The Department of Health and Human Services (HHS) released new buprenorphine practice guidelines that ease the requirements of the X waiver needed to prescribe buprenorphine to treat opioid use disorder. These guidelines allow physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives to prescribe buprenorphine to up to 30 patients without the additional 8- or 24-hour training. In addition, practitioners no longer have to certify that they have the capacity to provide counseling and ancillary services, though they are encouraged to provide access to psychosocial services. Providers still need to obtain a “waiver” by filing a Notice of Intent to prescribe buprenorphine for OUD with SAMHSA. The regular waiver process still applies for higher patient limits.
Source: HHS Releases New Buprenorphine Practice Guidelines, Expanding Access to Treatment for Opioid Use Disorder (Substance Abuse and Mental Health Services Administration)
National Institute on Drug Abuse Director Nora Volkow writes about racial disparities in the field of substance use, where punitive approaches have exacerbated stigma and made it hard to implement appropriate health care. Communities of color have been disproportionately harmed by the decades of treating drug use as a crime rather than a health issue. She outlines the inequitable enforcement of drug laws, the ineffectiveness of punishment in addressing SUD, inequitable access to treatment and the long-term damaging impacts of punishment for drug possession. She highlights the need to move toward a public health approach and the need for research on the effectiveness and impact of public health responses, as well as racial disparities.
Source: Addiction Should Be Treated, Not Penalized (Health Affairs)
The Food and Drug Administration announced that it is working toward issuing proposed product standards within the next year to ban menthol cigarettes and all flavors — including menthol — in cigars. With these actions, the FDA aims to reduce youth initiation, increase the chances of smoking cessation among current smokers, and advance health equity and address health disparities experienced by Black communities and other communities of color, low-income populations and LGBTQ+ individuals, all of whom are more likely to use these products and have been disproportionately harmed by them.
Source: FDA Commits to Evidence-Based Actions Aimed at Saving Lives and Preventing Future Generations of Smokers (Food and Drug Administration)
Senators Durbin and Wyden, along with seven other Senate Democrats and Representative Krishnamoorthi, introduced the Tobacco Tax Equity Act of 2021, which would help reduce youth tobacco use by closing loopholes in the tax code that have long been exploited by the tobacco industry to avoid regulations and taxes for their products, including for large cigars, smokeless tobacco and pipe tobacco. The bill would apply tax parity across all tobacco products, including establishing the first federal e-cigarette tax and increasing the tobacco tax rate for the first time in a decade. It would also peg the tax rate to inflation to ensure it remains an effective public health tool.
Source: Durbin, Wyden, Krishnamoorthi, Colleagues Introduce Bicameral Bill To Reduce Tobacco Use in America (Senator Dick Durbin)
President Biden nominated Miriam Delphin-Rittmon to be Assistant Secretary for Mental Health and Substance Use. She is currently the Commissioner of the Connecticut State Department of Mental Health and Addiction Services, where she has been committed to promoting recovery-oriented, integrated, and culturally responsive services and systems. Her nomination has been sent to the Senate.
Source: President Biden Announces Six Key Administration Nominations (White House)
Drug overdoses rose across the country during the pandemic, but they skyrocketed in San Francisco, with 713 overdose deaths in 2020, more than double the 257 who died from COVID-19 in 2020. Fentanyl has now fully permeated the city’s drug market and was a factor in most overdoses last year. Unlike many other areas devastated by fentanyl, San Francisco has a well-funded and sophisticated public health system, calling into question the efficacy of the city’s approach. City officials say they want to reinforce and expand their harm reduction model, prioritizing clean syringes and naloxone. Critics agree harm reduction is necessary but say efforts to curtail the supply of drugs and reach out more aggressively to people with addiction are necessary. The prominence of fentanyl use in the city’s homelessness crisis has experts worried that the pace of overdose deaths could increase because of the intractable nature of both problems.
Source: San Francisco Contends With a Different Sort of Epidemic: Drug Deaths (New York Times)
The states reached a $300 million settlement with Indivior to resolve claims that the company falsely and aggressively marketed their buprenorphine-naloxone drug Suboxone, resulting in improper use of state Medicaid funds. The settlement will be paid to all 50 states, the District of Columbia and Puerto Rico. Indivior will pay a total of $300 million to resolve various civil fraud allegations impacting Medicaid and other federal health care programs, with $203.7 million going to Medicaid. The amount paid to the states, the District of Columbia, and Puerto Rico will be $90.7 million for their Medicaid recovery.
Source: Attorney General Bonta Announces $300 Million Settlement Against Indivior for Improper Marketing of an Opioid Addiction Recovery Product (California Attorney General)
Experts are cautioning that while reforming or removing the X waiver requirement to prescribe buprenorphine could have some benefits at the margin, a meaningful increase in treatment would require removing other, more significant barriers to treatment. The requirement is not what prevents most clinicians from prescribing buprenorphine, they argue, and even obtaining the waiver is not enough to promote prescribing. The often-cited French experience with buprenorphine decriminalization does not clearly generalize to the U.S. Policies should work to improve reimbursement for MOUD, improve parity enforcement, curb prior authorization requirements, require clinicians to receive SUD education prior to receiving or renewing their DEA license, and fully integrate and financially support SUD care to improve care quality and accountability and to reduce stigma.
The Kennedy Forum and National Alliance on Mental Illness released a new guide providing detailed information for consumers, providers and other stakeholders about the process of filing appeals for mental health and substance use disorder insurance coverage denials. The guide includes general background and terminology pertaining to health insurance plans, detailed overviews of the clinical and administrative appeals processes, information about the federal parity law, best practices for filing an appeal letter and answers to frequently asked questions.
Source: New Guide Helps Consumers Fight Coverage Denials of Mental Health & Addiction Care (Kennedy Forum)
A study on treatment outcomes prioritized by people with substance use disorder found that survival and improved quality of life matter more than completely stopping all substance use. Individuals care most about survival, improved quality of life and mental health, reducing harmful substance use, meeting basic needs, increasing self-confidence and self-efficacy, and increasing connection to services and supports. For 80% of individuals, COVID-19 did not change those priorities, but for the other 20%, quality of life became less important and connection to recovery support services and taking care of basic needs became more important. Based on these findings, the Patients Lead National Peer Council recommended that policymakers increase funding for the full continuum of services and target funding for harm reduction; that service providers clarify each individual’s goals and adjust services accordingly, and mental health supports be integrated for all; and that researchers investigate which services best achieve the outcomes patients want.