Policy News Roundup: September 19, 2024

Ghost networks trap patients

The main idea: Millions of Americans get trapped in “ghost networks,” unable to access care from providers listed in their insurer’s network. Providers may be listed in a network but have retired, died, stopped accepting insurance, stopped taking new patients, etc.

Why it’s important: It is effectively a “bait and switch” by insurance companies that leads customers to believe there are more options for care than exist.

Insurers have not been held accountable and have little incentive to closely monitor directories.

• It has fallen to researchers and secret shopper surveys to reveal the pervasiveness of directory errors.
• Lawmakers have passed bills and called for further reforms, but the directory errors continue to plague policyholders.
• Consumers face numerous barriers while trying to access care.

What to do: Experts provide tips for evaluating insurance plans, addressing directory errors, and what to do if you are unable to secure an appointment and if the insurer does not resolve the issue.

Source: “I Don’t Want to Die”: Needing Mental Health Care, He Got Trapped in His Insurer’s Ghost Network (ProPublica)

A study found that that the Oregon law decriminalizing drug possession was not associated with an increase in fatal overdose rates in the 2 years after its enactment. The increase in overdoses was caused by the rapid spread of fentanyl.

Reminder: The rapid spread of fentanyl in Oregon’s unregulated drug supply occurred in the first half of 2021, at the same time as enactment of Measure 110 to decriminalize small amounts of drugs for personal use.

• The opinions: Many people have blamed the policy change for the increase in overdoses in Oregon, leading policymakers to recriminalize drug possession. Proponents of decriminalization, however, have suggested that blaming the policy for the increase in overdoses is unfair.

Specifically:

• A positive crude association was found between decriminalization and fatal overdose rate, but after adjusting for the spread of fentanyl as a confounder, there was no longer an association between decriminalization and overdose mortality.

Going forward: Findings suggest that future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets and the role of fentanyl as the principal driver of the overdose epidemic in the U.S.

Source: Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon (JAMA)

The O’Neill Institute for National and Global Health Law at Georgetown University Law Center released a round-up report of state legislation passed in 2024 that seeks to curb overdose deaths and SUD.

Overall, there was a trend toward more law enforcement-centric approaches in 2024, with multiple states passing laws increasing drug-related penalties and creating new drug-related crimes.

The specifics:

• Multiple states passed laws aimed at increasing access to naloxone in various settings, including public schools and higher education.
• A handful of states took additional steps to increase access to harm reduction tools (e.g., drug testing equipment, syringes).
• A few states passed laws to expand access to medications for opioid use disorder (MOUD) in prisons.
• Several states passed laws regarding the management of opioid litigation funds.
• However: There were a multitude of punitive laws, including drug-induced homicide laws and laws increasing penalties for fentanyl possession and trafficking. While some states passed bills focused on improving access to harm reduction tools, other states rolled back such efforts.

Recommendations for states in 2025 include passing legislation to:

• Align MOUD regulations with new federal laws and regulations that expand access to such medications
• Ensure opioid settlement funds are effectively used to curb the overdose crisis
• Increase the availability of MOUD in carceral settings
• Develop evidence-based protocols for MOUD in emergency department settings
• Expand access to naloxone
• Adopt recovery-ready workplace policies and procedures
• Authorize syringe service programs

Source: A Close Look at State Drug Policy Legislation in 2024 (O’Neill Institute for National and Global Health Law at Georgetown University Law Center)

Voters across 41 states will decide more than 150 ballot measures in November dealing with a wide variety of issues.

Marijuana: Five states – Arkansas, Florida, Nebraska, North Dakota, and South Dakota – will vote on whether to legalize marijuana or further loosen restrictions on the drug.

• Florida’s measure would legalize marijuana for adult use.
• North Dakota and South Dakota will also vote on whether to legalize marijuana use for adults. In both states, it is the third time the issue has been on the ballot in recent years, with previous attempts failing or rejected by courts.
• Nebraska is voting on whether to legalize medical marijuana.
• Arkansas is voting on whether to loosen restrictions on medical marijuana, which voters legalized via ballot measure in 2016.

Psychedelics: In Massachusetts, a ballot initiative would allow the personal use of certain amounts of psychedelic substances and create a commission to tax and regulate them.

Penalties: California will vote on a proposal to strengthen penalties for some theft and drug crimes by rolling back parts of a 2014 ballot measure that downgraded many theft and drug crimes from felonies to misdemeanors.

Source: Weed, wages and same-sex marriage: The most intriguing ballot measures that voters will decide in November (Politico)