdose deaths rose in pregnant and postpartum individuals

A study found that overdose deaths rose between January-June 2018 and July-December 2021 among females aged 10-44 who were pregnant or pregnant within the previous 12 months. Overdose mortality more than tripled among those 35-44, from 4.9 deaths per 100,000 in 2018 to 15.8 in 2021. Over 60% of these pregnancy-associated overdose deaths occurred outside health care settings, though often in counties with available health care resources, such as emergency and obstetric care. While treatment is available to pregnant individuals with substance use disorder, significant barriers, such as penalization, stigma, discrimination and limited socioeconomic resources, may obstruct the path to care. Overdose mortality ratios increased substantially across almost all examined age, racial/ethnic, educational and marital status groups. Girls and women who died from an overdose during pregnancy, compared to those who died from obstetric causes, were more likely to be 10-34, be non-college graduates, be unmarried and die in “non-home, non-health care settings.”

Source: Overdose deaths increased in pregnant and postpartum women from early 2018 to late 2021 (National Institute on Drug Abuse)

Mental Health Justice Act reintroduced

Reps. Porter (D-CA), Cárdenas (D-CA), Pressley (D-MA) and Scanlon (D-PA) reintroduced the Mental Health Justice Act to help states, tribes and localities establish mental health responder units to support individuals in crisis. The bill would create a grant program that allows states, tribes and localities to hire, train and dispatch mental health professionals to respond to mental health emergencies when 911, 988 or another emergency hotline is called; empower the Department of Justice’s Civil Rights Division and the Substance Abuse and Mental Health Services Administration to provide technical assistance to grant recipients; require a study on the effectiveness of the grant program; and establish best practices for mental health professionals responding to mental health emergencies. A version of the bill passed the House in 2022. Over 40 organizations have endorsed the bill, including Partnership to End Addiction. Sen. Warren (D-MA) is introducing companion legislation in the Senate.

Source: Rep. Porter Reintroduces Bipartisan Mental Health Justice Act (Katie Porter)

SAMHSA announces over $74 million in behavioral health grants

The Substance Abuse and Mental Health Services Administration announced $74.4 million in grants to address behavioral health challenges in local communities by preventing substance use initiation, reducing the progression of substance use and addressing other related concerns. They include $30.4 million for Grants for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbance (SED), which provide resources to improve mental health outcomes for children and youth at risk for or who have SED and their families; $13.1 million for the Tribal Behavioral Health program, which aims to prevent and reduce suicidal behavior and substance use, prevent overdose, reduce the impact of trauma and promote mental health among American Indian/Alaska Native youth; $15.5 million each for the Strategic Prevention Framework – Partnerships for Success for States; and Strategic Prevention Framework – Partnerships for Success for Communities, Local Governments, Universities, Colleges, and Tribes/Tribal Organizations programs to help states and communities, local governments, universities, colleges and tribes support prevention of intentional substance misuse and mental health promotion services.

Source: Biden-Harris Administration Announces $74.4 Million in Funding Opportunities to Improve Behavioral Health (Substance Abuse and Mental Health Services Administration)

U.S. and China resume cooperation on drug trafficking

President Biden and Chinese President Xi announced the resumption of bilateral cooperation on counternarcotics, with a focus on reducing the flow of precursor chemicals fueling illicit fentanyl and synthetic drug trafficking. For years, bilateral cooperation on counternarcotics had been suspended. China is now taking law enforcement action against illicit precursor suppliers, has issued a notice to industry warning Chinese companies against illicit trade in precursor chemicals and pill press equipment, and has committed to restart key law enforcement cooperation. For the first time in nearly three years, China re-started submitting incidents to the International Narcotics Control Board’s global database, which is used to share real-time information internationally about things like suspicious shipments and suspected trafficking. The U.S. and China announced the launch of a counternarcotics working group to create a platform for policy and technical experts to discuss law enforcement efforts and exchange information on counternarcotics.

Source: FACT SHEET: Biden-⁠Harris Administration Continues Progress on Fight Against Global Illicit Drug Trafficking (White House)

FDA issues warning letters to online retailers selling vaping products that appeal to youth

The Food and Drug Administration issued warning letters to seven online retailers for selling and/or distributing unauthorized e-cigarettes packaged to look like youth-appealing toys and drink containers, including milk cartons, soft drink bottles and slushies. The products’ design may also help youth conceal the e-cigarettes from adults or be confused with an everyday object, leading young children to accidently ingest the contents.

Source: FDA Warns Retailers to Stop Selling Illegal Youth-Appealing E-Cigarettes Disguised as Everyday Items (Food and Drug Administration)

Purdue opioid settlement case to go before Supreme Court next week

The Supreme Court is set to hear arguments Monday over whether the Purdue opioid settlement agreement violates federal law. Under the agreement, in exchange for giving up ownership of Purdue and contributing $6 billion to fight the opioid crisis, members of the Sackler family would be exempt from civil lawsuits. The issue for the justices is whether the legal shield that bankruptcy provides can be extended to people such as the Sacklers, who have not declared bankruptcy themselves. The legal question has resulted in conflicting lower court decisions and has implications for other major product liability lawsuits settled through the bankruptcy system. The agreement also poses a moral conundrum that has divided people who lost loved ones or years of their own lives to opioids.

Source: OxyContin maker’s settlement plan divides victims of opioid crisis. Now it’s up to the Supreme Court (Associated Press)

New York law will expand access to fentanyl test strips

New York Governor Hochul signed into law Matthew’s Law to expand the public’s access to fentanyl testing supplies. The legislation allows local pharmacies and health care providers to provide test strips to all New Yorkers.

Source: Governor Hochul Signs Legislation to Protect Public Health and Combat Opioid Addiction (Governor Kathy Hochul)

Some are reconsidering Oregon's decriminalization law

Oregon’s decriminalization law is facing pushback after an explosion of public substance use fueled by the proliferation of fentanyl and a surge in deaths. When the law was approved three years ago, supporters championed it as a revolutionary approach that would transform addiction by minimalizing penalties for substance use and investing in treatment. However, even Democratic lawmakers who backed the law say they are open to revisiting it. The law is likely to dominate the upcoming legislative session. Critics say the law does not create an incentive to seek treatment. Republicans have urged Governor Kotek to call a special session on the issue. They have proposed harsher sanctions, but data shows criminalization has not deterred people from using substances. Some lawmakers have suggested criminalizing public substance use rather than possession. That would not address those who are unhoused, which is largely seen as a root cause of visible substance use. Backers of decriminalization note that states with stricter laws also reported increases in fentanyl deaths, though Oregon did have the highest increase in synthetic opioid overdose fatalities between 2019 and 2023. The law directed cannabis tax revenue toward new substance use disorder treatment infrastructure and created Behavioral Health Resource Networks in every county, which provide care regardless of ability to pay.

Source: Oregon’s first-in-the-nation drug decriminalization law is facing pushback amid the fentanyl crisis (Associated Press)

Polysubstance use is complicating some state treatment efforts

Addiction treatment options are being rendered less effective by the prevalence of fentanyl, xylazine and other synthetic substances. Vermont’s statewide program for medications for opioid use disorder, Hub and Spoke, now faces new challenges. Launched in 2012, Hub and Spoke put medications at the center of the treatment strategy. Vermont offers methadone at regional hub sites for those with the most intense needs, while smaller community clinics and doctors’ offices (i.e., spokes) provide care such as dispensing buprenorphine. Hub-and-spoke systems are now in many states nationwide. The rise of fentanyl, xylazine and stimulants is undercutting the effectiveness of medications. Common buprenorphine doses have proved less effective against fentanyl and can trigger violent, immediate withdrawal. Neither buprenorphine nor methadone is designed to treat xylazine or stimulant use disorder. Advocates have asked Vermont officials to fund more contingency management, and they encourage more widespread access to methadone, though that would also require loosening federal restrictions.

Source: Evolving Overdose Crisis Shakes Previously Effective Treatments (KFF Health News)

AMA releases annual overdose crisis report

The American Medical Association released the 2023 Overdose Epidemic Report, finding that opioid prescribing decreased for the 13th consecutive year, down nearly 50% since 2015, while overdoses and deaths related to illicitly manufactured fentanyl, xylazine and other synthetic substances continue to increase. There have been signs of progress in the past year, notably community-based distribution of naloxone and approval of over-the-counter naloxone. The report calls for an increase in harm reduction resources, for policymakers to support legislative and regulatory actions to remove administrative and other barriers to medications for substance use disorder treatment, for state insurance departments to enforce parity laws, for state officials to remove punitive policies against pregnant individuals and parents who have substance use disorder and for state departments of correction and private jails/prisons to ensure all individuals with opioid use disorder or mental illness receive evidence-based care while incarcerated and linkage to care upon release.

Source: New AMA report details grim realities of worsening overdose epidemic (American Medical Association)