New York City began operating the first government-sanctioned supervised injection sites in the nation this week. Arrangements have been made with law enforcement so that people can use the sites without fear of arrest. The sites will be operated at two existing needle exchange programs. A feasibility study conducted by the city health department found that the program could save up to 130 lives per year. The sites will be operated by a new nonprofit, OnPoint NYC, formed by two harm reduction organizations. Supervised injection sites have also been proposed in cities including Denver, Philadelphia, San Francisco and Seattle, but legal challenges have so far delayed programs in the U.S. It is unclear whether New York City’s sites will face legal challenges. Mayor Bill de Blasio expressed optimism that the centers would be allowed to stay open, given new administrations at the state and federal level that are more supportive of harm reduction efforts.
In light of the record number of overdose deaths and COVID-19’s impact, some believe that the response to the overdose crisis remains inadequate despite some of the positive steps the Biden administration has taken. Experts have lauded some aspects of the administration’s approach, particularly its focus on harm reduction. However, they express concern about ensuring the best strategies are used to address demand rather than supply and not just increase treatment but also access. They also highlight the need to educate people on the dangers of fentanyl. Partnership to End Addiction’s Vice President of Health Law and Policy Lindsey Vuolo explained that prevention has been too narrowly focused on the adolescent years. It should instead start earlier in a child’s life and be more broadly focused on healthy youth development and reducing risk factors.
Source: ‘Grossly Underwhelming’: Biden Pressed to Step Up Opioid Response (Daily Beast)
The Substance Abuse and Mental Health Services Administration (SAMHSA) is extending the methadone take-home flexibilities created during COVID-19 for one year after the eventual expiration of the COVID-19 Public Health Emergency. SAMHSA is also considering mechanisms to make the flexibility permanent. In March 2020, SAMHSA allowed opioid treatment programs to dispense 28 days of take-home methadone doses to stable patients for opioid use disorder treatment and up to 14 days for less stable patients. Preliminary studies show that nearly two years after the exemption was granted, stakeholders report increased engagement with treatment, improved patient satisfaction and very few incidents of misuse or diversion.
Source: SAMHSA Extends the Methadone Take-Home Flexibility for One Year While Working Toward a Permanent Solution (Substance Abuse and Mental Health Services Administration)
The House passed the Build Back Better reconciliation bill, but the bill is likely to undergo high-level changes in the Senate to ensure it can conform to Senate rules and win support from all 50 Democrats. The House-passed version of the bill includes funding for maternal mental health and addiction services, programs to increase and diversify the addiction workforce, peer recovery specialists, mental health and addiction services from tribal communities, the 988 crisis line, youth behavioral health, certified community behavioral health clinics, reentry employment and home and community-based services. It also authorizes civil monetary penalties for parity violations, extends the option for states to cover community-based mobile crisis intervention services, allows Medicaid coverage for incarcerated individuals 30 days prior to release, imposes a new excise tax on nicotine and expands health insurance coverage.
Source: Democrats’ $1.7T spending bill clears House, but Senate changes loom (Politico); Build Back Better Act — Rules Committee Print 117-18 Section-By-Section (House Committee on Rules)
The next head of the Food and Drug Administration (FDA) will take over an agency that has avoided answering the question of how to regulate the expansive tobacco product market for over a decade. Robert Califf, President Biden’s nominee, is being looked to as someone who can reboot FDA’s Center for Tobacco Products (CTP), a division that has come under criticism for appearing inconsistent with its regulatory power and unwilling to challenge the industry’s largest players. The FDA has not focused much on tobacco control since former Commissioner Scott Gottlieb left in 2019. Critics say that without a committed leader, CTP has been directionless, frustrating both industry and public health officials. Past commissioners have tried to guide CTP, but the politics of tobacco have stymied efforts. Regardless of the politics, Califf may have to act fast as a spate of lawsuits come to a head in coming months.
The Arizona attorney general announced a settlement in a consumer fraud lawsuit against Juul, in which the company agreed to pay $14.5 million and not market to young people in the state. Juul admitted no wrongdoing in the settlement. All but $2 million of the $14.5 million will be used for programs that discourage vaping, including cessation and education programs to prevent youth use and addiction. The other $2 million will go toward consumer fraud investigations. Juul agreed to implement a retailer monitoring program in which it will do compliance checks of at least 25 stores per month across the state for two years and take action against those that illegally sell to underage youth. The agreement requires Juul not to advertise near schools or target anyone under 21 and to not use social media to market.
Source: Juul to pay $14.5 million to settle Arizona vaping lawsuit (Associated Press)
A group of states appealing the Purdue settlement at a hearing this week urged a federal judge to reject the settlement. They argued that the legal protections the settlement extends to members of the Sackler family are improper and an abuse of the bankruptcy process. The states claimed that the Sacklers took more than $10 billion from Purdue, steered it toward bankruptcy and then used a settlement crafted in bankruptcy court to secure legal protections for themselves. The states also said that allowing the deal would usurp states’ ability to sue Sackler family members to hold them accountable. The Sacklers and Purdue maintained that they were not trying to manipulate the bankruptcy system. The judge said she hopes to rule by next week, though a decision could take longer. Any decision she reaches is likely to be appealed to a higher court.
Source: States: Sackler family members abusing bankruptcy process (Associated Press)
The Massachusetts Senate approved a bill that would guarantee residents are eligible for annual mental health wellness exams at no cost. The bill would create an online portal to help smooth the transition from emergency to long-term care, establish a panel to help resolve barriers to care for children with complex behavioral health needs in the emergency room and dedicate $122 million to support behavioral health professionals. It would improve parity enforcement, in part by allowing the Division of Insurance to more swiftly receive and investigate parity complaints. It would reimburse mental health providers more equitably, create a standard release form, eliminate prior authorization requirements for acute mental health treatment, increase access to care in geographically isolated areas and create a state 988 crisis hotline center to provide intervention services and crisis care coordination. The bill now goes to the House.
Source: Massachusetts Senate approves sweeping mental health bill (Associated Press)
The drug court model, once widely viewed as a progressive alternative to jail, is increasingly criticized for using the threat of jail to demand abstinence and for implicitly asserting that addiction is a crime. However, Judge Jason Lidyard, who runs a drug court in New Mexico, does not expect clients to abstain from using substances and refuses to use jail as a sanction. He refashioned the team working on the court, contracting with a harm reduction organization. Unlike many drug courts that screen out clients with prior violent convictions or habitual offenses, Lidyard has no eligibility criteria. He still asks participants to undergo urinalysis but never imposes sanctions for positive tests, using it merely as a monitoring tool to prompt open discussion. When people are arrested for drug crimes and brought before him to be arraigned, instead of ordering them to pretrial supervision and urinalysis, he requires them to attend an introductory meeting with a treatment provider and obtain naloxone. He has created peer-supported probation, in which defendants meet with a person with lived experience with addiction rather than an officer.
Source: The Judge Who Keeps People Out of Jail (Washington Post Magazine)
A collaborative of 15 leading mental health professional organizations, advocacy groups and funders published a roadmap for federal and state policymakers for implementing a full continuum of mental health and addiction services in conjunction with the federally mandated 988 crisis hotline. The roadmap rests on seven key pillars for system transformation of mental health care: early identification and crisis prevention, especially for families and young people; rapid deployment of emergency crisis response and suicide prevention; leveling inequities in access to care, including equitable access to peer support services, culturally and linguistically appropriate care and diversity of providers; establishing integrated health and mental health care; achieving parity; assuring evidence-based standards of care; and engaging a diverse mental health care workforce, peer support and community-based programs.