Administration announces new funding and efforts to address the overdose crisis
The Biden administration announced nearly $1.5 billion in grants to states, tribes and territories to address the addiction crisis through treatment, naloxone, recovery support, education efforts and other strategies. The administration also announced $104 million for entities working to expand access to treatment and prevention in rural communities and over $20 million for organizations that help connect individuals with addiction to community resources. It announced $12 million for law enforcement and sanctions on drug cartels. The Department of Labor (DOL) launched the Recovery-Ready Workplace Resource Hub with resources for businesses, unions and others exploring the benefits of becoming recovery-ready workplaces. The White House held a Recovery Month Summit to unveil these efforts, with speakers including the heads of the Office of National Drug Control Policy, Substance Abuse and Mental Health Services Administration and DOL, the Second Gentleman and Representatives David Trone (D-MD) and Madeleine Dean (D-PA), advocates in recovery and people who worked on the Dopesick series.
Source: Biden to announce $1.5 billion to fight U.S. opioid crisis (Reuters); FACT SHEET: Biden-Harris Administration Announces New Actions and Funding to Address the Overdose Epidemic and Support Recovery (White House)
Opioid crisis cost nearly $1.5 trillion in 2020
A report from Congress’s Joint Economic Committee found that the economic toll of the opioid addiction and overdose crisis in the U.S. reached nearly $1.5 trillion in 2020 and is likely to grow. After adapting a method used by Centers for Disease Control and Prevention (CDC) scientists and adjusting for inflation, it found that the crisis cost the U.S. economy $1.47 trillion in 2020, a $487 billion increase from 2019 and a 37% increase from 2017, when the CDC last measured the cost.
Senate Finance Committee releases draft legislation to expand the mental health workforce
The Senate Finance Committee released a discussion draft (summary) of legislation aimed at expanding the mental health workforce. It includes policies that would add 400 new Medicare-funded physician residency positions in psychiatry and psychiatry subspecialties; provide coverage of marriage and family therapist and mental health counselor services under Medicare Part B; and expand access to certain clinical social worker services under Medicare. It also would expand Medicare’s Health Professional Shortage Area bonus program to attract more mental health care providers to shortage areas; create a demonstration project to increase behavioral health provider capacity under Medicaid; require Medicaid to produce new guidance for states on increasing the mental health workforce; and make it easier for patients to see psychologist trainees by providing flexibility in Medicare’s direct supervision requirements.
Source: Wyden, Crapo, Stabenow, Daines Unveil Mental Health Workforce Enhancement Discussion Draft (United States Senate Committee on Finance)
CBO report outlines the opioid crisis and the federal policy response
The Congressional Budget Office released a report on the effects and evolution of the opioid crisis in the U.S., the factors that have contributed to it, the laws enacted to address it and the effects of the COVID-19 pandemic on the crisis. It defines opioids and opioid use disorder, outlines the toll of the opioid crisis and explains the evolution of the crisis. Between 2016 and 2018, three laws were enacted in response to the opioid crisis – the Comprehensive Addiction and Recovery Act (CARA), the 21st Century Cures Act and the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Collectively, the laws authorized additional appropriations of about $700 million to $1.6 billion per year between fiscal years 2017 and 2023, though quantifying the amount of authorized funding actually appropriated is challenging. The report also outlines the impact of the pandemic and the resulting policy changes and federal funding.
Source: The Opioid Crisis and Recent Federal Policy Responses (Congressional Budget Office)
NIH is working to increase research on recovery support services
National Institute on Drug Abuse (NIDA) Director Nora Volkow explains current research on recovery and the need for increased focus. Much less is known about recovery supports than about treatment, such as which kinds of services are most effective, how they work and how they are best adapted to the needs of different people. Without that knowledge, insurers and other payers may not cover these components of care, and people may not know which to choose. NIDA has been supporting research on peer and community-based recovery supports, active recovery communities and recovery modalities that integrate multiple services, such as recovery residences, but more focus is needed. The National Institutes of Health Helping to End Addiction Long-Term (HEAL) Initiative is supporting additional research projects on recovery residences, clinical continuing care, linkage to recovery community centers and peer interventions to increase retention in treatment with medications for opioid use disorder.
Source: Supporting Needed Research on Recovery (National Institute on Drug Abuse)
FDA issues guidance to ease access to naloxone
The Food and Drug Administration (FDA) said in new guidance that it will not enforce certain Drug Supply Chain Security Act requirements on programs distributing FDA-approved naloxone to underserved communities while an opioid public health emergency declaration is in place. This exempts harm reduction programs distributing naloxone from certain federal product tracing requirements to expand supply. The guidance clarifies two exemptions triggered by the public health emergency. The product tracing and verification requirements normally applied to trading partners of FDA-approved substances do not apply to distribution of naloxone to harm reduction programs/suppliers during the emergency, and wholesale distributor licensing requirements will not apply to harm reduction suppliers distributing naloxone. The FDA does not plan to take enforcement action against trading partners during the emergency that would otherwise meet the definition of wholesale distributor but are distributing naloxone for emergency medical reasons. It also will not take action against donations of naloxone to harm reduction programs.
Source: Opioid-Reversal Drug Access to Ease Under Relaxed FDA Rules (Bloomberg Law)
Government and other stakeholders can take steps to achieve universal MOUD access
Office of National Drug Control Policy (ONDCP) Director Rahul Gupta, Assistant Secretary for Health Rachel Levine, Javier Cepeda (ONDCP) and David Holtgrave (ONDCP) explain barriers to medications for opioid use disorder (MOUD) and the administration’s call for universal MOUD access by 2025. The federal government and medical accreditation bodies could bolster treatment and education infrastructure, including by enhancing MOUD-related content in curricula for all health-related professions, further building workforce capacity in addiction medicine through continuing education, ensuring efforts increase MOUD availability for people with co-occurring conditions and addressing accessibility challenges (such as child care and transportation). It will be important to increase access to MOUD in clinical and community-based programs, including by expanding low-threshold buprenorphine. Pandemic-era telehealth waivers and MOUD flexibility should be permanently extended. Additional efforts are needed to increase access for people who are incarcerated. Policymakers, health care systems, payers and clinicians could develop/support programs to address social determinants of health. Clinicians and researchers should use patient-first terminology and reduce stigma.
Source: ICYMI: Dr. Gupta Op-Ed on Transforming Management of Opioid Use Disorder with Universal Treatment (Office of National Drug Control Policy)
State and local news
Oregon establishes MH/SUD service centers outlined in decriminalization measure
Service centers to help people tackle mental health and substance use disorder mandated in Oregon’s decriminalization Measure 110 were supposed to be operational by October 2021, but this month, after a rough approval and funding process, the networks have been established. It could be months before many patients receive the array of help mandated, however, as providers hire and train staff, buy equipment and supplies and renovate buildings. County-based service networks are funded through marijuana taxes, providing about $300 million through June 2023. The 44 Behavioral Health and Resource Networks offer a range of services, from health screenings and addiction treatment to help with housing and job support. The networks were established in each county to help people where they live and drive a shift away from the criminal justice system and toward treatment and recovery.
Source: Oregon’s novel approach to drugs hits ‘milestone’ (Oregon Capital Chronicle)
Maine rejects Juul settlement
The Maine Attorney General’s office decided to walk away from an $11 million agreement with Juul after objecting to certain conditions from the company. Maine was set to receive about $11 million as part of a nearly $440 million settlement between Juul and 33 states and territories. As part of the agreement, Juul wanted states to waive the rights of school districts to pursue their own lawsuits, which Maine was not willing to agree to.
Source: Maine to walk away from multi-million dollar Juul settlement (Bangor Daily News)
Other news in addiction policy
Increased and improved capacity in addiction policymaking needed
Regina LaBelle and Michael Botticelli call for more robust training in addiction science and policymaking and for engaging people in recovery in policymaking. Little has been done to build capacity in addiction policymaking, despite the results of addiction policies based on neither science nor evidence. Georgetown University is one of the first institutions to establish a Master of Science in Addiction Policy & Practice, as well as an Addiction Policy Scholars program. For decades, policies have been rooted in fear and stigma, not science and compassion. Limited access to treatment persists, and the nation’s approach to addiction is built on laws and regulations that assume that what worked for one works for everyone. Relapse is treated with prison, when what is needed is a therapeutic approach. Investing in the addiction policy workforce is long overdue and necessary.
Source: To decrease US overdoses, increase recovery services and compassion (The Hill)
Medicare coverage for substance use disorder services must be expanded
Medicare does not cover intermediate levels of substance use disorder (SUD) treatment and is not subject to the Mental Health Parity and Addiction Equity Act (MHPAEA). Future legislation should apply MHPAEA to Medicare Parts A and B to eliminate limits on the length and settings of care, utilization management-associated barriers and restrictive reimbursement practices; apply MHPAEA to Parts C and D to eliminate restrictive utilization management and provider network, contracting and reimbursement practices; and authorize coverage of the full continuum of evidence-based SUD treatment services, including intensive outpatient, partial hospitalization and residential programs. It should also authorize coverage of community-based SUD treatment settings to expand capacity and allow for the delivery of care in the most common and accessible settings; and authorize coverage of all licensed mental health and SUD treatment providers and establish adequate reimbursement rates.