Overdose deaths have topped 1 million for the first time since the Centers for Disease Control and Prevention (CDC) began collecting data more than two decades ago. A new CDC report found that 932,364 people died from overdoses from 1999 through 2020, and an earlier preliminary report found another 100,000 deaths were expected in 2021. The new report found that in 2020, there were 91,799 overdose deaths. The age-adjusted rate of overdose deaths, 28.3 per 100,000, was 31% higher than the rate in 2019. The rate increased from 2019 to 2020 for all age groups 15 and older and all race and Hispanic origin groups. The rate of overdose deaths involving synthetic opioids increased 56% from 2019 to 2020. The rate involving cocaine increased 22% and the rate involving psychostimulants increased 50%.
Source: More than a million Americans have died from overdoses during the opioid epidemic (NPR); Drug Overdose Deaths in the United States, 1999–2020 (Centers for Disease Control and Prevention)
National Institute on Drug Abuse Director Nora Volkow explains the need to move away from the view that abstinence is the sole aim and only valid outcome of addiction treatment. This view, she states, reinforces stigma, promotes relapse and loss of hope for recovery, and undermines treatment. She writes that we must also offer support to people with addiction that protects against the worst consequences of substance use, including syringe services programs, naloxone distribution and other harm reduction measures. Continued and intermittent substance use must be acknowledged as part of the reality of the disorder, and we must stop stigmatizing people who use substances.
Rep. Donald Norcross of New Jersey explains the need for his Opioid Treatment Access Act, which would improve access to and modernize the delivery of opioid treatment for people with opioid use disorder. It would allow pharmacies to dispense methadone, and not necessarily for just a day at a time, so people can receive treatment at more convenient locations. It would also build on the Substance Abuse and Mental Health Services Administration’s COVID-19 exemptions to allow people to receive larger quantities of methadone at once. The measure would codify regulations that allow opioid treatment programs to operate mobile medication units without having to complete separate registrations. It would also allow states to permit aspects of opioid treatment to be conducted via telehealth.
Former Acting Director of the Office of National Drug Control Policy Regina LaBelle outlines actions that need to be taken to address the rising overdose deaths. First, state and local governments must act to remove policies and laws that limit harm reduction programs. Second, Congress must pass a budget for Fiscal Year 2022 and not rely on another continuing resolution. The president’s proposed budget would provide almost $41 billion to expand the public health and public safety response to include building out the addiction workforce capacity, and the Department of Health and Human Services budget request includes $3.5 billion for the Substance Abuse Prevention and Treatment Block Grant and a 10% set-aside for recovery support services. Third, Congress must act to remove barriers to treatment for people with addiction through the Mainstreaming Addiction Treatment Act and Medicaid Reentry Act.
Sens. Tammy Baldwin of Wisconsin and Elizabeth Warren of Massachusetts and Rep. Carolyn Maloney of New York, along with Reps. Ann Kuster of New Hampshire and David Trone of Maryland, led over 100 Democrats in reintroducing the Comprehensive Addiction Resources Emergency (CARE) Act, which would provide $125 billion over 10 years to address the substance use crisis. Originally introduced in 2018, the updated CARE Act of 2021 addresses the addiction crisis, including both opioids and stimulants. The bill is modeled on the Ryan White Act, which provided funding to help address the HIV/AIDS crisis. The CARE Act would provide funding to state and local governments to support programs to expand access to evidence-based treatment and recovery support services, mental health supports, early intervention and harm reduction. It would also provide funding for public health surveillance, biomedical research and improved training for health care professionals; expanded and innovative service delivery; and expanded access to naloxone.
The Substance Abuse and Mental Health Services Administration, Office of National Drug Control Policy and Centers for Disease Control and Prevention hosted a two-day National Harm Reduction Summit. It convened partners and experts from local, tribal, state and federal governments and non-government organizations, including representatives from the fields of harm reduction, substance use prevention, treatment, recovery and criminal justice. One of the goals was to develop a framework of harm reduction to help guide policies, programs and practices. A Steering Committee will provide guidance and synthesize summit findings to identify the guiding principles that should define a harm reduction program. A Review Committee will review the findings to refine the harm reduction definition, principles and strategies. After the two committees have reached a consensus on the draft guidance, the document will be shared for public comment.
Source: READOUT: White House, HHS Host National Harm Reduction Summit (Office of National Drug Control Policy); White House, SAMHSA Co-Host National Summit on Harm Reduction (Substance Abuse and Mental Health Services Administration)
U.S. District Court for the Southern District of New York Judge Colleen McMahon said the Purdue settlement should not go forward because it releases the Sackler family from liability in civil opioid-related cases. The Sacklers did not file for personal bankruptcy but had required the protections in exchange for contributing $4.5 billion. McMahon said the bankruptcy code does not explicitly permit a judge to grant such releases. The states that had appealed the plan hailed the ruling, while Purdue said it would appeal. It could take up to 18 months for the appeals court to rule. Washington’s Attorney General has vowed to take the issue to the Supreme Court, which could add another year. Even then, the negotiation may need to start over in bankruptcy court. In the meantime, Bankruptcy Judge Robert Drain extended temporary protections for the Sacklers until February 1. He called for Purdue, the Sacklers and nine states to determine whether they can reach a new settlement by January 14. If not, the mediation will end and litigation will continue.
Source: Judge Overturns Purdue Pharma’s Opioid Settlement (New York Times); Sackler Ruling Could Delay Purdue’s Payment of Billions by Years (Reuters); Purdue bankruptcy judge extends temporary litigation shield for Sacklers (Reuters); Judge orders mediation for Purdue, Sacklers over opioid settlement (Reuters)
The jury in the trial brought by Nassau and Suffolk Counties and New York State against drug manufacturers and distributors found Teva Pharmaceuticals liable for contributing to the opioid crisis. Another trial will determine how much Teva will pay. Teva said it will appeal and continue to seek a mistrial. The other defendants originally in the lawsuit already settled. In addition to finding Teva liable for the public nuisance, the jurors said that New York State, which is supposed to enforce controlled substances laws, bore a modest portion of responsibility. Jurors were asked to apportion responsibility among all defendants, including those that had already settled, and to determine blame among defendants separately for each of the counties and the state. The jury did not hold liable any defendants who had reached settlements or the counties. It assigned 10% of the responsibility to New York State and the rest to Teva.
Source: Pharmaceutical Company Is Found Liable in Landmark Opioid Trial (New York Times)
The New York City Health Department announced that, in the first three weeks of operation, staff at the two Overdose Prevention Centers averted at least 59 overdoses and that the centers have been used more than 2,000 times. The Board of Health issued a statement on taking action to prevent overdose deaths. It endorsed the Health Department’s actions to prevent overdose deaths by continuing to support overdose prevention centers and expanding harm reduction strategies, requested the Health Department report annually on its harm reduction efforts, and requested that the Health Department and harm reduction providers educate the public and local leaders about the benefits of overdose prevention centers. The board also urged the federal and state government to authorize overdose prevention centers and expand funding and support for harm reduction and medications for opioid use disorder (MOUD). It urged the federal and state government to lower barriers to MOUD by expanding access to methadone outside opioid treatment programs, eliminating the buprenorphine waiver and making COVID-19 take-home dose provisions permanent.
Source: Overdose Prevention Centers Averted 59 Overdoses in First Three Weeks of Operation (NYC Health)
The nation’s response to the opioid crisis has largely been limited to marginal increases in spending for the same failed policies and mediocre treatment programs. Regulatory reform addressing access, cost and culture is needed. The COVID-related telehealth and take-home flexibilities for medications for opioid use disorder (MOUD) should be permanently extended. Local access to pharmacies and health clinics should be leveraged to expand access to methadone and provide walk-in injection clinics for long-acting buprenorphine and extended-release naltrexone. Creating voucher-based payments for the uninsured, enforcing parity, expanding bundled payments for wraparound services and eliminating lifetime caps on treatment are critical to removing barriers. Public dollars and insurance reimbursement should be withheld from treatment programs that disallow MOUD. Clinical trainees should learn best practices for addiction prevention, treatment and recovery and have supervised practice before they graduate and become licensed providers.
Source: To Beat The Opioid Crisis, We Must Change The Rules Of The Game (Health Affairs)