The bellwether opioid trial against pharmacy chains began this week, with Trumbull and Lake counties, Ohio, arguing that CVS, Walgreens, Giant Eagle and Walmart helped fuel the opioid crisis. The trial is expected to last around six weeks and could set the tone for similar lawsuits against the pharmacies. The pharmacies argue that their pharmacists were just filling prescriptions written by physicians and that they followed guidelines established by the Drug Enforcement Administration and the state in how they dispensed opioids. The counties claim that the companies did not employ enough pharmacists and failed to adequately train them, failed to identify “red flags” of misuse and prioritized filling prescriptions quickly while patients shopped at their stores. Rite Aid was removed from the suit before the trial after settling with the counties in August.
Source: Pharmacies face 1st trial over role in opioid crisis (ABC); Pharmacy chains failed to prevent opioid misuse, U.S. jury hears (Reuters)
Nemour Children’s Health and Mental Health America has released an issue brief describing the state of children’s behavioral health. It offers federal policy recommendations, including those to expand the workforce (e.g., financial incentives, increased funding for training, integration of behavioral health); ensure access (e.g., provide a continuum of services integrated across settings accessible to families by increasing reimbursement rates, investing in care infrastructure and supporting integration of mental health care into child-serving settings); prioritize prevention and early intervention (e.g., increase funding, incorporate into health and education programs, establish federal coordinating center); elevate children in the federal leadership structure (e.g., establish a White House Office on Children and Youth, Federal Children’s Cabinet, Interdepartmental Task Force on Child Well-Being and White House Conference on Building Back Better for Children and Youth); and promote innovative payment and delivery models.
Source: Pediatric Mental, Emotional and Behavioral Health: Federal Policy Recommendations for Congress and the Executive Branch (Nemours)
The Substance Abuse and Mental Health Services Administration (SAMHSA) is launching an Office of Recovery to advance the agency’s commitment to, and support of, recovery for all Americans. SAMHSA will now have a dedicated team with a deep understanding of recovery to promote policies, programs and services to those in or seeking recovery. The Office of Recovery will promote the involvement of people with lived experience throughout agency and stakeholder activities, foster relationships with internal and external organizations in the mental health and addiction recovery fields, and identify health disparities in high-risk and vulnerable populations to ensure equity for support services.
Source: SAMHSA to Launch New “Office of Recovery” to Expand Its Commitment to Recovery for All Americans (Substance Abuse and Mental Health Services Administration)
The Food and Drug Administration (FDA) has finalized its rules for premarket tobacco applications and substantial equivalence reports, nearly a month after the deadline for reviewing applications and 13 months after companies had to submit applications. The FDA has already ordered companies to pull millions of e-cigarettes because their applications did not contain all the information needed, but some companies may now reapply. The rules have been maligned by the tobacco industry since they were first released in 2019, and the final versions are similar. The FDA largely dismissed companies’ complaints that the substantial equivalence pathway is too onerous to be streamlined and that the premarket application process would harm small businesses. The FDA declined to define “appropriate for the protection of public health,” the standard used to determine approval. Companies have said this will require them to guess at what rationale satisfies the standard.
Source: FDA publishes final rules on tobacco product applications (Politico); Twelve years later, the FDA puts out “fundamental” Tobacco Control Act rules (STAT)
President Biden has issued a proclamation declaring October 2021 National Youth Substance Use Prevention Month. The proclamation highlights the Drug-Free Communities program, which helps equip community coalitions to reduce youth substance use. It also emphasizes the role of parents, caregivers, educators and other community members in promoting evidence-based prevention efforts that encourage healthy lifestyles, promote alternatives to substance use and educate young people about the harms associated with substance use. It notes the administration’s commitment to addressing racial equity, including supporting the development of tailored tools that strengthen prevention efforts in diverse communities. Youth-focused efforts must account for the fact that poverty, homelessness, trauma and other adverse childhood experiences affect substance use and overall health of youth.
Source: A Proclamation on National Youth Substance Use Prevention Month, 2021 (White House)
Seattle’s city council has voted unanimously to relax its rules against naturally occurring drugs, joining a handful of other cities that have decriminalized psilocybin and similar substances in the past few years. The city’s police will make it among their lowest priorities to arrest or prosecute anyone engaging in activities related to “entheogens,” or substances like psilocybin and ayahuasca that are often used for spiritual or religious purposes. Seattle’s law would apply to substances like psilocybin and ayahuasca, but not to LSD, ketamine or MDMA, though such substances are often lumped together with the plant-based psychedelics.
Source: Seattle Votes to Decriminalize Psilocybin and Similar Substances (Bloomberg)
California Governor Newsom has approved a new 12.5% excise tax on e-cigarettes to be paid by consumers to boost public health and education programs in order to discourage youth vaping and bring taxes on e-cigarettes in line with levies on other tobacco products. The new tax comes a year after the governor signed legislation to ban the sale of flavored tobacco products, including those used in e-cigarettes. That measure is on hold because the tobacco industry qualified a referendum on the law for the November 2022 ballot. The new tax is projected to generate $38.4 million by 2023, with money to be split among programs including early childhood education, public health education and grants to students from disadvantaged communities pursuing education in the health field.
Source: California will impose new vaping tax to curb teen use, fund public health programs (Los Angeles Times)
California lawmakers are pursuing legislation and appealing to federal regulators to make contingency management more widely available. Washington, Montana and West Virginia are exploring similar strategies. Despite its proven effectiveness, contingency management remains controversial. Few insurers and state Medicaid programs cover it due to an interpretation of federal law suggesting that a law that forbids offering financial incentives to patients prohibits reimbursement for contingency management. A bill is now on Governor Newsom’s desk to allow the state’s Medicaid program to pay for the services. The Department of Health Care Services has asked federal regulators for explicit permission to offer contingency management through a statewide pilot project, and regulators appear poised to grant it after refusing to do so during the Trump administration. The Biden administration specifically stated in its 2021 drug control policy that one of its main priorities is to identify and address policy barriers related to contingency management.
Source: To Combat Meth, California Will Try A Bold Treatment: Pay Drug Users To Stop Using (NPR)
Rural communities face a unique set of health inequities due to structural urbanism (i.e., current models of health care funding are biased in favor of large populations) and the behavioral health workforce shortage. Social determinants are amplified by structural urbanism and contribute to barriers to care. Communities of color and other marginalized communities are particularly likely to experience barriers. A report published by the National Council for Mental Wellbeing proposes several potential solutions to advance health equity in rural communities, especially through integrated health care strategies. These include: increasing equitable funding strategies through Certified Community Behavioral Health Clinics, Medicaid expansion and American Rescue Plan funding; improving equity infrastructure by increasing internet and cell phone access; advancing telehealth to provide more services; using the Collaborative Care Model; increasing telemedicine opportunities at the individual clinic level; expanding the role of nurse practitioners and physician assistants; using innovative provider recruitment strategies; and advancing the professional development and education of the existing workforce.
Source: Integrated Approaches to Improving Rural Health Equity and Access (National Council for Mental Wellbeing)
In an article for TIME Magazine, Maia Szalavitz writes on the need to recognize the many paths to recovery beyond the total abstinence, 12-step program experience. Most American addiction treatment programs still focus on the 12 steps, posing lifelong abstinence and meeting attendance as the only ways to recover. Few residential programs permit medications for opioid use disorder, and only around half of outpatient facilities use them, and typically on a strictly short-term basis. Even when they do allow medication, writes Szalavitz, most treatment centers also push people to attend 12-step programs, which can create deadly pressure to stop using the medications. She argues that recovery should be defined as “any positive change,” from starting to use clean needles to becoming completely abstinent (i.e., harm reduction). She notes that, in 12-step programs, people who break continuous abstinence at all are seen as returning to square one, which can make relapses more dangerous. Alternatively, she concludes, people should be able to define recovery for themselves and let others do the same.
Source: Rethinking What it Means to Recover from Addiction (TIME)