State and local governments debate use of opioid settlement funds for law enforcement
State and local governments are putting opioid settlement funds toward law enforcement, triggering questions about what the money was meant for. At least 85% of funds must be spent on “opioid remediation,” but a new cruiser could help officers reach the scene of an overdose, for example, making it a gray area. Some argue that efforts to crack down on trafficking warrant law enforcement spending, while others say the war on drugs failed and it is time to emphasize treatment and social services. Some local officials recognize the limits of what law enforcement can do to stop addiction but see it as the only service in town. Each decision is a trade-off; increasing funding for one approach means shortchanging another. Many advocates say law enforcement has been well funded for years, while prevention and treatment efforts lag.
Congress shows little urgency to reauthorize SUPPORT Act and address growing overdose crisis
In 2018, Republicans, Democrats and President Trump united around the SUPPORT Act to provide $20 billion for addiction treatment, prevention and recovery. Five years later, the SUPPORT Act has lapsed and the number of overdose deaths has continued to grow. However, Congress is showing little urgency about reupping the law. Congress can continue to fund opioid-fighting efforts without passing a new version of the SUPPORT Act, but failing to pass another law forfeits the opportunity to try new approaches. The law’s expiration means states are no longer required to cover all FDA-approved treatments for opioid use disorder through Medicaid, but advocates do not expect any state to drop that coverage. Grants to improve access to treatment and recovery have expired, but funding will continue if Congress already appropriated the money. The SUPPORT Act gave states the option to use federal Medicaid funds to cover up to 30 days of treatment in facilities with more than 16 beds. When that option ended, the two states that used it (South Dakota and Tennessee) steered Medicaid recipients toward facilities not subject to the exclusion. Some advocates suggest bolder changes, like access to methadone in pharmacies, are necessary.
NIDA study shows telehealth is associated with increased retention in OUD treatment
A National Institute on Drug Abuse study of 2019-2020 Medicaid data in Kentucky and Ohio found that starting buprenorphine for opioid use disorder through telehealth was associated with an increased likelihood of staying in treatment longer compared to starting treatment in a non-telehealth setting. In Kentucky, 48% of those who started buprenorphine treatment via telehealth remained in treatment for 90 continuous days, compared to 44% of those who started treatment in non-telehealth settings. In Ohio, 32% of those who started via telehealth remained in treatment for 90 continuous days, compared to 28% of those who started in non-telehealth settings. The study found significant increases in telemedicine delivery of buprenorphine following the more permissive telehealth flexibilities implemented during the COVID pandemic. The study also found that receiving buprenorphine treatment via telehealth was not associated with an increased likelihood of nonfatal overdose. Non-Hispanic Black individuals, men and those who had experienced a prior opioid overdose were less likely to receive treatment for opioid use disorder via telehealth and were less likely to remain in treatment through the continuous 90-day period.
Source: Telehealth supports retention in treatment for opioid use disorder (National Institute on Drug Abuse)
Legislation introduced to expand OUD treatment access for adolescents
Sen. Peters (D-MI) introduced the Youth Prevention and Recovery Reauthorization Act to reauthorize a grant program in the SUPPORT Act that expands access to opioid use disorder (OUD) treatment for adolescents. The SUPPORT Act established the Youth Prevention and Recovery Initiative to make an existing addiction program available for young adults. It provides funding to hospitals, local governments and other eligible entities to increase access to medications for OUD for adolescents and young adults, improve local awareness among youth of the risks associated with fentanyl and train health care providers, families and school personnel on best practices to support youth with OUD. The bill would reauthorize the initiative, which has provided three-year grants to youth-focused entities providing treatment, prevention and recovery support services. The authorization of the program expired with the SUPPORT Act at the end of September. The bill is endorsed by Partnership to End Addiction, as well as the American Academy of Pediatrics, American Psychiatric Association, American Congress of Obstetricians and Gynecologists and American Academy of Addiction Psychiatry.
Support grows for bill to expand methadone access, but clinics remain opposed
Methadone is accessible only at specialized clinics that require patients to participate in counseling, submit to frequent drug tests and show up in person each day to receive a dose. Sens. Markey (D-MA) and Paul (R-KY) have introduced a bill that would allow doctors specializing in addiction to prescribe methadone directly to patients. A growing coalition of patient advocates, health providers and lawmakers have charged that current rules are costing thousands of lives and that the change is overdue. AATOD, the trade group representing methadone clinics, however, is opposed, citing obstacles including doctors’ lack of enthusiasm about prescribing methadone, pharmacists’ unwillingness to stock and dispense it and manufacturers’ reluctance to manufacture and distribute it more widely. The group warns that the change could increase methadone overdoses. Proponents suggest that this risk pales in comparison to the number of lives that could be saved. They point to evidence from the COVID emergency measures expanding access to take-home methadone, which shows that intentional methadone misuse and overdoses did not increase.
White House supplemental funding requests include funding to address fentanyl trafficking and expand treatment services
President Biden submitted supplemental funding requests to Congress, including requests for $1.2 billion to fight fentanyl trafficking and $1.55 billion to strengthen addiction treatment, overdose prevention and recovery support services. In his National Security supplemental package, Biden urged Congress to provide resources for law enforcement personnel to continue to secure the southwest border and stop the flow of fentanyl into the country. This included $1.2 billion for the Department of Homeland Security to increase its counter-fentanyl activities, including by deploying more non-intrusive inspection systems and hiring additional Customs and Border Protection officers. It also included $23 million for the Department of Justice for illicit fentanyl testing and tracing to support investigations and enforcement. The domestic supplemental funding request included $1.55 billion to expand services provided through the State Opioid Response grant program to strengthen addiction treatment, overdose prevention and recovery support services across the country.
Source: A Key Priority of President Biden’s Unity Agenda, White House Calls on Congress to Deliver Critical Resources to Address the Nation’s Overdose Epidemic and Save Lives (Office of National Drug Control Policy)
State and local news
Washington insurance commissioner fines UnitedHealthcare for lack of parity compliance
The Washington insurance commissioner imposed a $500,000 fine against UnitedHealthcare Insurance Company (UHIC) for failing to demonstrate how it administers its mental health and substance use disorder (MH/SUD) benefits in accordance with state and federal laws. Specific issues included failure to address an apparent disparity that showed a higher number of inpatient facility MH/SUD cases reviewed and denied for medical necessity compared to inpatient facility stays associated with a medical service; failure to address an apparent disparity between reimbursement rates for MH/SUD providers as compared to medical/surgical providers; and potential noncompliance with parity laws. Under the compliance plan, UHIC must work with the commissioner to address its issues and report to the office every six months for two years. If any of the reports show a disparity of more than 10% between behavioral health and medical services, UHIC must show how it will resolve the disparity. The reports must include prior authorization approval rates for inpatient care, office visit reimbursement rates and out-of-network provider usage. UHIC agreed to show that its network adequacy standards for behavioral health services are comparable to those for medical services.
Source: Kreidler fines UnitedHealthcare $500,000 for not demonstrating compliance with mental health parity laws (Washington State Office of the Insurance Commissioner)
Cities and states struggle over whether to accept supervised consumption sites
Philadelphia showcases the tensions and legal battles around supervised consumption sites, encapsulating a broader struggle among state and federal health officials searching for methods to curtail overdoses. The sites operate in a legal gray area. Some cities and states have moved to open facilities despite the risk of federal reprisals. Yet even liberal elected officials and communities, like those in Philadelphia, continue to question more lenient approaches. Philadelphia’s City Council recently passed and overrode the mayor’s veto of legislation largely banning the sites, and Pennsylvania senators passed legislation banning the sites. San Francisco’s lone facility closed last December, and California Governor Newsom vetoed legislation that would have allowed some sites. The top federal prosecutor in Manhattan threatened the group operating New York’s sites, saying they were running afoul of the law. Rhode Island lawmakers legalized the sites in 2021, but lease negotiations, construction delays and supply chain problems stalled the opening. Fears have not been borne out by research, which shows the sites save lives and have not led to upticks in crime or substance use. Experts say that not everyone is ready for treatment, and that there are major obstacles to treatment, making such sites essential.
Source: To Combat the Opioid Epidemic, Cities Ponder Facilities for Drug Use (The New York Times)
Philadelphia uses door-to-door canvassing approach to distribute harm reduction materials and addiction resources
The Philadelphia Office of Community Empowerment and Opportunity’s Philly Counts team includes outreach workers and canvassers who distribute Narcan, fentanyl test strips and resources on substance use and addiction treatment services. Their goal is to spread awareness about rising overdose deaths in the community, particularly among Black and brown residents, and equip people with tools to help those struggling with substance use. Black and brown people who use substances have suffered disproportionate rates of arrests, incarceration and child welfare charges, which may make people hesitate to seek out harm reduction or treatment services. The new door-to-door canvassing approach aims to cut through that hesitancy and stigma and seeks to normalize Narcan as an everyday household item. The project focuses on areas with increases in overdose deaths outside of the Kensington and Allegheny neighborhoods, where substance use is most visible and harm reduction services are typically concentrated. The project aims to hit more than 100,000 doors in certain zip codes across the city.
Other news in addiction policy
Addiction treatment for youth is lacking despite rising overdoses and growing mental health crisis
A rise in overdose deaths among youth is colliding with an inadequate pediatric mental health system, including a lack of addiction treatment. Limited treatment options and coverage gaps mean many kids are not getting needed care. Most resources for addiction have been geared towards adults. There is a shortage of trained clinicians who can help identify and treat substance use issues in kids. More than half of U.S. children are covered through Medicaid or CHIP, which generally pay less than commercial insurance. State Medicaid programs generally offer more comprehensive behavioral health benefits for kids than private insurance does, but low reimbursement rates lead some providers to not accept Medicaid. Kids who need substance use care usually go to the emergency room and sometimes stay there rather than transferring to the appropriate care setting, which often is not available. Children are much less likely than adults to receive medications for opioid use disorder. Experts say addiction specialists must work with pediatric providers to expand care access.