Policy News Roundup: October 28, 2021

    Key reads

    HHS releases new Overdose Prevention Strategy

    The Department of Health and Human Services announced a new Overdose Prevention Strategy to increase access to care among those who use substances. It prioritizes four target areas — primary prevention, harm reduction, evidence-based treatment and recovery support. It reflects the administration’s principles of maximizing healthy equity for underserved populations, using best available evidence to inform policy, integrating addiction services into other health care and social services, and reducing stigma. It breaks ground by providing federal support for harm reduction, including by providing resources for researching fentanyl test strips and increasing access to naloxone. Goals for improving prevention include supporting the advancement of pain management treatments and reducing clinically inappropriate prescribing. The plan also aims to increase and expand access to treatment and recovery services. The Centers for Disease Control and Prevention also announced a new education campaign to teach young adults about the risks of fentanyl and mixing substances, as well as about naloxone and stigma.

    Source: HHS unveils drug overdose prevention plan to boost accessibility to care (The Hill); HHS Secretary Becerra Announces New Overdose Prevention Strategy (Department of Health and Human Services)

    SAMHSA releases 2020 survey on substance use

    The Substance Abuse and Mental Health Services Administration (SAMHSA) released the 2020 National Survey on Drug Use and Health. SAMHSA cautions against comparing 2020 estimates with prior years’ because of COVID-19-necessitated methodological changes in data collection. Additionally, the diagnostic criteria used changed, making substance use disorder estimates not comparable to prior years. In 2020, 20.7% of people 12+ used nicotine products in the past month. In this group, 63% of adolescents 12-17 vaped nicotine but did not use tobacco products, while 88.9% of those 26+ used only tobacco products. Among people 12+, 21.4% used illicit drugs in the past year, including 17.9% who used marijuana, while 3.4% of people 12+ misused opioids in the past year. The survey found 40.3 million people 12+ (14.5%) had a substance use disorder in the past year, including 28.3 million with alcohol use disorder, 18.4 million with illicit drug use disorder and 6.5 million with both. Among them, 6.5% received any substance use treatment.

    Source: SAMHSA releases 2020 National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration)

    Federal news

    ONDCP releases state model law for use of opioid litigation funds

    The Office of National Drug Control Policy released a model law for state legislatures that would help ensure opioid litigation settlement funds are directed to addressing addiction and the overdose crisis in impacted communities and with public accountability. Through the Model Opioid Litigation Proceeds Act, states would establish a dedicated fund separate from the general treasury designated for targeted purposes; ensure that proceeds deposited into the fund are only used for infrastructure, programs, services, supports and resources for substance use disorder prevention, treatment, recovery and harm reduction; ensure distributions from the fund supplement, rather than supplant, any existing or future local, state or federal government funding for such purposes, including insurance benefits, federal grant funding and Medicaid and Medicare funds; and ensure that a council of diverse stakeholders is established to ensure public involvement, accountability and transparency in allocating and accounting for the funding.

    Source: ONDCP Announces Model Law for States to Help Ensure Opioid Litigation Settlements Funds Address Addiction and Overdose (Office of National Drug Control Policy)

    Cigarette sales increased for the first time in 20 years

    The Federal Trade Commission data found that the number of annual cigarette sales increased in 2020 for the first time in two decades. The number of cigarettes sold by the largest cigarette companies in the U.S. increased from 202.9 billion in 2019 to 203.7 billion in 2020. Smokeless tobacco sales increased from 126 million pounds in 2019 to 126.9 million pounds in 2020. The amount spent on cigarette advertising and promotion increased from $7.62 billion in 2019 to $7.84 billion in 2020. The report noted 2020 sales are still significantly below all prior years other than 2019.

    Source: FTC data: Annual cigarette sales increased for the first time in 20 years (Axios)

    ONDCP announces funding for Drug-Free Communities prevention program

    The Office of National Drug Control Policy announced $23.6 million in continuation funding for 189 Drug-Free Communities (DFC) Support Programs across the country to support community coalitions working to prevent youth substance use. In 2021, a total of 745 community coalitions in all 50 states have received over $93 million through DFC grants. This was the largest single-year investment in the DFC program’s history.

    Source: The Biden-⁠Harris Administration Announces Funding for 189 Community Coalitions Across the Country Working to Prevent Youth Substance Use (Office of National Drug Control Policy)

    State and local news

    Most states still do not have legislation for 988 implementation

    Congress recently enacted laws to create 988, the first nationwide telephone number to help people with any behavioral health crisis 24 hours a day, seven days a week. A review of state 988 implementation laws found that as of October 12, nine states had passed binding legislation, including seven that created advisory groups charged with implementation; four that authorized/imposed a surcharge to support 988 operations (typically collected by telecommunications companies from customers, for 911); and two that directed Medicaid agencies to submit waiver applications or Medicaid state plan amendments to the federal government to allow for federal reimbursement of crisis services delivered to Medicaid beneficiaries. As part of a 2021 budget measure, California allocated $150 million for mobile crisis infrastructure but did not specify how much to spend on 988, though the Department of Health Care Services later designated $20 million to support the line. Two other states passed resolutions with no force of law — with one creating a commission to study and provide recommendations for implementing 988, and another simply recognizing 988 as the “universal mental health and suicide prevention crisis phone number.”

    Source: Most States Have Not Yet Acted to Support New 988 Behavioral Health Lifeline (Pew)

    New York City pushing toward supervised injection facilities

    The New York City health department is “moving aggressively” to green-light the long-stalled pilot program to open supervised injection facilities. The pilot has failed to get off the ground since the City Council funded a feasibility study in 2016. Under pressure from Council members and advocates, Mayor Bill de Blasio released the study in 2018 and then punted further action to the state. Former Governor Cuomo, facing re-election, delayed the pilot indefinitely and cited concerns that the Justice Department under President Trump would mount a legal fight. Now, de Blasio is using his last weeks in office to direct the health department to coordinate with the new state and federal administrations, which are likely more receptive, to implement the pilot. Eric Adams, de Blasio’s likely successor, said he supports the implementation of the sites.

    Source: De Blasio administration pushes to approve supervised injection sites (Politico)

    Boston declares an emergency on substance use and homelessness

    Boston declared addiction and homelessness a public health emergency in order to help the city clear the sprawling homeless camp at Massachusetts Avenue and Melnea Cass Boulevard (Mass and Cass) that is the epicenter of the city’s opioid crisis. Officials said they will get those with opioid use disorder into treatment and permanent shelter after removing around 150 tents in the area, which is home to several methadone clinics and social services and has long been a haven for crime and illegal drug sales and use. Mayor Kim Janey said the tents will not disappear overnight, as it will require ongoing outreach to individuals and making sure there are alternatives. Officials stressed that the city is not criminalizing homelessness and that no one will be forcibly removed. People who live in tents will be given advance notice and offered treatment or a shelter bed.

    Source: Boston declares addiction, homelessness emergency (Associated Press)

    Other news in addiction policy

    Sustainable funding needed to ensure access to mobile crisis services

    In a white paper prepared for the Robert Wood Johnson Foundation’s State Health and Value Strategies program, Patricia M. Boozang and Ashley Traube argue that sustainable, hybrid coverage and funding approaches are needed to ensure universal access to mobile crisis services. In such a model, mobile crisis providers would obtain base funding that allows them to maintain continuous coverage and third-party insurance reimbursement for services rendered to individuals covered by commercial or Medicaid plans. As states review opportunities to expand mobile crisis services under the American Rescue Plan, which gives states the option of covering community mobile crisis intervention in Medicaid for five years, policymakers may consider a hybrid funding model that provides a consistent funding stream to ensure 24/7 availability for all. Base funding could come from state general fund dollars, federal grants, 988 fees and revenue generated by insurer assessments. Strategies states can use to require commercial insurance coverage of mobile crisis services include adding mobile crisis services to the Essential Health Benefit benchmark plan, enforcing parity and ensuring network adequacy for mobile crisis services.

    Source: A Hybrid Funding and Coverage Model to Ensure Universal Access to Mobile Crisis Services (Manatt)

    Addiction Stigma Index survey measuring stigma is released

    Shatterproof developed an Addiction Stigma Index to establish a baseline measure of addiction stigma and to monitor it over time, as current measurement and evaluation efforts are lacking and insufficient. The Index includes more than 50 measures of stigma, and measures public, structural and self-stigma. It found that levels of stigma toward individuals in long-term recovery from heroin addiction are more negative than toward individuals with active addictions to prescription opioids. Three-quarters of respondents consider someone with an active addiction to be untrustworthy. More than one-third are unwilling to move next door to a person in recovery or have them as a friend, and more than half are unwilling to have someone in recovery marry into their family. Fewer than one-quarter view addiction as a chronic disease. Levels of stigma among health care professionals are similar to those in the general population, with nearly half believing that treating opioid use disorder with medications is “substituting one drug for another.”

    Source: A new index measures the extent and depth of addiction stigma (STAT)

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    October 2021