Policy News Roundup: September 7, 2023

Key reads

Overdose deaths involving counterfeit pills are increasing

A study from the Centers for Disease Control and Prevention found that a growing number of overdose deaths in the U.S. involve counterfeit pills. Overdose deaths involving counterfeit pills more than doubled from the second half of 2019 to the second half of 2021, accounting for about 5% of overdose deaths in 2021. The rate tripled in Western states. Most cases involved counterfeit oxycodone. Illicitly manufactured fentanyl was found in nearly all overdose deaths with evidence of counterfeit pills. Methamphetamine was also found in about 25% of deaths involving counterfeit pills, and cocaine and benzodiazepines were found in about one in eight cases. Decedents with evidence of counterfeit pill use, compared to those without, were younger, more often Hispanic or Latino and more frequently had a history of intentional prescription drug misuse. Overdose prevention messaging that highlights the dangers of pills obtained illicitly or without a prescription, encourages product testing by persons using substances and is tailored to persons most at risk (e.g., younger persons) could help prevent overdose deaths.

Source: Counterfeit Pills Fuel Rising Number of Fatal Drug Overdoses (HealthDay)

Over-the-counter Narcan now available in stores

The first over-the-counter naloxone will be available in stores starting this week. Last Wednesday, manufacturer Emergent BioSolutions said it had begun shipping the two-dose, 4-milligram Narcan nasal spray to retailers like Walgreens, Walmart and Rite Aid. The suggested retail price is $44.99, though prices could vary by retailer. State and local government programs and harm reduction groups who distribute naloxone at no cost were able to buy the packages for $41 starting August 31. Blue Cross Blue Shield of Massachusetts announced it would fully cover over-the-counter Narcan for its members, but it is unclear if other insurers will follow suit. Medicaid private plans have the option of covering over-the-counter drugs but might require state agencies to first add naloxone to formularies.

Source: Narcan is coming to drug store shelves — for those who can afford it (Axios)

White House announces $450 million and meets with families for International Overdose Awareness Day

On International Overdose Awareness Day, the White House announced more than $450 million to strengthen prevention, harm reduction, treatment and recovery support services and crack down on illicit drug trafficking. This includes $20.5 million for Drug-Free Communities, $1 million to the Real Deal on Fentanyl awareness/education campaign, $279 million in Overdose Data to Action grants to states and (for the first time) localities, and more than $80 million to rural communities to respond to overdose risk. It also includes more than $57.6 million through the Substance Abuse and Mental Health Services Administration, including for the Comprehensive Opioid Recovery Centers, Promoting the Integration of Primary and Behavioral Health Care, Recovery Community Services, Rural EMS Training Grant, Treatment for Individuals with Serious Mental Illness, Serious Emotional Disturbance or Co-Occurring Disorders Experiencing Homelessness, and Treatment, Recovery and Workforce Support Grant programs. In addition it includes more than $18.9 million for the High Intensity Drug Trafficking Area program. The White House also hosted a meeting with families who have lost loved ones to overdose, who shared their personal experiences and stressed the importance of increasing access to substance use services.

Source: FACT SHEET: On Int’l Overdose Awareness Day, the Biden-⁠Harris Administration Announces More Than $450 Million in New Funding to Support President Biden’s Unity Agenda Efforts to Beat the Overdose Epidemic and Save Lives (White House); Readout of White House Meeting with Families on International Overdose Awareness Day (White House)

HHS recommends moving marijuana to Schedule III

In a letter to the Drug Enforcement Administration (DEA), the Department of Health and Human Services (HHS) asked for marijuana to be reclassified as Schedule III. DEA confirmed it had received a letter from HHS providing its findings and recommendation on marijuana scheduling, pursuant to President Biden’s request for a review. HHS conducted a scientific and medical evaluation for consideration by DEA, which has final authority to schedule or reschedule a drug under the Controlled Substances Act. DEA will now initiate its review. If DEA does reschedule marijuana, marijuana businesses are likely to benefit because it would likely mean access to federal financial benefits meant to help businesses, including tax breaks marijuana companies currently cannot use. Individuals could see reduced federal penalties for possession, but it could still be criminalized at the federal level. Rescheduling could dilute some of the stigma around marijuana use, which could pave the way for other policy changes. Rescheduling could also expand possibilities for scientific research and could mean more medicinal products could be approved by the Food and Drug Administration.

Source: US health officials look to move marijuana to lower-risk drug category (Reuters); Marijuana could be classified as a lower-risk drug. Here’s what that means. (Vox)

Federal government struggles with how to regulate delta-8 THC

Since the 2018 Farm Bill created the loophole for retailers to sell hemp-derived delta-8 THC, government officials cannot seem to figure out how to regulate it. The Food and Drug Administration (FDA) said in January that Congress must create regulations to rein in hemp-derived cannabinoids. In July, Congress responded, asking the FDA how to do so. The Drug Enforcement Administration (DEA) is evaluating whether it will issue rules to close the loophole entirely. The lack of federal action has led several states to restrict or ban delta-8. DEA confirmed that synthetic THC-O is regulated under the Controlled Substances Act (CSA). Delta-8 can be extracted from hemp by isolating delta-8 THC naturally occurring in the plant, which is unregulated, or by chemically converting CBD into delta-8 THC-O, which falls under the CSA. Many products sold as delta-8 THC are actually delta-8 THC-O. The FDA has issued warnings to companies selling delta-8 in ways that violate the Federal Food, Drug, and Cosmetic Act (such as making claims that delta-8 can treat medical conditions). Delta-8 regulation is not likely to be settled in the upcoming farm bill reauthorization.

Source: The U.S. has a chance to regulate delta-8 THC. Will it? (NBC)

Republican presidential candidates talk tough on fentanyl but do not mention treatment

Republican presidential candidates are talking tough about their plans to respond to fentanyl. Ron DeSantis pledged to use “lethal force” by sending troops to attack cartels in Mexico, and Donald Trump called for the death penalty for convicted drug dealers. Vivek Ramaswamy has suggested decriminalizing nearly all substances. However, few candidates have mentioned treatment. Candidates’ emphasis on the crisis highlights the issue’s continued importance to voters across the political spectrum, but the candidates clearly think they are better served focusing on interdiction than on treatment. This may reflect that Americans have not forgotten about the opioid crisis and want to hear candidates address it but have grown cynical of grand plans to scale up the fractured treatment system. Republican candidates appear to have settled on a message that the administration’s border policies have failed. Though the fentanyl crisis proliferated largely under Trump, his administration did make strides on treatment. Key figures involved in those efforts, however, like Mike Pence and Chris Christie, have also not made treatment a focus in the campaign.

Source: Republicans say they’ll stop fentanyl at the border. But what are their plans for treatment? (STAT)

State lawmakers are working to address rising youth fentanyl overdoses

State and federal officials are struggling to respond to the increasing number of children dying of fentanyl overdoses. States enacted more than 100 laws during 2023 legislative sessions seeking to raise awareness, increase penalties for dealers and prevent overdoses. Some focus on the danger fentanyl poses to young people. Texas lawmakers enacted Tucker’s Law to launch an education campaign about fentanyl’s dangers in middle and high schools. Mississippi enacted a bill mandating a media campaign aimed at youth. California lawmakers are considering bills to require schools to tackle opioid overdoses in their safety plans and require the state health department to make overdose reversal drugs available in schools. In Congress, the Protecting Kids from Fentanyl Act would permit states to use money from a federal grant to educate children and provide training and naloxone to school employees. More needs to be done, including increasing the number of providers who can treat teens with addiction. Few treatment providers for adolescents are available, and only a fraction offer medication treatment.

Source: Fentanyl is killing kids. State lawmakers are searching for answers. (Politico)

Schools face new challenge of fentanyl as teen overdoses rise

Fentanyl is a new challenge for schools this fall. School buildings have posters in hallways memorializing students who have died. Social media posts and back-to-school messages from school staff include warnings and pleas to turn in pills students have bought online, no questions asked. Schools are stocking naloxone and revamping drug awareness/prevention programs. Some are promoting use of fentanyl test strips, but they remain illegal in several states. There are multiple federal, bipartisan bills aimed at supporting schools in dealing with fentanyl, including one that would give money to schools to stock naloxone and train teachers and nurses in updated drug education. Of the 20 largest school districts in the country, only five confirmed that they stocked naloxone in all of their schools last year. Drug education is ad-hoc and often outdated, but schools have the potential to reach millions of kids if they decide to teach students about fentanyl.

Source: As more teens overdose on fentanyl, schools face a drug crisis unlike any other (NPR)

Despite a promising start, most states have not permanently funded 988

Since 988 launched a year ago, there has been a 33% increase in calls, chats and texts. But even with early signs of success, the program’s financial future is shaky. Over the past two years, the federal government has provided about $1 billion from the American Rescue Plan and Bipartisan Safer Communities Act to launch 988. After that funding runs out, it is up to states to fund their call centers. Only eight states have enacted legislation to sustain 988 through phone fees. Others have budgeted short-term funding, but many predominantly rural states have not made long-term plans to provide support. To keep in-state staffers answering phones, promises of long-term funding are critical. With short-term funding, it is hard to reassure prospective call operators of job security or compete with rising wages in other industries. Funding allows call centers to train staff members and keep phone lines updated, and helps support mobile crisis units.

Source: Most states have yet to permanently fund 988 Lifeline despite early successes (CBS)

Death rates for people under 40 have skyrocketed in recent years due to overdoses

Death rates among U.S. residents under 40 were up by nearly a third in 2021 over 2018, and last year were still 21% higher. COVID was a small part of the increase, causing about 23,000 deaths between 2018 and 2022 in the age group. Vehicle accidents and suicide (about 96,000 each) and gun homicide (about 65,000) took a toll, but there were nearly 177,000 overdose deaths. Accidental overdose became the top cause of death in 13 states for people under 40, overtaking suicide in nine states and vehicle accidents in five. It is now the top cause in 37 states. In 40 states and D.C., overdose was the biggest increase in deaths for young people. States struggling most with deaths of young people, driven mostly by overdoses, include New Mexico, West Virginia, Louisiana, Mississippi and Alaska. The lowest rates were in Hawaii, Massachusetts, Rhode Island, Utah and New Jersey. Massachusetts and New Jersey were the only states with decreases in deaths, and they had drops in overdose deaths. Overdoses dominated the increase in deaths across racial and urban-rural divides, but disparities exist.

Source: Death rates for people under 40 have skyrocketed. Blame fentanyl. (Stateline)

Poll finds most Americans believe they would know how to get a loved one help for addiction

A poll found that 71% of Americans say they would know how to get a friend or family member help with addiction. Most would refer them to recovery treatment (73%) and/or initiate a conversation (74%). Respondents were most likely to say they would recommend inpatient treatment (24%) or support groups (23%). The poll found 19% had no opinion and did not know. Smaller groups selected outpatient rehabilitation, interventions, medication-assisted treatment, detox or quitting cold turkey, cognitive behavioral therapy and digital therapeutics. Adults 18-34 were twice as likely as adults 65+ to say they know someone they suspect struggles with addiction. Younger adults were more likely to say they would initiate a conversation with someone with addiction. When asked who they would reach out to for help, 53% selected doctor, 51% family, 43% local community resources, 36% friends, 34% online resources, 21% church/clergy, 8% social media and 4% university/school. The poll found 65% said recovery was “being able to function better in life,” 38% said “feeling better,” 36% said “feeling back to one’s old self” and 20% said “no longer having a diagnosis,” while 7% said recovery was not possible.

Source: New APA Poll: Most Americans Believe They’d Know How to Get Help for a Loved One Living with Addiction; Define Recovery as “Being Able to Function Better in Life” (American Psychiatric Association)